The Link Between Panic Disorder, Anxiety, and IBS

Irritable bowel syndrome, its cognition, anxiety sensitivity, and anticipatory anxiety in panic disorder patients

The Link Between Panic Disorder, Anxiety, and IBS

Volume 67, Issue 6 First published: 25 July 2013

The present study examined the effect of irritable bowel syndrome (IBS), cognitive appraisal of IBS, and anxiety sensitivity on anticipatory anxiety (AA) and agoraphobia (AG) in patients with panic disorder (PD).

We examined 244 PD patients who completed a set of questionnaires that included the Rome II Modular Questionnaire to assess the presence of IBS, the Anxiety Sensitivity Index (ASI), the Cognitive Appraisal Rating Scale (CARS; assessing the cognitive appraisal of abdominal symptoms in four dimensions: commitment, appraisal of effect, appraisal of threat, and controllability), and items about the severity of AA and AG. The Mini International Neuropsychiatric Interview was used to diagnose AG and PD.

After excluding individuals with possible organic gastrointestinal diseases by using ‘red flag items,’ valid data were obtained from 174 participants, including 110 PD patients without IBS (PD/IBS[–]) and 64 with IBS (PD/IBS[+]).

The PD/IBS[+] group had higher AA and higher comorbidity with AG than the PD/IBS[–] group. In the PD/IBS[+] group, the controllability score of CARS was significantly correlated with AA and ASI.

Multiple regression analysis showed a significant effect of ASI but not of controllability on AA in PD/IBS[+] subjects.

This study suggested that the presence of IBS may be related to agoraphobia and anticipatory anxiety in PD patients. Cognitive appraisal could be partly related to anticipatory anxiety in PD patients with IBS with anxiety sensitivity mediating this correlation.

THE CORRELATION BETWEEN panic disorder (PD) and irritable bowel syndrome (IBS) has attracted much attention.

1-6 PD shares various symptoms with IBS, such as autonomic symptoms, anticipatory anxiety, depression, and avoidant behavior due to fear of symptoms.5 In addition, PD patients have been shown to have a high prevalence of IBS.

1-5 For example, PD patients reportedly have a higher prevalence of IBS than patients with other psychiatric diseases.6

Studies have shown that the presence of IBS might be related to the development or severity of PD.5, 7-12 Most PD patients develop IBS before PD, and IBS might be associated with the severity of anticipatory anxiety, agoraphobia, and panic attacks in PD patients.

5, 7 the brain–gut axis, the hypersensitivity and increased motility of the colon observed in patients with IBS8 might increase the activity of the locus coeruleus,9, 10 which would then activate noradrenergic neurons, such as those neurons in the locus coeruleus, inducing fear and anxiety and subsequently the onset of PD.

11, 12 In addition, cognitive factors may play an important role in panic/IBS comorbidity and the severity of PD symptoms in PD patients with IBS.

Maunder13 has suggested that the experience of uncontrollable somatic symptoms, which is common in IBS patients and leads to avoidant behaviors, acts as a provocative factor for PD in patients with mild or subclinical PD‐ symptoms who had otherwise not been identified as suffering from PD.

We have previously reported that the cognition of abdominal symptoms may intensify anxiety in individuals with IBS.14 The manner in which PD patients with IBS appraise their abdominal symptoms (e.g. that abdominal symptoms are uncontrollable or have a negative impact) may therefore be related to the severity of their PD‐related symptoms.

Another factor that might affect anxiety‐related symptoms in PD and IBS is anxiety sensitivity. Anxiety sensitivity is an enduring, trait‐ tendency; it is believed that anxiety and its symptoms are harmful to the body or mental state. This tendency may be a psychological vulnerability factor for PD.

PD patients were reported to have high scores for anxiety sensitivity.15 Anxiety sensitivity has also been suggested as a possible cognitive mechanism that governs fear behavior.16 In addition, individuals with IBS have also been reported to have high scores for anxiety sensitivity.

14, 17 We have observed that anxiety sensitivity is related to the cognition of abdominal symptoms and anxiety in individuals with IBS.14

Thus, we hypothesized that: (i) PD patients with IBS would have high anxiety sensitivity and severe anxiety‐related symptoms, including anticipatory anxiety and agoraphobia, compared with those without IBS; and (ii) anxiety‐related symptoms would be exacerbated by maladaptive cognition of IBS symptoms, which might be affected by anxiety sensitivity in PD patients with IBS.

