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

Table 1 Key findings from the review

Factor	Prevalence (%)	Impact
Anxiety	62	Exacerbates FGID symptoms via stress reactivity and visceral hypersensitivity
Depression	38	Linked to altered pain perception, appetite changes, and fatigue
ADHD	24	Impulsivity and poor regulation worsen eating patterns and symptom severity
Emotional dysregulation	58	Leads to somatization and heightened symptom perception
High-stress family dynamics	≥ 50	Contributes to increased symptom severity and emotional insecurity
School stress	41	Triggers FGID symptoms during academic or social pressures
Early-life trauma	46	Disrupts HPA axis and gut-brain communication, worsening long-term outcomes
Visceral hypersensitivity	54	Amplifies pain perception to normal gut stimuli

FGID: Functional gastrointestinal disorder; ADHD: Attention deficit hyperactivity disorder; HPA: Hypothalamic-pituitary-adrenal.

Table 2 The psychological mechanisms underlying various functional gastrointestinal disorders

FGID	Psychological mechanisms
Infant colic	Psychosocial stress: High parental stress and anxiety may contribute to infant colic through alterations in caregiving responses and infant stress reactivity
	Parent-infant interaction: Stressful caregiving environments and ineffective soothing strategies may exacerbate colic symptoms
	Family dynamics: Parental conflict or lack of support can increase stress levels, impacting infant behavior and gastrointestinal symptoms
Functional constipation	Psychosocial stress: Stress from social or academic pressures can affect bowel habits and lead to constipation
	Emotional regulation: Difficulty managing emotions may result in withholding behavior, contributing to constipation
	Family dynamics: Overcontrolling or punitive parenting styles regarding toilet training may increase constipation risk
	Coping mechanisms: Ineffective coping strategies or anxiety about bowel movements can exacerbate symptoms
GER	Psychosocial stress: Stress can affect gastrointestinal motility and increase acid reflux symptoms
	Emotional regulation: Stress or anxiety may exacerbate ger symptoms by increasing gastric acid production or sensitivity
	Family dynamics: High-stress family environments may influence feeding practices and exacerbate reflux symptoms
Diarrhea	Psychosocial stress: Stress and anxiety can affect gut motility and contribute to episodes of diarrhea
	Emotional regulation: Difficulty managing stress can lead to gastrointestinal disturbances, including diarrhea
	Family dynamics: Family stressors or dysfunctional family environments may impact bowel habits and exacerbate diarrhea
IBS	Psychosocial stress: Stress and anxiety play a significant role in IBS, influencing symptoms through the brain-gut axis
	Emotional regulation: Difficulty managing emotions can lead to altered gut motility and heightened sensitivity
	Family dynamics: Dysfunctional family environments or high levels of family stress may exacerbate IBS symptoms.
	Coping mechanisms: Ineffective coping strategies may lead to somatization of stress
Cyclic vomiting syndrome	Psychosocial stress: Stressful events or emotional distress can trigger episodes of cyclic vomiting
	Emotional regulation: Poor emotional regulation may contribute to the severity and frequency of vomiting episodes
	Family dynamics: Stressful family environments or parental anxiety can impact the frequency and intensity of episodes
Dysfunctional abdominal pain	Psychosocial stress: Emotional stress and psychosocial factors can contribute to chronic abdominal pain through the brain-gut axis
	Emotional regulation: Ineffective emotional regulation can lead to persistent pain perception
	Family dynamics: Family stress and conflicts may exacerbate symptoms by affecting the child’s emotional state
	Coping mechanisms: Poor coping strategies and somatization of stress may perpetuate pain symptoms
Abdominal migraine	Psychosocial stress: Stress can trigger episodes of abdominal migraine by affecting the brain-gut axis and stress-response systems
	Emotional regulation: Poor emotional regulation can lead to somatization of stress and exacerbate symptoms
	Family dynamics: Parental stress or emotional instability can impact the child’s susceptibility to abdominal migraines
	Early life stressors: Trauma or adverse experiences can alter stress-response systems, contributing to abdominal migraine
	Coping mechanisms: Ineffective coping strategies may exacerbate the frequency and severity of episodes

This table provides an overview of the psychological mechanisms associated with each FGID, focusing on factors such as psychosocial stress, emotional regulation, family dynamics, and coping mechanisms. IBS: Irritable bowel syndrome; FGID: Functional gastrointestinal disorder; GER: Gastroesophageal reflux.

