by Aiswarya Asokan (South India)
Scrabble tiles spelling out “mental health” sit on a white background. A branch with leaves is in the upper right corner.
Living with IBD comes with a lot of constraints that no one prepares you for. Every time one goes through a major life transition like starting college, joining work, or getting into a relationship, adapting to the changes is never easy. It’s often difficult to fit in due to our IBD, which in turn puts us under a lot of stress and anxiety. Research indicates that bowel-related issues are a widespread cultural taboo and historically, IBD has been seen as “psychosomatic,” further stigmatizing the condition.
To learn more about this, I read a paper titled “The mediating role of psychological inflexibility on internalised stigma and patient outcomes in a sample of adults with inflammatory bowel disease.” This study was conducted to examine the relationship between ‘psychological inflexibility’ (when someone struggles to adapt to challenges, avoiding emotions or feels stuck) and ‘internalized stigma’ (when individuals adopt negative societal beliefs or shame as their own, and devalue their identity) on health outcomes. The authors looked at outcomes like mental distress (depression, anxiety, stress), health related quality of life, self-efficacy, self-concealment (hiding personal information that is distressing or negative from others), beliefs about emotions, and fatigue (physical and mental) in adults with IBD using an online survey of 382 participants.
This study suggested that:
Adults with IBD who had higher rates of psychological inflexibility also had higher rates of internalized stigma, negative beliefs about their emotions, self-concealment, mental distress, fatigue, and impaired quality of life.
Psychological inflexibility was inversely related to committed action, stigma resistance, and IBD self-efficacy.
Adults with IBD who had higher rates of internalized stigma also showed higher rates of mental distress, self concealment, negative beliefs about their emotions, fatigue, and poor health-related quality of life.
Internalized stigma was inversely correlated to stigma resistance, IBD related self-efficacy, and committed action.
Participant’s age and educational level showed an inverse correlation with their psychological inflexibility. Their IBD severity (in the past 3 months), the presence of an ostomy, and their COVID-19 self-isolation status were positively correlated.
Internalized stigma was higher for individuals with an ostomy, those currently taking steroids, who had experienced severe IBD in the past 3 months, and who were more self-isolated, whereas educational level was inversely correlated.
Other interesting insights from this study:
Individuals who face discrimination regarding their IBD, who are less able to employ ‘flexible’ responses may spend more energy avoiding stigmatizing experiences, making it harder for them to engage in meaningful activities.
New research indicates that general familiarity with IBD can help reduce public stigma; highlighting the importance of IBD awareness campaigns to increase public understanding of IBD, thereby reducing stigma.
These study findings suggest that lower levels of internalized stigma is associated with increased psychological flexibility and better patient outcomes. Modalities of therapy like ‘Acceptance and Commitment Therapy’ (ACT) – which aim to increase psychological flexibility by changing individuals’ relationship with their thoughts, feelings and behaviors – may be a helpful intervention.
Personally, years of living with IBD have enabled me to build a circle of people where I can take my armor off. But still, going through repeated flares, body image issues, breaks from education, social isolation, and being under steroids takes a toll on my mental health and quality of living. Often the medical team's support stops once your blood counts are under control, leaving us with the responsibility of picking up ourselves and moving on with the new normal.
Citation:
Reynolds DP, Chalder T, Henderson C. The mediating role of psychological inflexibility on internalised stigma and patient outcomes in a sample of adults with inflammatory bowel disease. J Crohns Colitis. 2025 Apr 1:. doi: 10.1093/ecco-jcc/jjaf055. Epub ahead of print. https://pubmed.ncbi.nlm.nih.gov/40168103/
Photo from “Total Shape” on Unsplash.