As described above, PD and IBS may be mutually reinforcing through a duplicated mechanism of aggravation; therefore, it is clinically useful to investigate the correlation between cognitive factors, such as the manner in which PD patients with IBS appraise their abdominal symptoms and the symptoms and cognitions associated with PD. Thus far, little information is available regarding the psychological process related to the aggravation of anxiety‐related symptoms in PD patients with IBS. Hence, we investigated: (i) the difference in anxiety sensitivity and anxiety‐related symptoms (anticipatory anxiety and agoraphobia) according to the presence/absence of IBS in PD patients; and (ii) how the cognition of IBS is related to the severity of anxiety sensitivity, anticipatory anxiety, and agoraphobia in PD patients with IBS.

A total of 244 PD outpatients who attended a psychosomatic and psychiatric clinic participated in this study. PD was diagnosed according to DSM‐IV criteria18 and clinical records. An interview that used the Mini International Neuropsychiatric Interview (MINI) was also conducted to diagnose most of the patients.

The participants were mainly prescribed antidepressants, such as paroxetine (10–40 mg/day), fluvoxamine (25–250 mg/day), and imipramine (10–150 mg/day), and/or anxiolytics, such as ethyl loflazepate (0.5–2.0 mg/day) and lorazepam (0.5–3 mg/day), regardless of the presence of IBS.

After excluding individuals with red‐flag items to exclude organic gastrointestinal diseases, valid data were obtained from 174 participants (55 men and 119 women). Interviews that used the MINI were conducted with 151 patients among the 174. The mean age of the participants was 37.7 ± 9.2 years.

The participants included 110 PD patients who did not meet the criteria for IBS (63%; PD/IBS[–]) and 64 PD patients with IBS (37%; PD/IBS[+]). The duration of PD among the participants was 10.9 ± 10.5 years. The groups did not differ significantly in the duration of PD.

The onset of IBS preceded PD in 28 patients (44% in PD/IBS[+]) while the onset of PD preceded IBS in 17 patients (27% in PD/IBS[+]). Simultaneous onset was found in 15 patients (23% in PD/IBS[+]). The chronological correlation was unknown in four patients (6% in PD/IBS[+]). There is no significant difference between the frequency of IBS preceding PD and that of PD preceding IBS in the PD/IBS[+] group.

The MINI19 was designed as a brief structured interview for major axis I psychiatric disorders in the DSM‐IV. We used this interview to confirm the presence of agoraphobia in the participants of this study.

The Rome II diagnostic criteria for gastrointestinal disorders are widely used. IBS and its subtypes were defined according to the Rome II Modular Questionnaire.

20, 21 The presence of IBS was confirmed if participants had abdominal pain or discomfort at least once a week during at least 3 weeks in the last 3 months and had at least two of the three following symptoms: (i) pain or discomfort that improved or stopped after a bowel movement; (ii) a change in the number of bowel movements when the pain or discomfort started; and (iii) either softer or harder stools than usual when the pain or discomfort started.

Seven red‐flag items, the American Gastroenterological Association's guidelines for IBS, were used to distinguish organic from functional gastrointestinal diseases.

Individuals reporting any of these red‐flag items were excluded from this study.

The items included unexplained weight loss, a history of organic bowel disease, a history of digestive surgery, being awakened by abdominal pain during night sleep, fever or arthralgia, blood in the stool, and anemia.

The Anxiety Sensitivity Index (ASI)22, 23 is a 16‐item reliable and valid index of the tendency to believe that the physical sensations associated with anxiety are harmful and bear negative physical, social, or psychological consequences. The total score ranges from 16 to 80. Each item is rated on a scale of 1 [not at all] to 5 [strongly agree].

The Cognitive Appraisal Rating Scale (CARS)24 was used to measure IBS‐related cognition, that is, how individuals with IBS usually rate themselves when they have symptoms of IBS.

The CARS consists of four factors (commitment, appraisal of effect, appraisal of threat, and controllability) that are assessed by two items rated on a scale of 1–4. The total score ranges from 8 to 32 (score on each subscale ranges from 2 to 8).

The ‘commitment,’ ‘appraisal of effect,’ ‘appraisal of threat,’ and ‘controllability’ subscales of the CARS correspond to ‘challenge,’ ‘harmful effect,’ ‘threat,’ and ‘controllability,’ respectively, in the construct advocated by Lazarus and Folkman.

25 ‘Commitment’ is an attempt to improve that situation, ‘appraisal of effect’ is thinking that the situation may have an influence on one, ‘appraisal of threat’ is a thought that the situation may threaten one's life, and ‘controllability’ is a thought that one could deal with the situation.

The CARS was standardized for the Japanese population and has sufficient validity and reliability.24 We thus considered CARS to be suitable for this study. We instructed only those participants who met the criteria for IBS to complete the CARS.