Table 3 The short-term psychological impacts of functional gastrointestinal disorders in infants and children

FGID	Emotional impacts	Sleep impacts	Behavioral impacts	Social impacts	Cognitive/academic impacts	Somatic & physical impacts	Parental/family dynamics
Infant colic	Excessive crying, irritability, heightened anxiety in both infant and caregiver	Sleep disruption due to frequent crying and inability to soothe	Temper tantrums, irritability, emotional dependency	Strain in caregiver-infant bonding, parental frustration	Limited cognitive growth if stress persists	Physical discomfort, feeding difficulties	Increased parental stress, feelings of helplessness, strained family dynamics due to constant soothing efforts
Functional constipation	Anxiety related to bowel movements, frustration from discomfort	Restless sleep due to discomfort	Avoidance of toileting, fear of painful bowel movements	Avoidance of social situations like school or playdates due to fear of accidents	Difficulty concentrating at school, anxiety-driven distractions	Somatization of abdominal pain, stool withholding behaviors	Increased parental worry and intervention; pressure on family dynamics as caregiving intensifies
GER	Anxiety around feeding, irritability, excessive crying, emotional distress related to discomfort	Interrupted sleep due to pain or discomfort from reflux	Feeding aversion, refusal to eat, tantrums around mealtime	Social withdrawal due to irritability, reluctance to participate in feeding situations	Impaired cognitive development due to poor nutrition or sleep deprivation	Poor weight gain, feeding difficulties, heightened focus on somatic symptoms	Parental anxiety regarding feeding and health, increased stress from constant monitoring of symptoms
Functional diarrhea	Frustration, anxiety related to frequent bowel movements	Sleep disturbances due to frequent nocturnal diarrhea	Avoidance of foods, temper tantrums, anxiety-driven irritability	Social withdrawal due to embarrassment over bowel movements or accidents	Difficulty concentrating in school, absenteeism due to frequent episodes of diarrhea	Somatic complaints like stomach cramps and discomfort	Increased family stress around toileting and diet, tension from dealing with frequent accidents
Cyclic vomiting syndrome	Extreme emotional distress related to unpredictable vomiting episodes, fear of nausea	Sleep disturbances during vomiting episodes, fatigue after episodes	Avoidance of food, reluctance to eat, oppositional behaviors around eating	Withdrawal from social activities to avoid public vomiting, avoidance of mealtimes with others	Missed school days, academic setbacks from frequent episodes, cognitive distraction from fear of vomiting	Dehydration, weight loss, malnutrition due to feeding aversion	High parental anxiety and stress in managing episodic care, tension in family dynamics due to medical uncertainty
IBS	Anxiety about pain or discomfort, emotional distress from unpredictability of symptoms	Difficulty falling asleep due to pain or abdominal discomfort	Fear-driven avoidance of activities, irritability, mood swings	Social isolation due to unpredictability of bowel movements, avoidance of peer interactions	Academic challenges due to absenteeism, difficulty concentrating due to pain and worry	Increased complaints of abdominal pain, potential somatization of discomfort	Parental stress around managing symptoms, anxiety in helping child avoid flare-ups, family tension during episodes
Functional abdominal pain	Emotional distress linked to chronic pain, frustration due to lack of relief from discomfort	Sleep interruptions due to ongoing pain, difficulty falling asleep	Increased tantrums, mood swings, irritability	Social withdrawal, avoidance of activities due to fear of pain episodes	Cognitive distraction due to pain, frequent absenteeism, academic underperformance	Frequent complaints of stomach pain, somatization of emotional distress	Parental anxiety, frustration over not finding relief, overprotective behaviors from caregivers
Abdominal migraine	Anxiety related to unpredictability of episodes, emotional distress due to recurrent pain	Interrupted sleep due to abdominal pain episodes, difficulty falling asleep	Avoidance of food or social activities, mood swings, oppositional behaviors	Social withdrawal, avoidance of peer interactions due to fear of episodes	Missed school days, concentration difficulties, academic delays linked to frequent absences	Somatization, frequent complaints of pain, feeding aversion, poor weight gain	Increased parental stress, family disruption due to focus on managing pain episodes

This table outlines the major psychological, social, cognitive, and physical impacts that each functional gastrointestinal disorder can have on children in the short term. It highlights the complexity of these conditions and their effect on a child's overall well-being and family dynamics. GER: Gastroesophageal reflux; FGID: Functional gastrointestinal disorder; IBS: Irritable bowel syndrome.

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.