Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms

Submitted: October 16, 2023
Accepted: November 9, 2023
Published: December 31, 2023
Abstract Views: 546
PDF: 316
HTML: 12
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

A comprehensive investigation of psychological features in chronic patients is very important for tailoring effective treatments. In this study we tested anxiety, depression, health related quality of life (HR-QoL), alexithymia, coping styles, and defense mechanisms, in eighty-four patients with Crohn disease (CD) and ulcerative colitis (UC). Participants reported low to moderate HRQoL and anxiety, apart from alexithymia. Women experienced lower QoL and higher levels of anxiety and depressive symptoms. Coping and defense strategies were related to distress symptoms and QoL. Positive attitude and principalization, showed negative associations with depression, anxiety and alexithymia and were also found to be associated with mental health. CD patients used significantly more turning against objects (p=0.02) and projections (p=0.01) and UC patients used more reversal (p=0.04). Elderly women showed higher anxiety symptoms and lower perceived QoL. Multiple regression analysis revealed anxiety and depression were independently associated with QoL. Significant differences emerged in defense styles among CD and UC. CD participants used more maladaptive coping and defense styles which were related to mental distress, depression and anxiety, together with higher level of alexithymia. Findings suggest that psychological aspects play a key role in mental health in patients suffering from inflammatory bowel diseases. A multi-integrated clinical strategy including psychotherapeutic interventions should be considered in treating CD and UC.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

American Psychiatric Association, (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Washington, DC: American Psychiatric Association. DOI: https://doi.org/10.1176/appi.books.9780890425596
Bagby, R.M., Taylor, G.J., & Parker, J.D., (1994). The Twenty-item Toronto Alexithymia Scale--II. Convergent, discriminant, and concurrent validity. Journal of Psychosomatic Research, 38(1), 33-40. doi: 10.1016/0022-3999(94)90006-x. DOI: https://doi.org/10.1016/0022-3999(94)90006-X
Barberio, B., Zamani, M., Black, C.J., Savarino, E.V., & Ford, A.C., (2021). Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis. The Lancet Gastroenterology and Hepatology, 6(5), 359-370. doi: 10.1016/S2468-1253(21)00014-5. DOI: https://doi.org/10.1016/S2468-1253(21)00014-5
Beck, A.T., Steer, R.A., & Brown, G.K., (1996). Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation. DOI: https://doi.org/10.1037/t00742-000
Boggatz, T., (2020). Person-centred care and quality of life. In: Quality of Life and Person-Centered Care for Older People. Springer, Cham. DOI: https://doi.org/10.1007/978-3-030-29990-3
Boldrini, T., Pontillo, M., Tanzilli, A., Giovanardi, G., Di Cicilia, G., Salcuni, S., Vicari, S., & Lingiardi, V., (2020). An attachment perspective on the risk for psychosis: clinical correlates and the predictive value of attachment patterns and mentalization. Schizophrenia research, 222, 209-217. doi: 10.1016/j.schres.2020.05.052. DOI: https://doi.org/10.1016/j.schres.2020.05.052
Bouwman, W., Verhaegh, W. & van de Stolpe, A., (2022). Improved diagnosis of inflammatory bowel disease and prediction and monitoring of response to anti-TNF alpha treatment based on measurement of signal transduction pathway activity. Frontiers in Pharmacology, 13, 1008976. doi: 10.3389/fphar.2022.1008976. DOI: https://doi.org/10.3389/fphar.2022.1008976