The anticipatory anxiety score was calculated by using two items for the frequency (rated from 0 [none] to 4 [at all times]) and degree (rated from 0 [none] to 4 [extremely severe]) of anticipatory anxiety for the past week.

Agoraphobia score was calculated by using two items, namely, the frequency of avoidant behavior (rated from 0 [none] to 4 [at all times]) and the degree of interference, for the past week (rated from 0 [none] to 4 [extremely severe]). The score for each variable ranged from 0 to 8.

The internal reliabilities (coefficient Alfa) of items for anticipatory anxiety and items for agoraphobia in data of the present study were 0.90 and 0.85, respectively.

Regarding correlations between these scores and the ASI score as indicator of concurrent validity, the anticipatory anxiety score and the agoraphobia score positively correlated with the ASI score (rs = 0.48, P


Irritable Bowel Syndrome and Anxiety

The Link Between Panic Disorder, Anxiety, and IBS

I am writing this article as the No Panic helplines receive a very large number of queries about irritable bowel syndrome. I hope that this article might begin to clarify some of the issues.

I suppose that one should say from the very start that irritable bowel syndrome is a umbrella term to cover a number of different conditions.

These conditions have a number of common characteristics, to which I refer below, and most forms of irritable bowel syndrome comprise both physiological and psychological components.

It is a condition that is extremely common and some medical textbooks state that about 50% of referrals to gastro-enterologists are for this condition.

The main symptoms are usually abdominal pain and altered bowel habits, and constipation often alternates with diarrhoea. The pain may be of a dull or aching variety, but sometimes it may be knife- in its nature. The location of the pain also varies; sometimes it is in the lower quadrant of the abdomen, at other times it can occur in the middle of the abdomen, just under the ribs.

Sometimes the bowel motions may be very frequent and watery, particularly in the morning. This frequency of bowel activity in the morning often leads patients to avoid going out before the bowel activity slows down, or ceases, and this may also cause sufferers to develop an avoidance of situations where toilets are not readily present.

Sometimes, sufferers take regular amounts of anti-diarrhoeal medicines, which can then make the constipation aspects of the problem more severe.

Yet other patients become so worried about the diarrhoea, they restrict all foods that they believe (often incorrectly) will cause their diarrhoea – so they will often have, what is in effect, a very low fibre diet.

Such diets, of course, are generally unhealthy and may then cause further problems.

Thus, one can begin to see how irritable bowel syndrome may actually cause considerable anxiety and avoidance. In turn, the anxiety and avoidance produces a heightened pattern of physiological arousal, which may then cause further symptoms.

As many of you will know, anxiety sufferers, without irritable bowel syndrome, may experience diarrhoea at the height of their anxiety, and this diarrhoea is generally caused by the speeding up of activity in the gut muscles.

The causation of irritable bowel syndrome is something that remains the source of debate and controversy. However, it seems clear from the physiological point of view, that some people have particularly sensitive intestinal tracts and muscle activity is increased.

There is also some evidence that some people are particularly sensitive to certain foodstuffs. Without doubt, anxiety is a factor that can increase bowel activity and, thus, it is ly in most cases that there is a mixture of both physiological and psychological components to causation.

However, it should also be said that in some people the anxiety component of causation may be minor, while in other cases, anxiety is a very substantial factor.

Thus, psychological factors, such as anxiety, may be important in increasing or even causing irritable bowel syndrome and the irritable bowel syndrome itself leads to secondary anxiety because of the obvious problems associated with having such symptoms.

It must be said at this point that there is some evidence that other psychological approaches have been shown to be helpful in the treatment of irritable bowel syndrome and, for some patients, it is clear that some forms of psychotherapy seems to have an effect. Having said this, the behavioural management of the bowel problem itself is important and a purely psychological approach to the problem is unly to be of benefit to the vast majority of patients.

Therefore, as far as treatment is concerned, psychological treatments, such as cognitive behaviour therapy, may make an important contribution to management.

If the person is pre-disposed to anxiety, any form of anxiety-management training, including relaxation, breathing exercises and overall attempts to reduce arousal, such as exercise, can reduce the level of anxiety symptoms and thus reduce activity.

In the case of people whose irritable bowel problem causes further anxiety and avoidance behaviour, it is very important that the patient is taught methods to reduce avoidance behaviour and to break the pattern of pre-occupation with irritable bowel syndrome-related thoughts.

Over the years, I have treated many patients with irritable bowel syndrome and it is essential that one works closely with the patient’s family doctor or gastro-enterologist, to ensure that the advice given to the patient is consistent.

Sometimes, patients are greatly resistant to changing their diet on the advice of their doctor, because of their fear (usually unfounded) that such dietary changes will cause the problem to increase. In my experience, most patients who present will need both help with reducing overall anxiety and dealing with an almost obsessive preoccupation with the bowel habit and associated avoidance behaviour.

