Functional dyspepsia (FD) and irritable bowel syndrome (IBS) often overlap each other, and they have similar aspects of pathophysiology. For example, visceral hypersensitivity, intestinal dysmotility, psychologic distress, and onset after acute gastroenteritis. On the psychological aspects, anxiety and depression often coexist with FD and IBS. It has been reported that fibromyalgia and chronic fatigue syndrome also coexist with FD and IBS. In addition, it's important to distinguish organic disease with functional gastrointestinal disorder, so we described differential diagnosis of FD and IBS.

We also examined the comorbidity of FD and IBS in our study of general population (Iwaki Heath Promotion Project). We extracted FD and IBS by the questionnaire of RomeⅢ. We evaluated depressive state by The Center for Epidemiologic Studies Depression Scale (CES-D) and sleep disorder by Pittsburgh Sleep Quality Index (PSQI-J). FD group showed significantly higher score in CES-D than non-FD group. In addition, IBS group showed significantly higher score in CES-D and global score of PSQI-J than non-IBS group. It is suggested that IBS coexisted with depression and sleep disorder. Moreover, IBS group and FD group overlapped with high probability, and there was a strong tendency in the overlapped subjects with depressive state.

Patients with eating disorders including anorexia nervosa and bulimia nervosa show various complications which make the disorders hard to treat. Anorexia nervosa patients have symptoms over all body due to severe malnutrition and dehydration : liver dysfunction, kidney failure, constipation, unhairing, and others. Particularly, hypoglycemia, arrhythmia caused by electrolyte imbalance, and refeeding syndrome which would occur in the initial stage of realimentation are life threatening. It is possible that effects of stagnation in body height growth and osteoporosis would remain even after weight restoration. Patients with self-induced vomiting often show dental caries, and electrolyte imbalance gets worse by binge-purge behavior (vomiting, laxative/diuretic misuse). Both anorexia nervosa and bulimia nervosa frequently present depression, anxiety, and personality disorders. Psychiatric comorbidities become an obstacle for treatment of eating disorders. Proper treatment of comorbidities is required in medical care of eating disorders.

Chronic headaches were reviewed and defined as one of the stress-related disorders. Chronic headaches are mostly regarded as a psychosomatic disease, and it is very important to understand the brain mechanism of pain recognition to treat chronic headaches satisfactorily. Chronic headaches have characteristic features which derive from the anatomical condition of the paravertebral myofascial pain syndrome. Also sleep disturbance is another important factor of the headache chronification, which is thought to be connected with REM impairment by stressful life events or irrational cognition. Narrative-based medicine could be as important as evidence-based diagnosis for the appropriate approach to manage chronic headaches.

Pain disorder is defined as a disorder in which pain in one or more anatomic sites is exclusively or predominantly caused by psychologic factors. It is also the main focus of the patient's attention, and results in significant distress and dysfunction. Various terminology has been used to describe this condition, including functional somatic syndrome. Functional somatic syndromes are clusters of bodily symptoms, mainly pain, which include functional diseases such as irritable bowel syndrome, tension-type headache and fibromyalgia. Recently, central sensitization has been suggested to play a role in functional somatic syndrome. Central sensitization refers to the amplification of pain by central nervous system mechanisms. The aim of this review is to discuss complications of pain disorder from the view point of functional somatic disorder and central sensitization.

Depression is predicted to be the leading contributor to the global burden of disease by 2030. Recently, depression has received attention for its association with somatic and psychiatric diseases. When diagnosing depression, clinicians should exclude depressive mood resulting from somatic and psychiatric diseases such as thyroid dysfunction, adrenal dysfunction, neurocognitive disorders, parkinsonism, sleep apnea syndrome, iron or zinc deficiency, bipolar disorder and alcohol dependence. As depression is highly comorbid with chronic illness, we need to address both conditions using a Bio-Psycho-Social approach. Stroke, diabetes, and cardiovascular disease are three major chronic diseases associated with depression. As evidence suggests that stroke confers a substantial risk for suicidal ideation, suicidal thoughts should be carefully evaluated. Depression among stroke patients would be treated with drugs (e.g., tricyclic antidepressants, selective serotonin reuptake inhibitors, or serotonin and norepinephrine reuptake inhibitors) and exercise combination therapy. In cases of depression among diabetes patients, combined pharmacotherapy and cognitive behavioral therapy (CBT) is recommended. Meanwhile, depression among heart failure patients may be treated with CBT.

Background : The concern of some patients seeking treatment for irritable bowel syndrome (IBS) is associated with intestinal gas rather than abdominal pain or disturbance in bowel habits. Such patients are often called informally IBS “gas type.” We report on a patient with IBS and gas symptoms wherein cognitive behavior therapy with interceptive exposure (CBT-IE) was applied, which aimed to relieve IBS symptoms.

Case report : A woman in her 20s had IBS (mixed type). Her chief complaints were frequent bowel movement and abdominal bloating. The patient had been refractory to standard treatments for IBS for several years. Subsequently, she was referred to an X Hospital. CBT-IE consists of 10 sessions containing psycho-education, self-monitoring, cognitive restructuring, attention training, and exposure (in vivo/interoceptive). Although the patient had agreed to undergo treatment and completed 10 sessions, both frequent bowel movement and abdominal bloating did not improve after the intervention.

Discussion : The patient complained consistently of her phobia of her foul odor (intestinal gas odor) throughout the intervention. In the first session, she refused cognitive restructuring. Topics of the session often deviated from the contents of CBT-IE because she wanted to talk about the foul odor. She rarely engaged in home works. It is not infrequent that cognitive fear of self-odor (Jikoshu-kyofu) in IBS patients is hard to change. Some case reports showed the effectivity of Morita therapy on admission for IBS＋Jikoshu-kyofu. Acceptance and commitment therapy (ACT) contains the essence of Morita therapy and meditation, which was also reported to be effective for abdominal bloating. Therefore, ACT might be worth studying as a possible therapeutic intervention for IBS＋Jikoshu-kyofu.