Abstract
Psychological factors can have an impact on every medical condition, if only because a patient’s state of mind will affect how assiduously he or she will take the prescribed medications. Psychophysiological phenomena vary in their importance according to the disease, and are arguably strongest in the so-called functional disorders. In irritable bowel syndrome, for example, symptoms are highly vulnerable to the effects of psychological distress on bowel motility and on the threshold for perceiving internal phenomena as painful. But such mechanisms can be important in “organic” conditions as well — watching your national soccer team play in the World Cup can bring on a myocardial infarction [1] — so the severity of Crohn’s disease (CD) does not exclude an impact of psychological factors on onset and clinical evolution.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Wilbert-Lampen U, Leistner D, Greven S et al (2008) Cardiovascular events during World Cup soccer. N Engl J Med 358(5):475–483.
Aronowitz R, Spiro HM (1988) The rise and fall of the psychosomatic hypothesis in ulcerative colitis. J Clin Gastroenterol 10(3):298–305
Ader R, Felten DL, Cohen N (eds) (2006) Psychoneuroimmunology. 4th edn, Academic, San Diego
Mitchell CM, Drossman DA (1987) Survey of the AGA membership relating to patients with functional gastrointestinal disorders. Gastroenterol 92:1282–1284
Robertson DAF, Ray J, Diamond I, Edwards JG (1989) Personality profile and affective state of patients with inflammatory bowel disease. Gut 30:623–626
Wilson LM, Baldwin AL (1999) Environmental stress causes mast cell degranulation, endothelial and epithelial changes, and edema in the rat intestinal mucosa. Microcirculation 6(3):189–198
Collins SM, McHugh K, Jacobson K et al (1996) Previous inflammation alters the response of the rat colon to stress. Gastroenterol 111(6):1509–1515
Qiu BS, Vallance BA, Blennerhassett PA, Collins SM (1999) The role of CD4+ lymphocytes in the susceptibility of mice to stress-induced reactivation of experimental colitis. Nat Med 5:1178–1182
Gareau MG, Silva MA, Perdue MH (2008) Pathophysiological mechanisms of stress—induced intestinal damage. Current Mol Med 8:274–281
Velin AK, Ericson AC, Braaf Y et al (2004) Increased antigen and bacterial uptake in follicle associated epithelium induced by chronic psychological stress in rats. Guts 53(4):494–500
Soderholm JD, Perdue MH (2001) Stress and the gastrointestinal tract II. Stress and intestinal barrier function. Am J Physiol Gastrointest Liver Physiol 280(1):G7–G13
Saunders PR, Hanssen NP, Perdue MH (1997) Cholinergic nerves mediate stress-induced intestinal transport abnormalities in Wistar-Kyoto rats. Am J Physiol 273(2 Pt 1):G486–G490
Barreau F, Ferrier L, Fioramonti J, Bueno L (2004) Neonatal maternal deprivation triggers long term alterations in colonic epithelial barrier and mucosal immunity in rats. Gut 53:501–506
Varghese AK, Verdú EF, Bercik P et al (2006) Antidepressants attenuate increased susceptibility to colitis in a murine model of depression. Gastroenterol May 130(6):1743–1753
Farhadi A, Keshavarzian A, Van de Kar LD et al (2005) Heightened responses to stressors in patients with inflammatory bowel disease. Am J Gastroenterol August 100(8):1796–1804
Mawdsley J, Macey M, Feakins R et al (2006) The efect of acute psychological stress on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Gastroenterol 131:410–419
Li J, Nørgrd B, Precht DH, Olsen J (2004) Psychological stress and inflammatory bowel disease: a follow-up study in parents who lost a child in Denmark. Am J Gastroenterol 99(6):1129–33
Lerebours E, Gower-Rousseau C, Merle V et al (2007) Stressful life events as a risk factor for inflammatory bowel disease onset: a population-based case-control study. Am J Gastroenterol 102(1):122–131
von Wietersheim J, Kohler T, Feiereis H (1992) Relapse-precipitating life events and feelings in patients with inflammatory bowel disease. Psychother Psychosom 58:103–112
Paar GH, Bezzenberger U, Lorenz-Meyer H (1988) Über den Zusammenhang von psychosozialem Streb und Krankheitsactivität bei Patienten mit Morbus Crohn und Colitis ulcerosa. Z Gastroenterologie 26:648–657
Mittermaier C, Dejaco C, Waldhoer T et al (2004) Impact of depressive mood on relapse in patients with inflammatory bowel disease: a prospective 18-month follow-up study. Psychosom Med Jan–Feb 66(1):79–84
Mardini HE, Kip KE, Wilson JW (2004) Crohn’s disease: a two-year prospective study of the association between psychological distress and disease activity. Dig Dis Sci Mar 49(3):492–497
Bitton A, Dobkin PL, Edwardes MD et al (2008) Predicting relapse in Crohn’s disease: a biopsychosocial model. Gut 57:1386–1392
Persoons P, Vermeire S, Demyttenaere K et al (2005) The impact of major depressive disorder on the short-and long-term outcome of Crohn’s disease treatment with infliximab. Ali ment Pharmacol Ther Jul 22(2):101–110
Duffy LC, Zielezny MA, Marshall JR et al (1991) Lag time between stress events and risk of recurrent episodes of inflammatory bowel disease. Epidemiology 2(2):141–145.