Bressi, C., Taylor, G., Parker, J., Bressi, S., Brambilla, V., Aguglia, E., Allegranti, I., Bongiorno, A., Giberti, F., Bucca, M., Todarello, O., Callegari, C., Vender, S., Gala, C., & Invernizzi, G., (1996). Cross validation of the factor structure of the 20-item Toronto Alexithymia Scale: an Italian multicenter study. Journal of Psychosomatic Research, 41(6), 551-559. doi: 10.1016/s0022-3999(96)00228-0. DOI: https://doi.org/10.1016/S0022-3999(96)00228-0
Cai, Z., Wang, S., & Li, J., (2021). Treatment of inflammatory bowel disease: a comprehensive review. Frontiers in Medicine, 8, 765474. doi: 10.3389/fmed.2021.765474 DOI: https://doi.org/10.3389/fmed.2021.765474
Carrozzino, D., & Porcelli, P., (2018). Alexithymia in gastroenterology and hepatology: a systematic review. Frontiers in Psychology, 9, 470. doi: 10.3389/fpsyg.2018.00470. DOI: https://doi.org/10.3389/fpsyg.2018.00470
Ciccocioppo, R., Klersy, C., Russo, M.L., Valli, M., Boccaccio, V., Imbesi, V., Ardizzone, S., Porro, G.B., & Corazza, G.R., (2011). Validation of the Italian translation of the Inflammatory Bowel Disease questionnaire. Digestive and liver disease: official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver, 43(7), 535-541. doi: 10.1016/j.dld.2010.12.014. DOI: https://doi.org/10.1016/j.dld.2010.12.014
Conversano, C., Di Giuseppe, M., & Lingiardi, V., (2023) Case report: changes in defense mechanisms, personality functioning, and body mass index during psychotherapy with patients with anorexia nervosa. Frontiers in Psychology, 14, 1081467. doi: 10.3389/fpsyg.2023.1081467. DOI: https://doi.org/10.3389/fpsyg.2023.1081467
Conversano, C., Di Giuseppe, M., Miccoli, M., Ciacchini, R., Di Silvestre, A., Lo Sterzo, R., Gemignani, A., & Orrù, G., (2020). Retrospective analyses of psychological distress and defense style among cancer patients. Clinical Neuropsychiatry, 17(4), 217-224. doi: 10.36131/cnfioritieditore20200403
Di Giuseppe, M., Orrù, G., Gemignani, A., Ciacchini, R., Miniati, M., & Conversano, C., (2022). Mindfulness and defense mechanisms as explicit and implicit emotion regulation strategies against psychological distress during massive catastrophic events. International Journal of Environmental Research and Public Health, 19, 12690. doi: 10.3390/ijerph191912690 DOI: https://doi.org/10.3390/ijerph191912690
Di Giuseppe, M., Prout, T. A., Fabiani, M., & Kui, T., (2020). Defensive profile of parents of children with externalizing problems receiving Regulation-Focused Psychotherapy for Children (RFP-C): A pilot study. Mediterranean Journal of Clinical Psychology, 8(2). doi: 10.6092/2282-1619/mjcp-2515.
Di Giuseppe, M., Perry, J.C., Prout, T.A., & Conversano, C., (2021). Editorial: Recent empirical research and methodologies in defense mechanisms: Defenses as fundamental contributors to adaptation. Frontiers in Psychology, 12, 802602. doi: 10.3389/fpsyg.2021.802602 DOI: https://doi.org/10.3389/fpsyg.2021.802602
Dorrian, A., Dempster, M., Adair, P., (2009). Adjustment to inflammatory bowel disease: the relative influence of illness perceptions and coping. Inflammatory bowel disease, 15(1), 47-55. doi: 10.1002/ibd.20583. PMID: 18626980. DOI: https://doi.org/10.1002/ibd.20583
Erkic, M., Bailer, J., Fenske, S. C., Schmidt, S. N. I., Trojan, J., & Schroder, A., (2018). Impaired emotion and a reduction in trust in patients with somatic symptom disorder. Clinical Psychology & Psychotherapy, 25, 163-172. doi: 10.1002/cpp.2151 DOI: https://doi.org/10.1002/cpp.2151
Fava, G.A., Tomba, E., & Sonino, N., (2012). Clinimetrics: the science of clinical measurements. International Journal of Clinical Practice, 66, 11-15. doi: 10.1111/j.1742-1241.2011. 02825. DOI: https://doi.org/10.1111/j.1742-1241.2011.02825.x
Foà, C., Tonarelli, A., Caricati, L., Fruggeri, L., (2015). COPE-NVI-25: validazione italiana della versione ridotta della Coping Orientation to the Problems Experienced (COPE-NVI). Psicologia della salute, 2, 123-140. doi:10.3280/PDS2015-002007. DOI: https://doi.org/10.3280/PDS2015-002007