It is very important for the therapist to understand the physiological nature of the problem, but unfortunately this is not always the case. As far as medication is concerned, there is no doubt that drugs that have specific action on the bowel may, in some cases, be very helpful.

Equally, there is some evidence that some medication used to treat anxiety may also reduce bowel activity.

However, the use of tranquillising medications, such as Valium, Ativan and similar drugs, should be avoided,  although they may be very helpful in the short term, it should be borne in mind that the longer-term problems of addiction are substantial.

Professor Kevin Gournay is an Emeritus Professor at the Institute of Psychiatry. He has more than 35 years of experience and is the author of more than 130 articles and books. He is based in Cheshunt Hertfordshire.

How can No Panic help?

No Panic specialises in self-help recovery and our services aim to providing people with the skills they need to manage their condition and work towards recovery.

Become a member


How Stress and Anxiety Can Aggravate IBS Symptoms

The Link Between Panic Disorder, Anxiety, and IBS

Which came first — the IBS or the anxiety? Each is known to trigger the other. Stress and anxiety are intended to be your body’s responses to danger. But today’s challenges with work, school, and relationship responsibilities mean these emotional states have become more of an everyday occurrence. If you have IBS, stress and anxiety can come to rule your life.

No definitive cure exists for IBS. But there are ways you can reduce stress in your life, which can help to lessen your IBS symptoms.

How does stress and anxiety affect the gut?

Together, the brain and the nerves that control your body are called the central nervous system. This system operates on internal controls that seemingly run on autopilot.

It’s usually divided into two parts: the sympathetic and parasympathetic nervous systems.

Some classify it as having a third part, the enteric nervous system, which controls most of the activity of the gastrointestinal system.

The sympathetic and parasympathetic systems usually work in tandem. The parasympathetic system is known as the “rest and digest” system. It controls body functions urination, defecation, digestion, tear production, and saliva production — in short, many of the functions your body does in going through the activities of daily life.

The sympathetic nervous system is your “fight or flight” side. Stress and anxiety activate this system. They set off a chain reaction of hormone release that increases how fast your heart beats, pumps more blood to your muscles, and slows or even stops digestive processes in your stomach.

According to an article published in the World Journal of Gastroenterology, having IBS results in disturbances in the balance between your brain and gut.

The result is that stress and anxiety sometimes trigger overactivity of your gut. This causes the diarrhea and stomach churning that those with IBS know well.

In others, the brain signals are underactive, and their gut may slow down, resulting in constipation, gas, and abdominal discomfort.

How stress may trigger IBS

The body’s goal is to maintain homeostasis, or a steady state of being. After a stress response, fluctuating hormones are meant to return to normal levels. However, when people experience chronic stress and anxiety, their bodies can’t achieve homeostasis. This is often the case when a person has IBS.

Stress can wreak havoc on your gut. It causes the release of many hormones, including corticotropin-releasing factor (CRF). This hormone is linked to the gut’s healthy bacteria, which maintains bowel function.

The extra CRF also activates your body’s immune response. While that may sound a good thing, immune activity can have adverse effects, as is the case when a person has a strong allergic response to a healthy food.

Chronic stress can cause your intestinal bacteria to be imbalanced, a condition known as dysbiosis. According to an article in the World Journal of Gastroenterology, stress-induced dysbiosis may play a key role in a person developing IBS.

How stress may worsen IBS

An estimated 40 to 60 percent of those with IBS have a psychiatric disorder, such as anxiety or depression. Stress and major life traumas, such as a breakup, loss of a close family member, or a family member leaving home, are all known to worsen the symptoms associated with IBS.

Stress can have the following effects on IBS:

  • reduces intestinal blood flow
  • increases intestinal permeability
  • activates your immune system
  • causes your immune system to become inflamed

All of these changes can greatly affect IBS systems. And for a person who has a lot of stress in their life, the symptoms can become severe.

Treating the stress and IBS connection

Some people know the source of their stress, while others have a hard time recognizing it. One of the ways to start treating your stress and its connection to IBS is to keep a journal.

In this journal, you can write about the patterns of your day and the state of your symptoms. No detail is too small. Abdominal pain, constipation, and gas are all symptoms that you may be able to link back to worsening IBS. You may have to keep the journal for a while — major life events and stressors could trigger a flare-up a few weeks or months later.

Once you’ve identified the stressors in your life, you can take steps to both remove them and teach yourself to cope with the stress these situations can create.