Vandenbergh V, Amery WK, Waelkens J (1987) Trigger factors in migraine: a study conducted by the Belgian Migraine Society. Headache 27:191–6
Fava GA, Pavan L (1976) Large bowel disorders II, Psychopathology and alexithymia. Psychother Psychosom 27:100–105
Helzer JE, Stillings WA, Chammas S et al (1982) A controlled study of the association between ulcerative colitis and psychiatric diagnosis. Dig Dis Sci 27(6):513–518
Riley SA, Mani V, Goodman MJ, Lucas S (1990) Why do patients with ulcerative colitis relapse? Gut 31:179–183
Levenstein S, Prantera C, Varvo V et al (1994) Psychological stress and disease activity in ulcerative colitis: a multidimensional cross-sectional study. Am J Gastroenterol 89:1219–1225
Levenstein S, Prantera C, Varvo V et al (2000) Stress and exacerbation in ulcerative colitis: a prospective study of patients enrolled in remission. Am J Gastroenterol 95(5):1213–1220
Bitton A, Sewitch M, Peppercorn MA et al (2003) Psychosocial determinants of relapse in ulcerative colitis: A longitudinal study. Am J Gastroenterol 98:2203–2208
Maunder R, Greenberg G, Hunter J et al (2006) Psychobiological subtypes of ulcerative colitis: pANCA status moderates the relationship between disease activity and psychological distress. Am J Gastroenterol 101:2546–2551
Maunder RG, Greenberg GR, Nolan RP et al (2006) Autonomic response to standardized stress predicts subsequent disease activity in ulcerative colitis. European Journal of Gastroenterology and Hepatology 18:413–420
Vidal A, Gomez-Gil E, Sans M et al (1006) Life events and inflammatory bowel disease relapse: a prospective study of patients enrolled in remission. Am J Gastroenterol 101:775–781
North CS, Alpers DH, Helzer JE et al (1991) Do life events or depression exacerbate inflammatory bowel disease? A prospective study. Ann Int Med 114:381–386
Greene BR, Blanchard EB, Wan CK (1994) Long-term monitoring of psychosocial stress and symptomatology in inflammatory bowel disease. Behav Res Ther 32(2):217–226
Brown GW, Harris TO (1978) Social origins of depression: a study of psychiatric disorder in women. Tavistock, London
Daniels GE (1944) Nonspecific ulcerative colitis as a psychosomatic disease. Med Clin N A. 28:593–602
Gazzard BG, Price HL, Liby GW, Dawson AM (1978) The social toll of Crohn’s disease. Br Med J. 2:1117–1119
Arapakis G, Lyketsos CG, Gerolymatos K et al (1986) Low dominance and high intropunitiveness in ulcerative colitis and irritable bowel syndrome. Psychother Psychosom 46:171–176
Bellini M, Tansella M (1976) Obsessional scores and subjective general psychiatric complaints of patients with duodenal ulcer or ulcerative colitis. Psychol Med 6:461–467
Helzer JE, Chammas S, Norland CC et al (1984) A study of the association between Crohn’s disease and psychiatric illness. Gastroenterol 86:324–330
Taylor G, Bagby R, Parker J (1997) Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge University Press, Cambridge
Porcelli P, Leoci C, Guerra V et al (1996) A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. J Psychosom Res 41(6):569–573
Jorgensen J, Ranlov PJ, Bjerrum PJ et al (2001) Is an increased intestinal permeability a valid predictor of relapse in Crohn disease? Scand J Gastroenterol Suppl 36(5):521–527
Sartor RB (1997) Pathogenesis and immune mechanisms of chronic inflammatory bowel diseases. Am J Gastroenterol 92(12 Suppl):5S–11S
Arnott I, Kingstone K, Ghosh S (2000) Abnormal intestinal permeability predicts relapse in inactive Crohn disease. Scand J Gastroenterol Nov 35(4):1163–1169
Hollander D, Vadheim CM, Brettholz E et al (1986) Increased intestinal permeability in patients with Crohn’s disease and their relatives: a possible etiologic factor. Ann Int Med 105:883–885
Barclay G, Turnberg L (1987) Effect of psychological stress on salt and water transport in the human jejunum. Gastroenterol Jul 93(1):91–97
Santos J, Saperas E, Nogueiras C et al (1998) Release of mast cell mediators into the jejunum by cold pain stress in humans. Gastroenterol 114(4):640–648
