The March 1 issue of AFP includes a feature article on "Gas, Bloating, and Belching: Approach to Evaluation and Management" which discusses the high prevalence of functional gastrointestinal disorders (FGIDs). The authors note that "[t]hese disorders are characterized by disordered motility and visceral hypersensitivity that are often worsened by psychological distress." FGIDs, of course, are far from the only conditions precipitated or worsened by stress; a new study out last week found a correlation between years of stressful employment and type 2 diabetes in women. Increasingly, a history of highly stressful experiences, such as interpersonal violence (IPV) and/or adverse childhood experiences (ACEs), has been linked to diabetes, cardiovascular disease, and cancer. Identifying and responding to our patients' stress, regardless of degree or cause, may help them to lead healthier lives.
A recent article in Annals of Family Medicine elucidates the relationship between stress and physical symptoms:
Chronic stress profoundly impacts the body’s cardiovascular, endocrine, and immune systems, increasing the risk of atherosclerosis, diabetes, and infection. Even when controlling for traditional risk factors, diseases like obesity, heart disease, asthma, and even certain cancers are more likely to occur in survivors of violence. The link between medical disease and history of abuse, however, is often obscured by the way these patients present: survivors rarely volunteer their histories of violence, often making somatic and nonspecific complaints the only tip-off to a deeper problem.A willingness to explore our patients' sources of stress, and potentially dive into deeper issues, is a critical first step to making these connections. The BATHE technique is one way to explore these issues; there are also tools available to screen for a history of ACEs and/or IPV.
Several resources exist to help our patients respond to their stress. The American Academy of Pediatrics has information on their website to enable practices to become trauma-centered to better help patients with a history of ACEs. The National Domestic Violence Hotline website has resources for patients who are experiencing IPV, and additional local resources may be available in your area as well. Family physicians may choose to provide counseling in their offices and/or refer to a local counseling center. Basic stress management techniques can benefit most patients, regardless of the severity of their stress; familydoctor.org has a page on "Managing Daily Stress" with practical, simple steps.
Our willingness to engage with our patients' stressors, and normalize the strength of the mind-body connection, may help them improve their health-related quality of life. As family physicians who often have meaningful, long-standing relationships with our patients, we are well-suited to engage in these processes.
