Reflective Functioning in Patients with Irritable Bowel Syndrome, Non-Affective Psychosis and Affective Disorders—Differences and Similarities

Abstract

Irritable bowel syndrome (IBS), as part of the functional somatic syndromes, is frequent in the general population. Medical care and morbidity costs are high, and so is the psychological and somatic strain. The etiopathogenesis of IBS is still poorly understood; it is assumed to be multifactorial and to include biopsychosocial factors. Links between the intestine, psyche, nervous system (e.g., via the hypothalamic–pituitary–adrenal axis (HPA-Axis/neurotransmitters) and with the microbiome, the immune system have lately been investigated. Factors such as personality traits, mentalization, and early attachment strategies (deactivating and hyperactivating) have been suggested to influence IBS with relevance for treatment regimens. At this time, data on reflective functioning (RF) is lacking. Within a cross-sectional, we examined the mentalizing capacity of a clinical sample (n = 90) consisting of patients with IBS (n = 30), affective disorders (AD; n = 28), and non-affective psychosis (NAP; n = 32). The reflective functioning scale was used based on the brief reflective function interview (BRFI). The results revealed severe impairment in patients with IBS concerning their mentalizing ability, which was comparable to patients with affective disorders. Patients with non-affective-psychosis showed the lowest mentalizing ability. Thus, psychotherapeutic treatment with a focus on mentalization could be a promising approach.

Inflammatory Bowel Disease and Irritable Bowel Syndrome: What Differences in Mentalization Abilities? A Scoping Review

“…Among the included studies, three compared patients suffering from IBS with patients diagnosed with IBD [26][27][28], while other studies focused on patients with one of these conditions (IBS or IBD) and compared them with a control group [29][30][31][32]. RFS mean (SD) scores were 2.7 (1.4) for IBS, 1.4 (1.9) for NAP, and 3.3 (1.7) for AD.…”

“…There were differences between IBS-M and IBS-C (p = 0.023). No significant differences between IBS-M and IBS-D, and between IBS-D and IBS-C. With regard to the instruments used to assess mentalization, three studies used the Mentalization Questionnaire (MZQ) [26,28,31], two studies used the Metacognitions Questionnaire-30 (MCQ-30) [27,32], one study used both the Reflective Functioning Questionnaire (RFQ) and Reading the Mind in the Eyes Test (RMET) [29], and one study used both the Brief Reflective Function Interview (BRFI) and Reflective Functioning Scale (RFS) [30].…”

“…Regarding participant characteristics, the mean age of IBD patients involved in the studies was between 33.9 years [26] and 39.6 years [29], while the mean age of IBS patients was between 35.4 years [32] and 40.8 years [30].…”

“…Finally, Dzirlo et al [30] conducted a study among patients with IBS, patients with Non-Affective Psychosis (NAP), and patients with an Affective Disorder (AD) to investigate RF. The results showed lower RF scores in the NAP group than in the IBS group (z = −3.013, p = 0.008), while no significant differences were observed between the IBS and AD (z = 0.990, p = 0.322) groups.…”

Commentary: The framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSY-PSS)

“…More specifically, the importance of deficits in mentalizing and personality functioning, especially specific structural deficits in affective processing, are empirically well-supported for patients with PSS: In recent studies, patients with IBS showed higher mentalizing deficits than healthy controls ( 4 , 8 ) and patients with inflammatory bowel diseases ( 4 ). Additionally, in gastroenterological patients, the diagnostic B-criterion of SSD was associated with higher mentalizing deficits and deficits in personality functioning according to the Operationalized Psychodynamic Diagnosis System ( 6 ).…”