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Sygdomsopfattelse og irritabel tyktarm

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Afføring, diarre, forstoppelse eller mavesmerter er ofte emner, vi undlader at tale om, blandt andet fordi det anses for værende pinligt. Dog er der rigtig mange i Danmark og på verdensplan, der er plaget af disse gener. Studier viser, at ens opfattelse af sygdom har en sammenhæng med problemerne.

 

Af Dinna Trehøje, Cand. psych, biopat/naturopath IBM og zoneterapeut
Artiklen blev bragt i magasinet sund-forskning – december 2019/januar 2020

 

I den vestlige verden er der mellem 10-20 procent af befolkningen, der lider af irritabel tyktarm, hvilket i høj grad påvirker livskvaliteten negativt. Irritabel tyktarm er en kronisk tilstand og bliver beskrevet ved at være en klynge af symptomer, hvor der er abdominale smerter (mavesmerter) eller ubehag til stede med forandrede afføringsvaner, som ikke kan forklares af lægerne. Der findes ingen specifik behandling i det konventionelle behandlingssystem, hvorfor det også er en kompleks diagnose, der kan skabe stor frustration. I den komplementære verden vil man forsøge at skabe balance eller afhjælpe irritabel tyktarm gennem fx zoneterapi, kostændringer og kosttilskud.

Psykologisk ved man, hvordan individets psyke har en indflydelse på, hvordan tarmen opfører sig. Gennem tiden har adskillige psykologiske studier gjort os klogere på, hvad der kan påvirke fremkomsten af irritabel tyktarm. Emotionelle tilstande, altså vores følelser og stemninger og de kognitive evner, har vist sig at have en stor indflydelse på udviklingen af irritabel tyktarm og har en medvirkende indflydelse for det enkelte menneskes sygdomsopfattelse.

 

Sygdomsopfattelse

Det er meget forskelligt, hvordan personer med en kronisk sygdom klarer sig i sygdomsprocessen. Hvis nogen kommer sig hurtigt, kan man have en tendens til at tænke, at vedkommende ikke var så hårdt ramt af sygdommen. Dog er der andre faktorer, der påvirker sygdommens proces end blot den biologiske. Sociale og kulturelle faktorer påvirker ligeledes mennesket i dets opfattelse af sygdom.

Følgende vil hovedsageligt fokusere på de psykologiske faktorer, der påvirker opfattelsen af sygdom, og hvad du selv kan være opmærksom på, hvis du vil ændre nogle tankemønstre hos dig selv.

Sygdomsopfattelse kan defineres som den opfattelse, der udvikles, når man forsøger at forstå og løse et helbredsproblem. Yderligere kan sygdomsopfattelse beskrives ved den sunde fornuft, vedkommende udvikler i forhold til bestemte symptomer. Det er ens egne subjektive kognitive konstruktioner af sundhedstruslen, der kan være afgørende for, hvordan sygdom opfattes, og hvordan man vil løse truslen mod helbredet.

 

Menneskets opfattelse og håndtering af sygdom har en afgørende betydning for udfaldet af sygdommen.

 

Emotioner og sygdomsopfattelse

Adskillige studier viser, hvordan vores følelser er relevante for, hvordan vi opfatter sygdom. De følelser, der ofte er i spil i forhold til en sygdomstrussel, består ofte af bekymring, frygt, hjælpeløshed, håbløshed og nedtrykthed. Det er afgørende, om man opfatter disse følelser på en negativ eller positiv måde. Har man et sind med et generelt højt positivt følelsesliv, viser studier, at denne positive sindstilstand forbindes til bedre mental og fysisk sundhed. En person med et højt positivt følelsesliv vil tænke, at de forskellige emotioner, som er nævnt her, er naturlige oven på en trussel, og at de derfor er accepterede at føle, fordi vedkommende også ved, at de forsvinder igen, når truslen om sygdom er overstået, eller man får vished om, hvad man fejler.

Hvis man derimod er et menneske med et mere negativt følelsesliv, så forbindes det til usunde funktionsmønstre. Men hvad menes der egentlig med et negativt følelsesliv? Det vil sige, at man bekymrer sig ud over det sædvanlige, at der er en manglende tilfredsstillelse over tid og hverdagslivet, lavt selvværd, selviagttagende tendenser, pessimisme, negative tanker, lavt energiniveau og en lav tolerance over for stressorer. Studier viser, at den måde, du anskuer livet på, har en direkte indflydelse på din krop, da dine tankeprocesser forbindes fysiologisk til kroppen.

 

Et fransk studie fra 2018 undersøgte emotionel aktivitet hos personer med irritabel tyktarm både ud fra medicinske og psykologiske tests.

 

Hypotesen var, at deltagerne med irritabel tyktarm ville være mindre udtryksfulde i deres emotionelle reaktioner end de raske deltagere, da deltagerne med irritabel tyktarm antages at have en højere neurofysiologisk respons, og at de ville score højere på tre psykologiske tests (angst, depression og alexitymi (sværere ved at identificere følelser)). Studiet viste, at deltagerne med irritabel tyktarm rapporterede en højere grad af indre smerte, flere depressive symptomer, højere tilstand af angstsymptomer, og at de havde sværere ved at identificere deres følelser (alexitymi) end kontrolgruppen, der var raske forsøgsdeltagere. Studiet viste desuden, at personer med irritabel tyktarm havde en højere fysiologisk respons og udviste flere negative emotionelle udtryk end kontrolgruppen.

