Anxiety may be more common in people with Crohn’s disease, but strategies such as talk therapy and stress management techniques can help.

People with Crohn’s disease often experience higher rates of anxiety and depression on average than people without Crohn’s or another type of inflammatory bowel disease (IBD).

Researchers don’t know exactly why this association exists, but it appears to go both ways. If you live with IBD, you have an increased risk of anxiety or depression. And some evidence shows the risk of IBD is higher in those who have anxiety or depression.

There’s emerging evidence that talk therapy, which is a standard treatment for anxiety with or without Crohn’s disease, can also help with IBD-related anxiety. Self-help techniques such as stress reduction can also help with anxiety management.

Many people living with Crohn’s disease also experience anxiety or depression.

A 2023 review of studies found a bidirectional association between these mental health conditions and inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis.

In the review, people with IBD had a 48% increased risk of anxiety and a 55% increased risk of depression. People with depression had a two-fold increased risk of developing IBD.

Another 2023 review of studies found that up to 65% of women with IBD also had anxiety or depression.

The stress associated with living with a chronic condition such as Crohn’s can cause anxiety for a number of reasons. People may feel especially anxious:

  • when they’re first diagnosed with Crohn’s
  • during a flare, when symptoms worsen
  • if they need surgery
  • if they’re experiencing side effects of their treatment
  • if their current treatment stops working

Anxiety may be associated with Crohn’s disease flares, hospitalization, and escalation of treatment.

Is anxiety a risk factor of Crohn’s disease?

Stress and anxiety may trigger Crohn’s symptoms in some people, but they do not cause the onset of Crohn’s.

While anxiety isn’t a risk factor for Crohn’s, there remains uncertainty about the exact relationship between IBD and mental health conditions.

Researchers hypothesize that bidirectional communication in the gut-brain axis can help explain this association. The gut-brain axis is a communication network in which the brain influences activities of the intestines while the gut impacts mood and mental health.

In addition, researchers suggest impaired quality of life, reduced social functioning, and long lasting symptoms of IBD can contribute to the development of mental health conditions.

Anxiety and Crohn’s disease are distinct diagnoses.

According to the American Psychiatric Association, anxiety is a normal response to stress and can be beneficial in certain situations. But excessive fear or anxiety that interferes with your daily life may be a sign of an anxiety disorder. Almost 30% of adults have an anxiety disorder at some point in their life.

According to the National Institutes of Health (NIH), signs of generalized anxiety disorder include:

  • feeling wound-up, on edge, or restless
  • getting tired easily
  • irritability
  • trouble concentrating
  • headaches, stomachaches, or muscle aches
  • uncontrolled worry
  • sleep problems

When researchers measure anxiety in people with IBD, they do not always use the same criteria as mental health professionals who diagnose anxiety disorders.

As an example, a researcher might use the Hospital Anxiety and Depression Scale (HADS) to assess symptoms of mental health issues in people with IBD. Therefore, someone who has anxiety symptoms on this scale might not meet the diagnosis of an anxiety disorder.

Crohn’s disease is a chronic condition that causes inflammation in the digestive tract. This can lead to symptoms such as:

  • diarrhea
  • abdominal cramping
  • weight loss
  • anemia
  • fatigue
  • eye pain or redness
  • fever
  • joint pain
  • nausea
  • loss of appetite
  • skin changes

Among people living with IBD, some seem to be at higher risk for developing anxiety or depression. A 2021 study found that people who had higher disease activity or had gone through surgery for Crohn’s were more likely to have anxiety or depression.

A study from 2018 found predictive factors for anxiety and depression in people with IBD included:

  • history of surgery
  • being female
  • smoking
  • extra-intestinal manifestations of IBD

Extra-intestinal manifestations of Crohn’s disease can include:

  • eye inflammation
  • arthritis
  • mouth ulcers
  • red bumps on the skin

Both anxiety and Crohn’s disease have individual risk factors, but these can evolve as research continues for each condition. Having a risk factor does not mean someone will develop the condition, and sometimes people get anxiety or Crohn’s with no known risk factors.

General risk factors for anxiety disorders include:

  • family history of anxiety or other mental health conditions
  • feelings of distress, nervousness, or shyness in childhood
  • exposure to stressful life events

Overall risk factors for Crohn’s disease include:

  • family history of Crohn’s disease
  • smoking
  • use of anti-inflammatory medications such as aspirin or ibuprofen
  • use of antibiotics or birth control pills
  • high fat diet

If you’re experiencing symptoms of anxiety or depression, speak with a mental health professional. They can help diagnose these conditions and work with you to develop a treatment plan.

A review published in 2021 found short-term evidence that individual and group talk therapy, also called cognitive behavioral therapy (CBT), can help people with IBD who also have anxiety or depression. The review noted that longer-term studies are necessary.

A 2022 literature review found that there was limited evidence that behavioral therapies and antidepressant medications may help relieve IBD symptoms as well as treat depression or anxiety.

Anxiety, with or without IBD, is typically treated with CBT, medications, and self-management techniques. CBT helps people learn new ways of thinking and reacting to manage anxiety. Medications for anxiety include short-term anti-anxiety medications, beta blockers to control physical symptoms, and antidepressants.

Self-management options include stress management techniques, meditation, and support groups with others who have anxiety.

People with inflammatory bowel disease (IBD), such as Crohn’s disease, are more likely to have anxiety and depression. The association seems to go both ways, as people with depression are more likely to develop IBD.

Researchers don’t yet know why this association exists. Some theories are that the gut-brain axis causes the gut to affect mood and mental health and the brain to affect the intestines. Others suggest that lower quality of life and reduced social functioning over the long term with IBD can lead to anxiety or depression.

Anxiety with or without Crohn’s disease is managed with cognitive behavioral therapy (CBT), medications, and self-management techniques such as meditation and stress reduction.