Here are some tips for coping with stress to reduce IBS:

  • Take up a stress-relieving practice, such as meditation or yoga. Through learning deep breathing and focusing your thoughts, you may be better able to handle stress.
  • Make efforts to sleep at least seven to eight hours a night. Getting plenty of sleep can provide you with the energy you need to go through your day. Going to sleep at a regular bedtime, avoiding use of electronic devices in bed, and keeping your bedroom cool and dark can all promote a better night’s sleep.
  • Seek professional help from a psychiatrist. While it may be difficult to talk about your IBS symptoms with another person, a psychiatrist can help you learn skills to manage stress. For example, they may help you learn cognitive-behavioral techniques to identify stress.
  • Participate in an IBS support group. Social support from others can be a key factor in managing stress and controlling IBS symptoms.
  • Try complementary medicine techniques such as acupuncture, massage, or reiki. These have helped some people with IBS reduce their symptoms.
  • Continue journaling as a means to identify how your methods of managing stress are improving and ideally how your symptoms are getting better.

While stress can be a contributing factor to IBS, it usually isn’t the sole factor. Focusing on stress reduction, as well as taking medications and managing your diet to lower risk of symptom triggers, can help you reduce IBS symptoms whenever possible.


Successfully Treat Irritable Bowel Syndrome (IBS) & Anxiety

The Link Between Panic Disorder, Anxiety, and IBS

  • You have a big presentation due at work which could make or break your promotion ….
  • You are going to meet someone for the first time; someone who can influence your entire future …
  • You are traveling to see your family for the first time in a year with your fiancé who they have never met ….
  • Your anxiety is running high and your heartbeat is racing and then it happens: You have to find a bathroom. NOW!

If one of these is a situation that you are all too familiar with then you might have already been diagnosed with Irritable Bowel Syndrome (IBS). If not, researchers have found that personal stress level and anxiety level can have a direct effect on the development of IBS. Sure, there might be other factors present for developing IBS but often there are few medical reasons why IBS occurs.

IBS affects the large intestine and causes gas, bloating, diarrhea, cramping, and constipation and it affects more women than men.

It may be an embarrassing situation to talk to a doctor about these symptoms but IBS is considered a chronic condition and you are going to need help controlling the symptoms.

Most of the time IBS can become controlled by managing a person's diet, lifestyle, and stress; however, others may need more assistance from a second party, and this may mean medication or counseling.

An effective treatment during counseling sessions is hypnotherapy. Hypnotherapy can reduce a person's panic attacks and anxiety.

While everyone has anxiety, it becomes disruptive for some people, especially those with IBS – even celebrities.

You may feel it will be impossible for your fast-thinking brain to become relaxed enough for hypnotherapy, but you would be surprised what you are willing to try when enough is enough.

Time Tested Hypnotherapy

When anxiety is high and it starts affecting your life, career, and developing personal relationships, hypnotherapy is commonly utilized. This could be better for your whole self because it does not involve taking a drug or messing with your personal hormones.

Hypnotherapy is usually effective with people that have anxiety problems because it puts the patient in a relaxed state so the anxiety does not flare up to cause problems with the treatment. With an anxiety flare there might be added muscle tension, rapid heartbeat, and with that rapid breathing.

There are two ways someone can reach the state needed for hypnosis. One is called progressive relaxation which focuses on the entire body becoming relaxed enough to enter the trance state.

The second method is called rapid induction, which is a faster way to achieve that trance state, and focuses on key areas of the body to place in a relaxed state.

Rapid induction is the method that is most effective when dealing with anxiety.

Rapid induction normally takes three minutes or less to reach the trance state needed for hypnotherapy. Developed in 1935 by Dave Elman, who actually wrote the book on hypnotherapy, is still seen as a great reference for today's practitioners. His induction method has helped people from those people experiencing pain from cancer treatment to people who want to quit smoking.

Dave Elman's method of deep trance state is not needed to get the desired effect to help with anxiety. During the light or medium trance state a therapist can uncover the root causes of a person's anxiety and stress.

Direct suggestions can take place to ease a person's anxiety towards that specific subject or stressor. Being relaxed helps with the overall healing process and has far fewer side effects than taking prescription drugs.

You may also be interested in these other articles about hypnotherapy:

Kim Kardashian Treats Pregnancy Anxiety With Hypnotherapy

Hypnotherapy's Secret To Weight Loss

An Example of Success

A recent example is a patient whose 13-year battle with IBS had become so severe over time that she was unable to successfully make it to work because of her 90-minute commute. She would miss work for days, risking that she might lose her job and be unable to provide for her family and herself.

In addition to IBS, she also suffered from panic attacks. While on her bus and train commute, unable to visit restrooms along the way, she said that her “stomach rolls and I feel trapped.”