Hvad der skyldes denne ringere evne til at emotionsregulere, synes interessant. Er det den irritable tyktarm, der påvirker individets emotionelle reaktioner, eller er det omvendt individets følelsesliv, der har en indflydelse på udviklingen af irritabel tyktarm? At blive opmærksom på sine følelser, og hvordan man reagerer herpå, er første skridt til at ændre sine reaktions- og tankemønstre.

 

Kognitiv opfattelse af sygdom

Adskillige studier viser, at mennesker benytter sig af fem forskellige kognitive komponenter til at forstå og håndtere sygdom, hvilket består af identitet, tidsperspektiv, årsag, konsekvenser og kontrol.

 

Identitet – der er et behov for at gøre det abstrakte (eksempelvis kropslige symptomer og følelser) til mere konkrete termer. Sygdomsidentitet kan både inddeles i det at beskrive det navn eller label, man giver sine symptomer og selve symptomet. Det skal forstås på den måde, at hvis man har kropslige symptomer, søger man at sætte navn herpå. Omvendt, hvis man får en label, det kunne eksempelvis være en diagnose som irritabel tyktarm, vil vedkommende være mere tilbøjelig til at søge efter symptomer på egen krop. Det kunne eksempelvis være, at du har fået stillet diagnosen irritabel tyktarm, og du opdager nu for første gang måske, at du har oppustethed eller nogle smerter, du ikke tidligere har lagt mærke til, fordi du nu kan læse, at det er et del af symptombilledet.

 

Tidsperspektivet – omhandler, hvordan man opfatter varigheden på sygdommen eller symptomerne, hvilket kan inddeles i kortvarigt, episodisk eller kronisk. Den forventede varighed af en sygdom er afgørende for, hvordan man tilgår sygdommen. Hvis man har en antagelse om, at sygdommen er kortvarig, er man ifølge et studie ikke tilbøjelig til at blive i sin behandling.

 

Årsag – det at kunne tillægge sine symptomer eller sygdom en bestemt årsag kan beskrives som årsagsforklaring. Tidligere skader, infektioner eller genetisk svaghed kan være med til at skabe mening med årsagen til sygdommen. Årsagsforklaring kan være en medfaktor til at skabe mening med sygdommen. (Og måske er det her, at vandene skilles, fordi lægerne ikke altid ser på sygdom med nogle indbyggede årsagssammenhænge, mens ”de alternative” som regel gør.)

 

Konsekvens – omhandler i hvilken grad man forestiller sig, at en sygdom eller et symptom vil påvirke det fremtidige liv. Hvilke personlige konsekvenser det vil få, og hvordan det vil påvirke ens sociale liv, økonomi eller fysiske tilstand, kunne være spørgsmål, man stiller. Et langt tidsperspektiv vil ofte være forbundet med tanken om, at konsekvenserne vil være mere alvorlige. Hvis man ikke tager potentielle konsekvenser alvorligt, kan man være mere tilbøjelig til at håndtere sygdommen uhensigtsmæssigt. Hvis man eksempelvis har diarre hver dag, og man ikke ser alvoren i, at dette kan have seriøse konsekvenser, vil man være mere tilbøjelig til ikke at ændre noget. Hvis man derimod forventer meget negative konsekvenser, kan det have et positivt udfald, hvis disse konsekvenser ikke var så slemme som først antaget.

 

Kontrol – hvilken kontrol har man over denne sygdom eller symptomerne? Kan sygdommen forhindres, forebygges, kontrolleres eller kan den overhovedet helbredes? Dette kan både være spørgsmål, man stiller angående den personlige kontrol i forhold til at håndtere sygdommen eller kontrollen over den behandling, man modtager. Det er vigtigt at tro på sin egen personlige kontrol. Dette viser sig især ved sygdomstilfælde af mindre alvorlig karakter. Her er man mere tilbøjelig til selv at forsøge at reducere symptomerne end at søge læge. Troen på egen personlig kontrol gør, at man i højere grad har en større tillid til sig selv i forhold til at håndtere symptomerne.

 

Adskillige studier viser, at de fem kognitive komponenter påvirker sygdomsopfattelsen hos individer med irritabel tyktarm, og hvordan de reagerer herpå.

Har du tænkt på, hvordan du opfatter din sygdom eller dine symptomer ud fra de fem komponenter? Med denne nye viden om, hvordan ens emotionelle måde at agere på, og hvordan faktorer som sygdomsidentitet, tidsangivelse, årsag, konsekvens og kontrol påvirker din tarm, er der så noget, du har lyst til at ændre på eller arbejde med? Ansvaret for den måde, du anskuer sygdom på, ligger hos dig, og kun du kan ændre din opfattelse heraf?

Artiklen tager udgangspunkt i Dinna Trehøjes afhandling fra Psykologisk Institut, Aarhus Universitet – skriv til redaktionen for kilder eller hele afhandlingen.

 

Mød en ny ekspert

Dinna Trehøje er uddannet cand.psych. fra Aarhus Universitet i 2018 med speciale i sygdomsopfattelse, smerte og funktionelle lidelser. Derudover har hun samtidig studeret til zoneterapeut og biopat/naturopath i biologisk medicin på Institut for Biologisk Medicin og blev færdiguddannet i 2017. Dinna Trehøje arbejder i øjeblikket med Support & Care-uddannelsen på Institut for Biologisk Medicin, der er en ny overbygningsuddannelse omhandlende konventionel og komplementær behandling af kræft.

 

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