Breaking the cycle: Psychological and social dimensions of pediatric functional gastrointestinal disorders

Table 4 The long-term social and psychological impacts of functional gastrointestinal disorders in infants and children, organized by the frequency and typical time of development for each impact

Impact	Description	Frequency	Time of development
Chronic anxiety	Ongoing fear of symptom recurrence; anticipatory anxiety related to potential triggers or social interactions	High	Childhood, worsening in adolescence
Social anxiety	Fear of social situations due to concerns about symptoms (e.g., needing the restroom, pain episodes)	Moderate	Childhood, but may persist long-term
Depression	Feelings of sadness, hopelessness, and frustration due to limitations & missed social or academic opportunities	Moderate	Late childhood to adolescence
Social isolation	Avoidance of social activities and interactions leads to a sense of loneliness and isolation	High	Childhood, especially during school
Low self-esteem	Negative self-perception due to perceived limitations or differences from peers	High	Childhood, may continue long-term
Body image concerns	Poor body image due to physical symptoms (e.g., bloating, weight changes)	Moderate	Late childhood to adolescence
Poor academic performance	Difficulty concentrating, frequent absenteeism, falling behind in school	Moderate	Childhood, can persist with chronic symptoms
Maladaptive coping mechanisms	Use of avoidance behaviors, over-reliance on caregivers, or negative coping strategies like self-isolation	Moderate	Late childhood to adolescence
Difficulty forming friendships	Challenges in establishing and maintaining peer relationships due to social avoidance and anxiety	High	Childhood, worsening over time
Risk of mood and behavioral disorders	Vulnerability to mood disorders like depression & behavioral disorders like ODD	Moderate	Adolescence
Somatization and health anxiety	Heightened focus on physical symptoms and preoccupation with health concerns	Moderate	Late childhood to adolescence
Parental stress and burnout	Parents may experience increased stress, affecting family dynamics and parent-child relationships	High	Childhood, ongoing
Strained sibling relationships	Tension and conflict with siblings who feel neglected or resentful of the affected child’s needs	Moderate	Childhood, may continue with stressors
Nutritional deficits	Malnutrition due to feeding issues and avoidance behaviors; impacts physical and cognitive development	High	Childhood, early intervention needed
Increased risk of eating disorders	Disordered eating behaviors due to restrictive eating patterns to avoid symptoms	Low	Adolescence
Impaired physical development	Limited physical activity and play, affecting fitness, motor skill development, and physical growth	Moderate	Childhood to adolescence

The table shows the types of impacts based on how frequently they occur and the typical time of development. Higher frequency impacts tend to develop early and persist, while some impacts, particularly behavioral and mood disorders, may appear later as the child grows older. ODD: Oppositional defiant disorder.