Elman's method of rapid induction was used to place Andrea in a trance state to gain access to the unconscious mind. While in the trance, the patient was provided with direct suggestions that she was going to be relaxed and calm when she was traveling and that she was in control of her thoughts, her feelings, and her body.

After the single session the patient was able to see the results of the hypnotherapy. She had no stomach discomfort when traveling and was free of panic attacks. She had no urges to know where every bathroom was located and, after a few months, she reported that she was still IBS symptom free.

Gaining Acceptance

Hypnosis is rapidly gaining acceptance for an effective treatment for IBS. Because IBS has little medical reasoning of why it occurs, a physiological approach is becoming the first defense in terms of treatment for IBS. Commonly doctors prescribe depression or anxiety related drugs. But who wants more chemicals in their bodies?

For those people with high anxiety and high stress, every day is seen as a hurdle to overcome and everyday situations are seen as a nightmare, combine that with IBS and self-confidence and self-control can quickly spiral control. Hypnosis is becoming more accepted by medical professionals as well as patients to treat IBS because it takes less time than traditional therapy and gives the opportunity to treat the whole person verses minor problems. (1)

Recommended For You

193 s

157 s



Date of original publication: November 11, 2015

Updated: February 11, 2016


IBS and panic attacks

The Link Between Panic Disorder, Anxiety, and IBS

People suffering from IBS may be more prone to panic attacks. These can be described as a sudden, intense b anxiety and can produce pronounced physical symptoms such as an increased heart rate, sweating, shaking, tremor and in severe cases hyperventilation, choking and nausea.

Panic attacks can be so severe that in some instances, people believe they are having a heart attack. If you want to learn more about panic attacks, please refer to our Stress and Anxiety Health Hub.

Why does IBS cause panic attacks?

An urgent need for the toilet is a common scenario for people suffering from IBS.

People may have been caught off guard in the past, needing to use the toilet when none can be found nearby – a good cause for panic. An episode of incontinence may even have been a result. The fear of a similar situation recurring can trigger a panic attack.

Unfortunately, in someone with IBS, a vicious cycle can result where the presence of recurring digestive issues can cause panic attacks and an episode of panic can then result in the onset of more punishing physical symptoms.

People suffering from IBS are more prone to stress and on the other hand, people who are prone to panic attacks, anxiety, stress, low mood or depression are more ly to suffer from IBS.

In the body there is a robust brain-gut connection which may explain why these two areas can have such a large influence on each other. Stress in the gut can quickly be communicated to the brain and affect our mood and stress response.

Read our blog on how stress may cause you digestive issues.

In this page, we focus on how IBS can cause panic attacks but if you think your panic attacks may be resulting in the incidence of IBS please follow the link to read more about psychological factors and IBS.

What can I try at home for panic attacks?

There may be a few simple steps you can take at home to help control your panic attacks:

  • Relax: Busy lifestyles can increase the risk of feeling anxious and having panic attacks. Take time out to par-take in activities you enjoy and avoid worrying thoughts. Relaxing our minds will mean we are less ly to have a panic attack triggering associated IBS symptoms
  • Cut out caffeine: Caffeine encourages the release of adrenaline, which can encourage sweating and heart palpitations, the nasty symptoms associated with panic attacks we are trying to avoid! Try switching your tea, coffee and soft drinks for a coffee substitute or a soothing herbal tea. Caffeine can also directly irritate the gut so best to avoid where possible
  • Exercise: Exercise encourages the release of feel good neurotransmitters called endorphins, which can positively effects our mood. Exercise may also help to take our mind off panicky thoughts
  • Plan ahead: Panic attacks, especially when linked to IBS, can be made worse if we are disorganised and have not thought ahead. Planning where you will be and what you need during the day can help a great deal. Working out where the nearest toilet is throughout your day can make a big difference and help you relax.

How can herbal remedies help me?

For people suffering from anxiety as a result of IBS, there are some herbal products out there specifically designed to help.

  • Silicol gel: If IBS is the cause of our panic attacks, we should try and address the fundamental issue first. Try using a supplement containing silicic acid such as Silicol gel. This acts as a protective barrier for the digestive tract, soothing and calming the walls of the intestine
  • Stress Relief drops: Next, there are herbs that may help to address the panic attacks directly. The A.Vogel Stress Relief drops contain a synergistic combination of two herbs, Valerian and Hops which have been used traditionally to help deal with anxiety disorders such as panic attacks.

How can my doctor help?

If home and herbal remedies fail to give you the help you need, a trip to your doctor may be in order. The focus of your treatment may be to address the IBS first; although generally conventional treatments do not get to the root of the problem. 

