Coeliac disease (CD) has received a lot of attention when it comes to physical health and diet. This makes sense, as it’s an autoimmune condition with physical symptoms and health consequences. Its only known treatment is also a strictly gluten free diet. However, for many people, CD affects more than just physical health.
Research is catching up and supporting what people with CD already know. More and more studies are describing psychological symptoms and conditions that are associated with CD. Such conditions include depression, fatigue, impaired memory and concentration, as well as anxiety (as we’ve looked at in a previous edition of Coeliac Link). Some literature suggests that this may be due to the impact of CD symptoms and nutritional deficiencies pre-diagnosis, or due to how having a chronic condition and dietary restrictions impacts on social relationships (Zingone et al., 2015). Whilst research is still working out exactly how these are linked, there are things we can to do to help us to manage the impact on our psychological wellbeing.
We still don’t know whether CD causes depression, but we do know that there are higher rates of depression among people with CD. So, what exactly is depression? And how do you know if you are depressed?
First off, it’s important to know that everyone feels sad or down sometimes. Part of being human is feeling a range of different emotions. The good and the bad; the pleasant and the unpleasant.
Depression is when you feel sad, down or miserable nearly all the time, for a period of 2 weeks or more. This is also commonly accompanied by a loss of interest or enjoyment, or feeling more irritable, grumpy, or guilty. Other signs include changes to appetite (eating more or less than usual), weight gain or loss, feeling exhausted, difficulties sleeping or sleeping too much, and problems with concentration. Because many of these signs are vague and are also indicative of other conditions, talking to a healthcare professional for a correct diagnosis is important.
Anxiety is a feeling of worry, nervousness, or unease. As humans, we are hardwired to try to avoid or escape whatever is triggering our anxiety. For example, if you are anxious about spiders, you will do whatever you can to avoid them. Some anxiety is normal, and to be expected. It is understandable to feel somewhat anxious about avoiding gluten in situations involving food. However, for some people, this anxiety can be so debilitating that it may affect their ability to enjoy or function in everyday life. This may include always avoiding social gatherings, feeling extremely anxious around food, or choosing not to disclose your CD diagnosis for fear of what people might think and risking getting ‘glutened’.
People with undiagnosed CD may experience anxiety due to having unexplained symptoms or feeling unwell. For many people, being diagnosed with CD and starting a strictly gluten free diet may alleviate some of the anxiety or stress they had. However, for some, the diagnosis of CD may create more anxiety. Triggers of anxiety could include efforts to avoid gluten, coping with dining out, and adjusting to a new chronic disease.
Coping strategies: Taking control of your wellbeing
So how can you take control of your physical and mental health? Here are a few ways:
Getting active doesn’t mean that you need to go out and run a marathon, or join a gym. Its about finding everyday ways that you can move your body and get your heart rate up. Think outside the box – dancing, gardening, taking the stairs, or walking to your next destination. Although some people are worried that they may feel more exhausted, if you increase your exercise gradually, it can actually help you feel more energised.
Although it can be difficult to manage the psychological impacts of CD, you are not alone. If you or someone you care about is struggling and need a bit of extra help, don’t hesitate to contact a healthcare professional:
Or take a look at these useful websites for more information and resources:
Article provided by Registered Health Psychologist Sarah McCambridge.
Sarah works clinically with people with chronic health conditions. Her professional and personal life came head-to-head when she was diagnosed with coeliac disease herself. As a result, Sarah has an interest in raising the awareness of the psychological impact of coeliac disease and empowering people living with it.
Bohlmeijer, E., Prenger, R., Taal., E. &, Cuijpers, P. (2010). The effects of mindfulness-based stress reduction therapy on mental health of adults with a chronic medical disease: A meta-analysis. Journal of Psychosomatic Research 68(6), 539-544.
Dowd, J. A. & Jung, M. E. (2017) Self Compassion directly and indirectly predicts dietary adherence and quality of life among adults with celiac disease. Appetite 113, 293 – 300.
Zingone, F. Swift, G. L., Card, T. R., Sanders, D. S., Ludvigsson, J. J., & Bai, J. C. (2015) Psychological morbidity of celiac disease: A review of the literature. United European Gastroenterology 3(2), 136 - 145.