Table 1.

Cognitive–Affective Processes Influencing the Symptom Experience in Functional Gastrointestinal Disorders

Term	Definition	Association with FGID	Outcomes	Management
Illness anxiety	Global tendency to worry about current and future bodily symptoms, formerly referred to as hypochondriasis	Low insight Extensive research into what is wrong Not easily reassured, Lack of acceptance Risk factor for development of FGID	Chronicity Social dysfunction, occupational difficulties, High health costs, Negative doctor–patient relationship, Poor treatment response	Responsive to CBT
Symptom-specific anxiety	Worry/hypervigilance around the likelihood/presence of specific symptoms and the contexts in which they occur	Belief that normal gut sensations are harmful or will lead to negative consequences Promotes GI symptoms	Drives health care use Negatively impacts treatment response	Aerophagia improved with distraction May be differentially responsive to interoceptive exposure-based behavior therapy
Hypervigilance/attentional bias	Altered attention toward, and increased engagement with, symptoms and reminder of symptoms	IBS patients showed higher recall of pain words and GI words compared with healthy controls NCCP patients hypervigilant toward cardiopulmonary sensations	Dismiss signs of improvement Ignore information suggesting that their FGID is not serious	Responsive to CBT
Catastrophizing	2-pronged cognitive process in which an individual magnifies the seriousness of symptoms and consequences while simultaneously viewing themselves as helpless	Results in symptom amplification Increased pain Inhibits pain inhibition Negatively affects interpersonal relationships Leads to increased worry, suffering, disability	High symptom reporting Reduced quality of life Can impact patient self-report Burdens provider	Improves with CBT Mediates outcome

NCCP, noncardiac chest pain.