Alonso C, Guilarte M, Vicario M et al (2008) Maladaptive intestinal epithelial responses to life stress may predispose healthy women to gut mucosal inflammation. Gastroenterol 135:163–172
Wallon C, Yang P-C, Keita AV et al (2008) Corticotropin-releasing hormone (CRH) regulates macromolecular permeability via mast cells in normal human colonic biopsies in vitro. Gut 57:50–58
Meddings JB, Swain MG (2000) Environmental stress-induced gastrointestinal permeability is mediated by endogenous glucocorticoids in the rat. Gastroenterol 119:1019–1028
Mikocka-Walus AA, Turnbull DA, Andrews JM et al (2008) The effect of functional gastrointestinal disorder on psychological comorbidity and quality of life in patients with inflammatory bowel disease. Aliment Pharmacol Ther 28:475–483
Kawahito Y, Sano H, Mukai S et al (1995) Corticotropin releasing hormone in colonic mucosa in patients with ulcerative colitis. Gut 37(4):544–551
Soderholm J, Yang P, Ceponis P et al (2002) Chronic stress induces mast cell—dependent bacterial adherence and initiates mucosal inflammation in rat intestine. Gastroenterol 123(4):1099–1108
Sartor R (1995) Current concepts of the etiology and pathogenesis of ulcerative colitis and Crohn’s disease. Gastroenterol Clin North Am 24(3):475–507
Ligumsky M, Simon PL, Karmeli F, Rachmilewitz D (1990) Role of interleukin 1 in inflammatory bowel disease-enhanced production during active disease. Gut 31:686–689
Dhabhar FS, McEwen BS (1996) Stress-induced enhancement of antigen-specific cell-mediated immunity. J Immunol 156(7):2608–2615
Sternberg EM, Hill JM, Chrousos GP et al (1989) Inflammatory mediator-induced hypothalamic-pituitary-adrenal axis activation is defective in streptococcal cell wall arthritis-susceptible Lewis rats. Proc Natl Acad Sci USA 86(7):2374–2378
Ackerman KD, Martino M, Heyman R et al (1998) Stressor-induced alteration of cytokine production in multiple sclerosis patients and controls. Psychosom Med 60(4):484–491
Zhou D, Kusnecov AW, Shurin MR et al (1993) Exposure to physical and psychological stressors elevates plasma interleukin 6: relationship to the activation of hypothalamic-pituitary-adrenal axis, Interleukins, signal transduction, and the immune system-mediated stress response. Endocrinology 133(6):2523–2530
Lyte M, Nelson SG, Thompson ML (1990) Innate and adaptive immune responses in a social conflict paradigm. Clin Immunol Immunopathol 57(1):137–147
Milunsky A (1980) Prenatal detection of neural tube defects, VI. Experience with 20,000 pregnancies. JAMA 244(24):2731–2735
Sternberg EM, Chrousos GP, Wilder RL, Gold PW (1992) The stress response and the regulation of inflammatory disease. Ann Int Med 117(10):854–666
Geenen R, Godaert GL, Heijnen CJ, Vianen ME et al (1998) Experimentally induced stress in rheumatoid arthritis of recent onset: effects on peripheral blood lymphocytes. Clin Exp Rheumatol 16(5):553–559
Kang D, Coe C, McCarthy D et al (1997) Cytokine profiles of stimulated blood lymphocytes in asthmatic and healthy adolescents across the school year. J Interferon Cytokine Res 17(8):481–487
Kuroki T, Ohta A, Aoki Y et al (2007) Stress maladjustment in the pathoetiology of ulcerative colitis. J Gastroenterol Jul 42(7):522–527
Sartor RB (1997) Enteric microflora in IBD: Pathogens or commensals? Inflamm Bowel Dis 3(3):230–235
Frank D, St Amand A, Feldman R et al (2007) Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci USA 104(34):13780–13785
Bailey MT, Coe CL (1999) Maternal separation disrupts the integrity of the intestinal microflora in infant rhesus monkeys. Dev Psychobiol 35(2):146–155
Lyte M, Ernst S (1992) Catecholamine induce growth of gram negative bacteria. Life Sci 50(3):203–212
Lyte M, Arulanandam BP, Frank CD (1996) Production of Shiga-like toxins by Escherichia coli O157:H7 can be influenced by the neuroendocrine hormone norepinephrine. J Lal Clin Med 128(4):392–398
Prugh DG (1951) The influence of emotional factors on the clinical course of ulcerative colitis in children. Gastroenterol 18(3):339–354
