Shame reduces quality of life in chronic gut disorders

Feelings of shame are linked to reduced quality of life – as shown by the first study to measure shame as a factor influencing the connection between chronic gastrointestinal disorders and mental health.

“The results highlight the importance of compassion in healthcare for these patients and their painful experiences of shame,” says Inês Trindade, psychology researcher at Örebro University.

The study is published in the scientific journal Gastroenterology and is a collaboration with researchers at the University of Gothenburg, led by Professor Magnus Simrén.

Inês Trindade has examined how feeling of shame affect people with “Disorders of Gut-Brain Interaction" (DGBI) – a group of disorders of chronic or recurrent gastrointestinal problems where clinical examinations are not able to identify the underlying causes. One example is IBS (Irritable Bowel Syndrome).

The study builds on the understanding that quality of life and psychological well-being interact with symptoms from the gut. More severe symptoms can lead to greater psychological distress. The same is true for the reverse – worsening mental health can exacerbate physical symptoms.
“We also know that gastrointestinal problems are often perceived as shameful due to judgmental societal attitudes. This creates a stigma that can cause individuals to feel shame,” says Inês Trindade.

These types of gastrointestinal disorders (DGBI) can have various consequences. They include needing to use the bathroom frequently, having diarrhoea or constipation, abdominal pain, and bloating. As a result, individuals with DGBI avoid certain foods and social situations to prevent discomfort or for fear of exposing symptoms to others. These physical problems are associated with psychological conditions, such as depression and anxiety, and with overall quality of life.

The study shows that different levels of perceived shame among participants impact quality of life. The same level of physical symptoms resulted in different levels of quality of life, depending on the level of shame felt by the person. Individuals with higher levels of shame experienced significantly lower quality of life than individuals with a lower level of shame – even with the same severity of symptoms.

“We demonstrate that shame is an important explanatory factor – a mechanism linking these gastrointestinal problems to poor mental health and reduced quality of life. But there is also a direct link between gastrointestinal symptoms and mental health that is not associated with shame,” says Inês Trindade.

She emphasises that it is normal to feel shame because we are social beings. However, this feeling can also have a corrosive effect leading to a range of negative psychological states. One example is the tendency to avoid contact with others.

Inês Trindade sees potential implications for healthcare based on the study’s results, even though patient-provider interactions were not the focus of this research project. Instead, she draws on results from other studies in interpreting the significance of her findings:

“Empathy and compassion are crucial remedies for feelings of shame. Acknowledging the patient’s experience and showing genuine interest are ways to provide support and help their condition. Even if it only is a ten-minute appointment, it can make all the difference. Empathy in healthcare is not a luxury – it’s part of evidence-based care,” says Inês Trindade.

More than 2,400 Swedish people participated in the study, and 537 met the criteria for a DGBI diagnosis related to gastrointestinal problems.