Galli, F., Tanzilli, A., Simonelli, A., Tassorelli, C., Sances, G., Parolin, M., Cristofalo, P., Gualco, I., & Lingiardi, V., (2019). Personality and personality disorders in medication-overuse headache: a controlled study by SWAP-200. Pain Research & Management, 2019, 1874078. doi: 10.1155/2019/1874078 DOI: https://doi.org/10.1155/2019/1874078
Gandek, B., Ware, J.E., Aaronson, N.K., Apolone, G., Bjorner, J.B., Brazier, J.E., Bullinger, M., Kaasa, S., Leplege, A., Prieto, L., & Sullivan, M., (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1171–1178. doi: 10.1016/s0895-4356(98)00109-7. DOI: https://doi.org/10.1016/S0895-4356(98)00109-7
GBD 2017 Inflammatory Bowel Disease Collaborators, (2020). The global, regional, and national burden of inflammatory bowel disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology and Hepatology, 5(1):17-30. doi: 10.1016/S2468-1253(19)30333-4. DOI: https://doi.org/10.1016/S2468-1253(19)30333-4
Ge, Li., Liu, S., Li, S., Yang, J., Hu, G., Xu, C. & Song, W., (2022). Psychological stress in inflammatory bowel disease: Psychoneuroimmunological insights into bidirectional gut–brain communications. Frontiers in Immunology, 13:1016578. doi: 10.3389/fimmu.2022.1016578 DOI: https://doi.org/10.3389/fimmu.2022.1016578
Hamilton, M.A., (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32(1), 50-55. doi: 10.1111/j.2044-8341.1959.tb00467. DOI: https://doi.org/10.1111/j.2044-8341.1959.tb00467.x
Hardy, P.Y., Fikri, J., Libbrecht, D., Louis, E., & Joris, J., (2022). Pain characteristics in patients with inflammatory bowel disease: a monocentric cross-sectional study. J Crohns Colitis, 16(9), 1363-1371. doi:10.1093/ecco-jcc/jjac051. DOI: https://doi.org/10.1093/ecco-jcc/jjac051
Ihilevich, D., & Gleser, G.C. (1994). D.M.I. – Defense Mechanisms Inventory. Firenze: Organizzazioni Speciali.
Jordan, C., Sin, J., Fear, N.T., & Chalder, T., (2016). A systematic review of the psychological correlates of adjustment outcomes in adults with inflammatory bowel disease. Clinical Psychology Review, 47, 28-40. doi: 10.1016/j.cpr.2016.06.001. DOI: https://doi.org/10.1016/j.cpr.2016.06.001
Lazurus, R.S., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer.
Leone, D., Gilardi, D., Corrò, B.E., Menichetti, J., Vegni, E., Correale, C., Mariangela, A., Furfaro, F., Bonovas, S., Peyrin-Biroulet, L., Danese, S., & Fiorino, G. (2019). Psychological characteristics of inflammatory bowel disease patients: a comparison between active and nonactive patients. Inflammatory Bowel Diseases, 25(8), 1399-1407. doi: 10.1093/ibd/izy400. DOI: https://doi.org/10.1093/ibd/izy400
Lingiardi, V., Gazzillo, F., Colli, A., De Bei, F., Tanzilli, A., Di Giuseppe, M., Nardelli, N., Caristo, C., Condino, V., Gentile, D., & Dazzi, N. (2010). Diagnosis and assessment of personality, therapeutic alliance and clinical exchange in psychotherapy research. Research in Psychotherapy: Psychopathology, Process and Outcome, 2, 97-124. doi: 10.4081/ripppo.2010.36. DOI: https://doi.org/10.4081/ripppo.2010.36
Martino, G., Caputo, A., Schwarz, P., Bellone, F., Fries, W., Quattropani, M.C., & Vicario, C.M., (2020). Alexithymia and inflammatory bowel disease: a systematic review. Frontiers in Psychology, 11, 1763. doi: 10.3389/fpsyg.2020.01763. DOI: https://doi.org/10.3389/fpsyg.2020.01763
Mawdsley, J.E., & Rampton, D.S., (2005). Psychological stress in IBD: new insights into pathogenic and therapeutic implications. Gut, 54(10), 1481-1491. doi: 10.1136/gut.2005.064261. DOI: https://doi.org/10.1136/gut.2005.064261