Bayless TM, Harris ML (1990) Inflammatory bowel disease and irritable bowel syndrome. Med Clin N A 74(1):21–9
Barsky AJ (1992) Amplification, somatization, and the somatoform disorders. Psychosomatics 33(1):28–34
Tysk C, Lindberg E, Jarnerot G, Floderus-Myrhed B (1988) Ulcerative colitis and Crohn’s disease in an unselected population of monozygotic and dizygotic twins. A study of heritability and the influence of smoking. Gut 29:990–996
Felder J, Korelitz B, Rajapakse R et al (2000) Effects of nonsteroidal antiinflammatory drugs on inflammatory bowel disease: a case-control study. Am J Gastroenterol 95(8):1949–1954
Nigro G, Angelini G, Grosso S et al (2001) Psychiatric predictors of noncompliance in inflammatory bowel disease: psychiatry and compliance. J Clin Gastroenterol 32(1): 66–68
Levenstein S, Prantera C, Luzi C, D’Ubaldi A (1985) Low residue or normal diet in Crohn’s disease: a prospective controlled study in Italian patients. Gut 26:989–993
Deinzer R, Forster P, Fuck L et al (1999) Increase of crevicular interleukin I beta under academic stress at experimental gingivitis sites and at sites of perfect oral hygiene. J Clin Periodontol 26(1):1–8
Tarter RE, Switala J, Carra J et al (1987) Inflammatory bowel disease: psychiatric status of patients before and after disease onset. Int J Psychiatry Med 17(2):173–181
Andrews H, Barczak P, Allan RN (1987) Psychiatric illness in patients with inflammatory bowel disease. Gut 28:1600–1604
Esler MD, Goulston KJ (1973) Levels of anxiety in colonic disorders. N Engl J Med 288(1):16–20
Simren M, Axelsson J, Gillberg R et al (2002) Quality of life in inflammatory bowel disease in remission: the impact of IBS-like symptoms and associated psychological factors. Am J Gastroenterol 97(2):389–396
Guthrie E, Jackson J, Shaffer J et al (2002) Psychological disorder and severity of inflammatory bowel disease predict health-related quality of life in ulcerative colitis and Crohn’s disease. Am J Gastroenterol 97(8):1994–1999
Drossman DA, Leserman J, Mitchell CM et al (1991) Health status and health care use in persons with inflammatory bowel disease: a national sample. Dig Dis Sci 36:1746–1755
Sewitch M, Dobkin P, Abrahamowicz M et al (2001) Psychological distress, social support and disease activity in inflammatory bowel disease. Am J Gastroenterol 96(5):1470–1479
Drossman DA, Patrick DL, Mitchell CM et al (1989) Health-related quality of life in inflammatory bowel disease: functional status and patient worries and concerns. Dig Dis Sci 34(9):1379–1386
Drossman DA, Leserman J, Li Z et al (1991) The rating form of IBD patient concerns: a new measure of health status. Psychosom Med 13(6):701–712
Levenstein S, Li Z, Almer S et al (2001) Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease. Am J Gastroenterol 96(6):1822–1830
Maunder R, Esplen MJ (1999) Facilitating adjustment to inflammatory bowel disease: a model of psychosocial intervention in non-psychiatric patients. Psychother Psychosom 68(5):230–240
Miehsler W, Weichselberger M, Offerlbauer-Ernst A et al (2008) Which patients with IBD need psychological interventions? A controlled study. Inflamm Bowel Dis 14:1273–1280
von Wietersheim J, Kessler H (2006) Psychotherapy with chronic inflammatory bowel disease patients: a review. Inflamm Bowel Dis 12(12):1175–1184
Milne B, Joachim G, Niedhardt J (1986) A stress management programme for inflammatory bowel disease patients. J Adv Nurs 11(5):561–567
Pickering TG, Schnall PL, Schwartz JE, Pieper CF (1991) Can behavioural factors produce a sustained elevation of blood pressure? Some observations and a hypothesis. J Hypertens Suppl 9(8):S66–S68
Mussell M, Bocker U, Nagel N et al (2003) Reducing psychological distress in patients with inflammatory bowel disease by cognitive-behavioural treatment: exploratory study of effectiveness. Scand J Gastroenterol 38(7):755–762
Smith GD, Watson R, Roger D et al (2002) Impact of a nurse-led counselling service on quality of life in patients with inflammatory bowel disease. J Adv Nurs 38(2):152–160
