Psychological Considerations for Food Intolerances: Celiac Sprue, Eosinophilic Esophagitis, and Non-Celiac Gluten Sensitivity

Abstract

Several chronic digestive conditions are physiologically based on food intolerance, including celiac disease, nonceliac gluten sensitivity, and eosinophilic esophagitis. Patients are expected to follow medically prescribed diets to eliminate identified food triggers to control symptoms. However, the psychological impacts of these dietary approaches are largely unaddressed in clinical practice. Hypervigilance and anxiety regarding food and symptoms, and disordered eating, may emerge and negatively affect outcomes. Clinicians working with pediatric and adult populations with food intolerances should be aware of these psychological comorbidities, and equally emphasize effective ways to help patients manage the mental and physical aspects of their condition.

Keywords: Celiac disease; Disordered eating; Eosinophilic esophagitis; Food intolerance; Mental health.

Fig. 1.

Too little pressure can result in complacency and exposure to offending foods, and too much pressure can lead to poorer HRQoL and high levels of anxiety.

Fig. 2.

Interrelated constructs when managing food intolerances.