Disorders of Gut-Brain Interaction: Understanding the Unique Female Experience From A Biopsychosocial Approach

Northern Virginia Clinical Psychologists, July 2025 Newsletter, Feature Article

Disorders of Gut-Brain Interaction (DGBIs) are complex conditions that involve gastrointestinal symptoms related to motility, visceral sensitivity, gut microbiota, and central nervous system processing. These disorders, such as irritable bowel syndrome (IBS), functional dyspepsia, and functional abdominal pain, stem from the intricate relationship between the gut and the brain. For many years, DGBIs were regarded as primarily psychological, which contributed to patient stigma and confusion about symptoms being “all in their head.” However, with growing recognition of the biological and psychosocial factors involved, patients have benefited from increased acceptance and validation of their experiences. In fact, educating patients about the multifactorial nature of these disorders is now considered an essential aspect of treatment.

The Gender Gap in DGBI Prevalence and Diagnosis

It has been shown that sex-based structural and hormonal differences play a key role in the differing prevalence and symptom presentation of DGBIs in women as compared with men. The Rome Foundation Global Epidemiology Study (RFGES in Sperber, 2023) revealed that 40% of adults across 26 countries met the criteria for DGBI, with women being disproportionately affected. The study highlighted that women were more frequently diagnosed with specific DGBIs, such as IBS (especially IBS-C), chronic constipation, chronic diarrhea, and functional abdominal pain. These higher rates of diagnosis raise important questions about underlying hormonal, structural, and psychosocial factors that may contribute to this gender disparity. At the Spring 2025 Virginia Academy of Clinical Psychologists (VACP) conference in Williamsburg, VA, GI Psychology’s Dr. Ellen Joseph provided some answers to these questions, which are summarized below.

Biological Factors Contributing to GI Symptoms

There are clear biological factors that can contribute to differential rates of prevalence and diagnosis, including sex-based differences in structural anatomy and hormones. Notably, differences in pelvic anatomy, the pelvic floor, and the gastrointestinal (GI) tract itself may influence the presentation of GI symptoms and contribute to a higher prevalence of DGBI diagnoses. Hormonal fluctuations, particularly those associated with estrogen and progesterone, also play a significant role in the exacerbation of GI symptoms in females. Changes in these hormone levels can lead to increased rates of reflux, constipation, and gut permeability, which can change or intensify in response to natural hormonal shifts experienced by most women across the lifespan, including menstruation, pregnancy, perimenopause, menopause, and post-menopause. Female specific conditions like dysmenorrhea, endometriosis, and pelvic floor dysfunction are also frequently associated with worsening IBS symptoms.

The Impact of Social and Cultural Factors

In addition to biological differences, social and cultural factors present unique challenges for women experiencing DGBIs. Women may be reluctant to discuss bodily functions in the face of societal norms, which can be compounded by the intersection of factors such as religion and race. Also, sexual and gender minorities are at increased risk of experiencing discrimination, marginalization, and trauma, which can exacerbate the stress response and worsen GI symptoms.

Finally, the historical dismissal of health concerns presented by women cannot be overlooked. Female patients are especially vulnerable to biases around mental or emotional origins of physical symptoms. This issue is especially important as research shows that females with IBS experience higher rates of anxiety and depression compared to their male counterparts. It is crucial for healthcare providers to present information in a way that emphasizes the interaction between mental health and GI symptoms, while avoiding any implication that these symptoms are imagined or exaggerated or that the patient is at fault.

Clinical Applications: Supporting Females with DGBIs

Understanding the biological, social, and psychological factors that affect females with DGBIs allows providers to tailor their approach to the unique needs of these patients. During intake, providers can assess the impact of perimenopause or menopause on GI symptoms and explore cultural and social factors that shape the patient’s health experience. By offering empathy and validation, providers can create a space for women to discuss “taboo” topics more openly and reduce stigma surrounding their symptoms. Psychoeducation is key. Educating female patients about the role of hormones and other biological factors can help them understand their condition and increase a sense of self-efficacy in managing their health. Gut-directed cognitive-behavioral therapy (CBT) and clinical hypnosis are evidence-based interventions for GI distress. Encouraging patients to track their symptoms in relation to their menstrual cycle or hormonal changes can provide insights into symptom patterns and reduce the tendency to view symptoms in isolation.

Future Directions

Managing DGBIs requires a comprehensive approach, addressing the psychological, social, and physiological factors contributing to these conditions. This model offers a holistic framework for understanding and treating DGBIs effectively. While much has been learned about DGBIs, more research is needed to understand the unique experiences of females, particularly in relation to normal development and aging. Future studies should explore the unique experiences of sexual and gender minorities given the paucity of research in this area. By fostering a deeper understanding of the complex interplay between biology, psychology, and social factors, clinical psychologists and other healthcare providers can better support their female patients in managing symptoms and reducing stigma and self-blame surrounding DGBIs.

If you’re interested in learning more about resources for yourself or your clients, consider the following resources:

• The ROME Foundation (https://theromefoundation.org)
• GI Psychology (https://www.gipsychology.com/resources)

Mind Your Gut: The Science Based Whole Body Guide to Living with IBS (Scarlata & Riehl, 2024)

Reference

Sperber, A. D. (2023). The Rome Foundation Global Epidemiology study: Conception, implementation, results, and future potential. Neurogastroenterology & Motility, 35, e14567. https://doi.org/10.1111/nmo.14567

About the Authors

Sarah Shires, MS, LPC-S (clinician), Ellen Joseph, PhD, LCP (partnership liaison, clinician) and Tiffany Duffing, PhD, LCP (co-founder) are affiliated with GI Psychology. GI Psychology, based in Burke, VA, specializes in treating children, adolescents, and adults with a variety of GI disorders, as well as treatments for chronic pain and other complex medical conditions. GI Psychology’s virtual treatment is nationally available and emphasizes gut-directed cognitive behavioral therapy and clinical hypnosis, as well as strong interdisciplinary collaboration.