Your doctor may suggest a type of behavioural treatment such as Cognitive Behavioural Therapy (CBT) to help address stress levels. Anti-anxiety or anti-depressant medications may be prescribed if necessary but beware of any side effects which may exacerbate IBS symptoms.


When Panic and IBS Attacks Happen at the Same Time

The Link Between Panic Disorder, Anxiety, and IBS

The symptoms of irritable bowel syndrome (IBS) and panic attack symptoms sound very different things, but in fact, it's very common to have bouts of both simultaneously.

That's unfortunate, of course, but there's a bright side: The strategies for dealing with one condition generally also are helpful for dealing with the other.

And so once you understand what the two have in common and learn how to cope, you may be able to manage both at the same time. / Getty Images

Both IBS and panic attacks are thought to be caused at least in part by a dysfunction in the central nervous system's natural stress response, sometimes called the “fight or flight” response. 

During a panic attack, the body reacts as if it's in serious danger. Common symptoms include:

  • Heart palpitations
  • Heavy perspiring
  • Shaking and trembling
  • Feeling as if you can't breathe
  • Dizziness or light-headedness
  • Fear of losing control or dying 
  • Feeling as if you're going to throw up

If you have IBS, you might experience some or all of these symptoms as well as abdominal pain, cramping, and diarrhea.

Martin Barraud / Getty Images

If you have both IBS and panic disorder, practicing relaxation exercises will be highly beneficial by helping you to build skills for calming your body and reducing your distress when you are experiencing a panic attack or an IBS attack or both. Even better, if you practice these skills regularly you will lower your baseline level of anxiety, which will reduce your risk of having either type of attack. 

Ben Pipe Photography/Cultura/Getty Images

Deep breathing exercises develop the skill of using the diaphragm to slow and deepen your breath, sending a message to your body that there is no immediate threat to your well-being. This helps to turn off your stress response and quiet your panic and digestive symptoms.

Deep breathing instructions:

  1. Place your hands on your belly and breathe in slowly and fully.
  2. As you inhale, imagine your belly is a balloon that's filling up with air.
  3. As you breathe out, focus on the sensation of a balloon deflating.

microgen/E+/Getty Images

As part of the stress response, your muscles tense up. Learning to progressively relax each muscle group helps to turn off the stress response and calm your body.

To practice progressive muscle relaxation skills:

  1. Sit or lie in a quiet place.
  2. Relax one group of muscles at a time, starting with those in your face and head and moving all the way down to your feet and toes.
  3. To do this, tense up the muscles you're focusing on, squeezing as tight as you can, and then let them go.

Hero Images/Getty Images

As you use breathing and/or muscle relaxation skills, you may find it helpful to calm your mind. Some ways to do this:

  • Calming self-talk (affirmations): Remind yourself there's nothing to worry about and that your symptoms will pass soon.
  • Visualization: Close your eyes and imagine you're in a peaceful safe place.
  • Guided imagery: Form an image in your mind that represents your distress, then imagine it changing into something that will help you feel calm rather than agitated.

Photo: Nils Hendrik Mueller/Cultura/Getty Images

The sensation of heat on the belly can be very soothing. You can use either a heating pad or a hot water bottle. Heat will help to calm the muscles and nerves in your digestive system and also will be psychologically soothing.

Tetra Images/Getty Images

Cognitive behavioral therapy (CBT) is a type of psychotherapy  learning new ways of thinking and behaving that can help to calm physiological symptoms.

Research has found CBT to be effective both for reducing symptoms of IBS and for relieving panic attacks.

 So whether you have one of these disorders or both, working with a cognitive behavioral therapist can be an effective way to deal with your symptoms. 

Thanks for your feedback!

What are your concerns?

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. Fichna J, Storr MA. Brain-Gut Interactions in IBS. Front Pharmacol. 2012;3:127.  doi:10.3389/fphar.2012.00127

  2. American Academy of Child & Adolescent Psychiatry. Panic Disorder in Children and Adolescents. 2013.

  3. Lempert T. Recurrent Spontaneous Attacks of Dizziness. Continuum (Minneap Minn). 2012;18(5):1086-1101 doi:10.1212/

  4. Moleski SM. Irritable Bowel Syndrome (IBS). Merck Manual Consumer Version. Updated June 2019.

  5. Park SH, Han KS, Kang CB. Relaxation Therapy for Irritable Bowel Syndrome: A Systematic Review. Asian Nursing Research. 2014;8(3):182-192. doi:10.1016/j.anr.2014.07.001

  6. Harvard Medical School. Relaxation techniques: Breath control helps quell errant stress response. Updated April 13, 2018.

