Illness schema and level of reported gastrointestinal symptoms in irritable bowel syndrome

Twenty individuals with irritable bowel syndrome (IBS) completed a diary recording the severity of gastrointestinal symptoms over a period of 5 days. On one morning participants read cues intended to draw attention to IBS symptoms and the impact of symptoms on daily life ("illness context"). On another morning participants read cues intended to draw their attention to neutral aspects of symptoms ("neutral context"). On the 3 remaining days control cues were given. On the illness-context day, participants reported increases in the frequency of thoughts about IBS and in the range and severity of gastrointestinal symptoms compared with control conditions. On the neutral-context day participants reported lower levels of anxiety and perceived symptoms to be less severe than under control conditions. It is suggested that individuals with IBS interpret symptoms and illness-related experiences within a complex schema. As the salience of this illness schema increases, for example through rumination about IBS, sensations are increasingly likely to be detected and attributed to IBS. In contrast, attending to low-level features of symptoms may introduce a more neutral schema, resulting in less symptom-related anxiety and a more objective appraisal of the occurrence and severity of symptoms.