All-or-Nothing Behavior and Catastrophic Thinking Predict Fatigue in Inflammatory Bowel Disease: A Prospective Cohort Study

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Fatigue affects 80% of patients with active inflammatory bowel disease (IBD) and 40% to 50% in remission of IBD, typically running a persistent course. However, owing to a lack of prospective research, there is limited understanding of the behavioral patterns that precipitate fatigue in IBD.
In people with chronic fatigue syndrome, a common pattern is all-or-nothing behavior. On days when fatigue is better, patients may try to catch up on lost productivity, thereby cramming activities and exerting themselves much more than normal. However, this leads to marked worsening in fatigue for subsequent days, precipitating a persistent boom-and-bust pattern of fatigue. Cognitive behavioral therapy (CBT) in chronic fatigue syndrome addresses all-or-nothing behavior and promotes graded increases in activity, producing significant improvements in fatigue. Although all-or-nothing behavior has been observed in irritable bowel syndrome, no study has tested the behavioral predictors of worsening fatigue in patients with IBD, including the role of all-or-nothing behavior. This is important because there are multiple competing pathways to fatigue in IBD, while IBD clinicians—who are frustrated at having few treatments for fatigue—would benefit from clear psychoeducational advice to offer patients.
In this prospective observational study, we tested the hypothesis that all-or-nothing behavior is associated with increased risk of fatigue in people with IBD. We further tested other cognitive and behavioral predictors of fatigue in IBD.
Original languageEnglish
JournalInflammatory bowel diseases
Publication statusAccepted/In press - 5 Aug 2023


  • fatigue
  • prospective
  • all-or-nothing behavior
  • catastrophic thinking
  • chronic fatigue syndrome


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