  7. American Psychological Association. Stress effects on the body.

  8. Cleveland Clinic. Exercise: Mind-Body Exercises & Heart Health. Updated December 14, 2018.

  9. Irritable Bowel Syndrome: Controlling Your Symptoms. Am Fam Physician. 2010;82(12):1449-1451.

  10. Gros DF, Antony MM, Mccabe RE, Lydiard RB. A preliminary investigation of the effects of cognitive behavioral therapy for panic disorder on gastrointestinal distress in patients with comorbid panic disorder and irritable bowel syndrome. Depress Anxiety. 2011;28(11):1027-1033. doi:10.1002/da.20863


Anxiety and IBS revisited: ten years later

The Link Between Panic Disorder, Anxiety, and IBS

1. Spiegel BM, Farid M, Esrailian E, Talley J, Chang L. Is irritable bowel syndrome a diagnosis of exclusion?: a survey of primary care providers, gastroenterologists, and IBS experts. Am J Gastroenterol. 2010;105(4):848–858. [PMC free article] [PubMed] [Google Scholar]

2. Gerson CD, Gerson MJ, Chang L, Corazziari ES, Dumitrascu D, Ghoshal UC, et al. A cross-cultural investigation of attachment style, catastrophizing, negative pain beliefs, and symptom severity in irritable bowel syndrome. Neurogastroenterol Motil. 2015;27(4):490–500. [PubMed] [Google Scholar]

3. Vandvik PO, Lydersen S, Farup PG. Prevalence, comorbidity and impact of irritable bowel syndrome in Norway. Scand J Gastroenterol. 2006;41(6):650–656. [PubMed] [Google Scholar]

4. Folks DG. The interface of psychiatry and irritable bowel syndrome. Curr Psychiatry Rep. 2004;6(3):210–215. [PubMed] [Google Scholar]

5. Solmaz M, Kavuk I, Sayar K. Psychological factors in the irritable bowel syndrome. Eur J Med Res. 2003;8(12):549–556. [PubMed] [Google Scholar]

6. Singh R, Pandey H, Singh R. Correlation of serotonin and monoamine oxidase levels with anxiety level in diarrhea-predominant irritable bowel syndrome. Indian J Gastroenterol. 2003;22(3):88–90. [PubMed] [Google Scholar]

7. Hazlett-Stevens H, Craske MG, Mayer EA, Chang L, Naliboff BD. Prevalence of irritable bowel syndrome among university students: the roles of worry, neuroticism, anxiety sensitivity and visceral anxiety. J Psychosom Res. 2003;55(6):501–505. [PubMed] [Google Scholar]

8. Miller V, Hopkins L, Whorwell PJ. Suicidal ideation in patients with irritable bowel syndrome. Clin Gastroenterol Hepatol. 2004;2(12):1064–1068. [PubMed] [Google Scholar]

9. Farbod F, Farzaneh N, Bijan M, Mehdi G, Nosratollah N. Psychological features in patients with and without irritable bowel syndrome: A case-control study using Symptom Checklist-90-Revised. Indian J Psychiatry. 2015;57(1):68–72. [PMC free article] [PubMed] [Google Scholar]

10. Gao J. Correlation between anxiety-depression status and cytokines in diarrhea-predominant irritable bowel syndrome. Exp Ther Med. 2013;6(1):93–96. [PMC free article] [PubMed] [Google Scholar]

11. Kabra N, Nadkarni A. Prevalence of depression and anxiety in irritable bowel syndrome: A clinic based study from India. Indian J Psychiatry. 2013;55(1):77–80. [PMC free article] [PubMed] [Google Scholar]

12. Farzaneh N, Ghobakhlou M, Moghimi-Dehkordi B, Naderi N, Fadai F. Anxiety and depression in a sample of Iranian patients with irritable bowel syndrome. Iran J Psychiatry Behav Sci. 2013;7(1):30–36. [PMC free article] [PubMed] [Google Scholar]

13. Zhao Y, Ke M, Wang Z, Wei J, Zhu L, Sun X, et al. Pathophysiplogical and psychosocial study in patients with functional vomiting. J Neurogastroenterol Motil. 2010;16:274–280. [PMC free article] [PubMed] [Google Scholar]

14. Han B. Correlation between gastrointestinal hormones and anxiety-depressive states in irritable bowel syndrome. Exp Ther Med. 2013;6(3):715–720. [PMC free article] [PubMed] [Google Scholar]

15. Bengtson MB, Aamodt G, Vatn M, Harris J. Co-occurrence of IBS and symptoms of anxiety or depression, among Norwegian twins, is influenced by both heredity and intrauterine growth. BMC Gastroenterol. 2015;15:9. [PMC free article] [PubMed] [Google Scholar]