Irritable bowel syndrome (IBS) is a heterogeneous disorder of gut-brain interaction, underpinned by altered motility, visceral hypersensitivity, intestinal permeability, neuroimmune signalling and microbiota changes. Psychological comorbidity, particularly anxiety and stress, is common and can both drive and amplify gastrointestinal symptoms through neural, endocrine, immune and microbial pathways. While first-line management remains non-pharmacological, a subgroup of adults with severe, non-ulcerated IBS in whom anxiety and tension are prominent contributors presents a genuine clinical dilemma. This article examines the role of chlordiazepoxide...