Schwarz SP, Blanchard EB (1991) Evaluation of a psychological treatment for inflammatory bowel disease. Behav Res Ther 29(2):167–177
Gold N, Issenman R, Roberts J, Watt S (2000) Well-adjusted children: an alternate view of children with inflammatory bowel disease and functional gastrointestinal complaints. Inflamm Bowel Dis 6(1):1–7
Díaz Sibaja M, Comeche Moreno M, Mas Hesse B (2007) Protocolized cognitive-behavioural group therapy for inflammatory bowel disease. Rev Esp Enferm Dig 99(10):593–598
Langhorst J, Mueller T, Luedtke R et al (2007) Effects of a comprehensive lifestyle modification program on quality-of-life in patients with ulcerative colitis: a twelve-month followup. Scand J Gastroenterol 42(6):734–745
Keller W, Pritsch M, Von Wietersheim J et al (2004) Effect of psychotherapy and relaxation on the psychosocial and somatic course of Crohn’s disease: main results of the German Prospective Multicenter Psychotherapy Treatment study on Crohn’s Disease. J Psychosom Res 56(6):687–696
Maunder R, Esplen M (2001) Supportive-expressive group psychotherapy for persons with inflammatory bowel disease. Can J Psychiatry 46(7):622–626
Kennedy AP, Nelson E, Reeves D et al (2004) A randomised controlled trial to assess the effectiveness and cost of a patient orientated self management approach to chronic inflammatory bowel disease. Gut 53:1639–1645
Waters B, Jensen L, Fedorak R (2005) Effects of formal education for patients with inflammatory bowel disease: a randomized controlled trial. Can J Gastroenterol 19(4):235–244
Shepanski M, Hurd L, Culton K et al (2005) Health-related quality of life improves in children and adolescents with inflammatory bowel disease after attending a camp sponsored by the Crohn’s and Colitis Foundation of America. Inflamm Bowel Dis 11(2):164–170
Levenstein S, Maunder R, Coe C (2003) Psychological factors in organic gastrointestinal disease. I. Inflammatory bowel disease. Available at: http://www.psychosomatic.org/ed_res/ed_res_IBD_powerpoint.htm
Guthrie E, Creed F, Dawson D, Tomenson B (1991) A controlled trial of psychological treatment for the irritable bowel syndrome. Gastroenterol 100(2):450–457
Payne A, Blanchard EB (1995) A controlled comparison of cognitive therapy and self-help support groups in the treatment of irritable bowel syndrome. J Cons Clin Psych 63:779–786
Spiegel D, Kraemer DC, Bloom JR, Gottheil E (1989) Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet 14:888–891
Mawdsley JE, Jenkins DG, Macey MG et al (2008) The effect of hypnosis on systemic and rectal mucosal measures of inflammation in ulcerative colitis. Am J Gastroenterol 103:1460–1469
Deter HC, Keller W, von Wietersheim J et al (2007) Psychological treatment may reduce the need for healthcare in patients with Crohn’s disease. Inflamm Bowel Dis 13(6):745–752
Jantschek G, Zeitz M, Pritsch M et al (1998) Effect of psychotherapy on the course of Crohn’s disease: Results of the German prospective multicenter psychotherapy treatment study on Crohn’s disease. German Study Group on Psychosocial Intervention in Crohn’s Disease. Scand J Gastroenterol 33(12):1289–1296
Garcia-Vega E, Fernandez-Rodriguez C (2004) A stress management programme for Crohn’s disease. Behav Res Ther 42(4):367–383
Spiro HM (1990) Six physicians with inflammatory bowel disease. J Clin Gastroenterol 12(6):636–642
Engel GL (1977) The need for a new medical model: a challenge for biomedicine. Science. 196(4286):129–136
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2010 Springer-Verlag Italia
About this chapter
Cite this chapter
Levenstein, S., Varvo, V. (2010). Psychological and Social Aspects. In: Tersigni, R., Prantera, C. (eds) Crohn’s Disease. Updates in Surgery. Springer, Milano. https://doi.org/10.1007/978-88-470-1472-5_26
Download citation
DOI: https://doi.org/10.1007/978-88-470-1472-5_26
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-1471-8
Online ISBN: 978-88-470-1472-5
eBook Packages: MedicineMedicine (R0)