Research suggests that about 1 in 6 individuals with coeliac disease are likely to have a diagnosable anxiety disorder. Anxiety is a symptom of various clinically diagnosable mental disorders (e.g. generalised anxiety disorder, panic disorder). Experiencing anxious feelings from time to time is a normal part of life and can manifest in many different situations where we find ourselves stressed or under pressure. Anxiety becomes problematic when it is excessive relative to the object/event of concern, or begins to cause problems at work, school, or in one’s personal relationships.

Research suggests that individuals with coeliac disease can experience feelings of anxiety associated with strict, ongoing dietary management. Interestingly, there is some evidence to suggest that individuals with excellent gluten-free diet adherence may be more susceptible to feeling anxious compared to less adherent individuals –potentially due to having a ‘hypervigilant’ approach to their diet and potential sources of gluten exposure. With this in mind, it is important to keep track of your mental health and to seek out support from a mental health professional or someone you trust if things become too challenging.

While anxiety can significantly impact quality of life, it is also associated with a higher probability of developing other mental health conditions, such as depression. Individuals who are diagnosed with a depressive condition, or who are experiencing severe depressive symptoms are less likely to properly adhere to the gluten-free diet and other medical treatment plans. Sub-optimal gluten-free eating can cause the re-emergence of coeliac symptoms which further maintain a state of psychological distress.

Symptoms of anxiety include

  • Excessive fear/worry
  • Catastrophising
  • Feelings of panic
  • Racing heart
  • Hyperventilation (i.e. breathing to quickly, disrupting the balance between oxygen and carbon dioxide)
  • Trembling
  • Disturbed sleep habits (e.g. insomnia)
  • Avoidance of situations that provoke anxiety, impacting work, study or socialising

Anxiety disorders include

Generalised anxiety disorder (GAD): excessive anxiety over various aspects about one’s life, such as work, school, and social activities, that lasts for at least six months

Social anxiety disorder (also sometimes called social phobia): involves excessive anxiety relating to social situations (e.g. parties, talking to strangers) where the person feels they may be scrutinised

Panic disorder: involves unexpected, recurrent panic attacks (i.e. overwhelming sense of fear, feeling of doom, racing heart, hyperventilation, sweating), fear of further attacks or behaviours aimed at avoiding future panic attacks


Visceral hypersensitivity

Research in gastrointestinal illnesses suggests that people vary in how sensitive and/or aware we are of gastrointestinal sensations. These sensations can vary from mild, benign events such as rumbling and contractions, to more uncomfortable or painful sensations such as distension, or feeling uncomfortably ‘bloated’.

The degree of sensitivity we have to these sensations is often referred to as visceral sensitivity, and those that have a high degree of visceral sensitivity can be said to have visceral hypersensitivity. This phenomenon has been researched predominantly in individuals with irritable bowel syndrome, where it is theorised that nerve pathways between the brain and enteric nervous systems have become ‘sensitised’ (i.e. where ordinary unnoticeable gut sensations are experienced as painful or uncomfortable).

Although research in coeliac samples is limited, findings in other gastrointestinal conditions suggest that visceral sensitivity is likely to be an important factor in how gastrointestinal coeliac symptoms impact psychological well-being.


Pain catastrophising

Although painful stimuli are generally broadly described as unpleasant, people varying considerably in the ways in which we anticipate, experience, and try to avoid painful experiences. Research suggests that some people engage in a phenomenon known as pain catastrophising, wherein they become preoccupied with the threat of painful stimuli and its effect on them.

Like visceral sensitivity, pain catastrophising can act as a mediator between symptoms (e.g. abdominal pain) and psychological well-being. Specifically, for some people, the impact of coeliac disease symptoms on their psychological well-being can be expected to be exacerbated by a tendency to anticipate, focus on, or magnify painful sensations.