Felt Stigma in Youth With Disorders of Gut–Brain Interaction: Implications for Abdominal Pain, Sleep, and Mood 2026 Adetayo et al

[Andy]

Abstract​

Children with painful disorders of gut–brain interactions (DGBIs) endorse pain-related stigmatization. However, little is known about how stigma may be associated with pain intensity. Consequently, we conducted a cross-sectional study to identify a potential pathway between felt stigma and abdominal pain in youth with DGBIs. 120 youth completed measures of health-related stigma, depressive symptoms, sleep disturbances, and pain severity. As expected, greater felt stigma was significantly correlated with greater depressive symptoms, sleep-related impairments, and abdominal pain. Furthermore, a sequential mediation analysis revealed a significant indirect effect of stigma on abdominal pain via higher depressive symptoms and greater sleep-related impairments. Results suggest potential considerations for modifying current treatments for DGBIs targeting abdominal pain. More specifically, providers should incorporate screening for and addressing felt stigma, sleep-related impairment, and depressive symptoms into their treatment planning. Involving pediatric behavioral health providers may help facilitate this aspect of DGBI intervention.

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[SNT Gatchaman]

As hypothesized, stigma was indirectly associated with abdominal pain in youth with DGBIs through worse mood and impaired sleep. These findings suggest one of the possible psychobiological mechanisms underlying DGBIs. In their psychobiological model of DGBIs, Guadagnoli and colleagues described how gastrointestinal symptoms (eg, abdominal pain) may be perceived as threatening.

Pain… perceived as threatening? What silliness is this? No, pain is a merely a sensation that everyone gets at all times and indicates all systems are functioning completely optimally and that nothing at all is in any way broken.

Perceived stigma due to symptoms may further compound this high threat appraisal, resulting in greater attunement to pain. Consequently, youth may be at risk for greater emotional distress, which may result in greater sleep disruptions. The downstream effects of both lower mood and poor sleep may activate the acute stress response, resulting in alterations to gastrointestinal functions, such as gut motility, microbiota, and immune functioning. Consequently, stigma may indirectly exacerbate abdominal pain in youth with DGBIs.

Stigma should be considered a social determinant of health and addressed as part of the comprehensive treatment of DGBIs.

 

[rvallee]

This is complete nonsense. And it's so obviously rationalization after the fact, deciding on why they made a decision after the decision has been made, with no consideration for evidence or outcomes.

Absolutely no one of this has any basis in reality, and they might as well be ranting about astral curses and space laser weather manipulation.

 

[Nightsong]

As such, it is important to understand factors that perpetuate stigma. Qualitative interviews of adolescents with chronic pain revealed that explanations of symptoms that favor psychological over physiological causes contributed to patients’ feelings of stigma.28 This is concerning given that accurate depictions of DGBIs should involve both biological and psychosocial factors.

Thus, gastroenterologists may be critical in reducing stigma through their framing of the DGBI diagnosis. It may be helpful to differentiate between structural and functional diseases prior to introducing DGBIs. In addition, clarification that the patient’s pain is real and not “in their head” may also reduce stigma. Inquiring about prior experiences of stigma can also facilitate trust between providers and patients.

Furthermore, providers should practice avoiding stigmatizing language (eg, using the term “neuromodulators” over “antidepressants”). Finally, assessing the patient and family’s understanding of their condition and treatment recommendations may both minimize misconceptions and increase adherence.32 More research on how to educate families without further stigmatizing them is needed

Pediatric psychologists may be beneficial to the DGBI treatment team, as they can assist medical professionals in teaching their patients about DGBI-related pain using the biopsychosocial model, which may help reduce stigma.

It's pretty hard, in this era of Google and ChatGPT, to hide the fact that an antidepressant is an antidepressant from even adolescent patients - not to mention that I haven't seen any positive results from robust trials of serotoninergics in this patient population.

And that the "biopsychosocial model" is in itself a principal cause and driver of stigma - and that this approach will exacerbate, rather than alleviate, the problem they are studying - does not, of course, seem to have occurred to the authors.