Mowat, C., Cole, A., Windsor, A., Ahmad, T., Arnott, I., Driscoll, R., Mitton, S., Orchard, T., Rutter, M., Younge, L., Lees, C., Ho, G. T., Satsangi, J., Bloom, S., & IBD Section of the British Society of Gastroenterology, (2011). Guidelines for the management of inflammatory bowel disease in adults. Gut, 60(5), 571-607. doi: 10.1136/gut.2010.224154. DOI: https://doi.org/10.1136/gut.2010.224154
Mussell, M., Böcker, U., Nagel, N., & Singer, M.V., (2004). Predictors of disease-related concerns and other aspects of health-related quality of life in outpatients with inflammatory bowel disease. European Journal of Gastroenterology and Hepatology, l16(12), 1273-1280. doi: 10.1097/00042737-200412000-00007. DOI: https://doi.org/10.1097/00042737-200412000-00007
Perry, J.C., & Ianni, F.F. (1998). Observer-rated measures of defense mechanisms. Journal of Personality, 66(6), 993-1024. doi: 10.1111/1467-6494.00040. DOI: https://doi.org/10.1111/1467-6494.00040
Porcelli, P., De Carne, N., & Leandro, G. (2014). Alexithymia and gastrointestinal specific anxiety in moderate to severe irritable bowel syndrome. Comprehensive Psychiatry, 55, 1647-1653. doi: 10.1016/j.comppsych.2014.05.022. DOI: https://doi.org/10.1016/j.comppsych.2014.05.022
Porcelli, P., Leoci, C., Guerra, V., Taylor, G.J., & Bagby, R.M., (1996). A longitudinal study of alexithymia and psychological distress in inflammatory bowel disease. Journal of Psychosomatic Research, 41, 569-573. doi: 10.1016/S0022-3999(96)00221-8. DOI: https://doi.org/10.1016/S0022-3999(96)00221-8
Porcelli, P., Zaka S., Leoci, C., Centonze, S., & Taylor, G.J., (1995). Alexithymia in inflammatory bowel disease. A case control study. Psychotherapy and Psychosomatics, 64, 49-53. doi: 10.1159/000288990. DOI: https://doi.org/10.1159/000288990
Shafer, L.A., Walker, J.R., Restall, G., Chhibba, T., Ivekovic, M., Singh, H., Targownik, L.E., & Bernstein, C.N. (2019). Association between IBD disability and reduced work productivity (presenteeism): a population-based study in Manitoba, Canada. Inflammatory Bowel Diseases, 25(2), 352-359. doi: 10.1093/ibd/izy236. DOI: https://doi.org/10.1093/ibd/izy236
Silverman, J., & Aafjes-van Doorn, K., (2023). Coping and defense mechanims: a scoping review. Clinical Psychology: Science and Practice, in press. DOI: https://doi.org/10.1037/cps0000139
Sweeney, L., Moss-Morris, R., Czuber-Dochan, W., Meade, L., Chumbley, G., & Norton, C. (2018). Systematic review: psychosocial factors associated with pain in inflammatory bowel disease. Alimentary Pharmacology & Therapeutics, 47(6), 715-729. doi: 10.1111/apt.14493. DOI: https://doi.org/10.1111/apt.14493
Szigethy, E.M., Allen, J.I., Reiss, M., Cohen, W., Perera, L.P., Brillstein, L., Cross, R.K., Schwartz, D.A., Kosinski, L.R., Colton, J.B., LaRusso, E., Atreja, A., & Regueiro, M.D., (2017). White paper AGA: the impact of mental and psychosocial factors on the care of patients with inflammatory bowel disease. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association, 15(7), 986-997. doi: 10.1016/j.cgh.2017.02.037. DOI: https://doi.org/10.1016/j.cgh.2017.02.037
Taylor, G.J., (2000). Recent developments in alexithymia theory and research. Canadian Journal of Psychiatry, 45, 134-142. doi: 10.1177/070674370004500203. DOI: https://doi.org/10.1177/070674370004500203
Taylor, G.J., Bagby, R.M., & Parker, J.D., (1999). Disorders of affect regulation: alexithymia in medical and psychiatric illness. Cambridge: Cambridge University Press.
Taylor, G.J., Bagby, R.M., & Parker, J.D., (2003). The 20-Item Toronto Alexithymia Scale: IV. reliability and factorial validity in different languages and cultures. Journal of Psychosomatic Research, 55, 277–283. doi: 10.1016/S0022-3999(02) 00601-3. DOI: https://doi.org/10.1016/S0022-3999(02)00601-3
Triantafillidis, J.K., Merikas, E., & Gikas, A. (2013). Psychological factors and stress in inflammatory bowel disease. Expert Review of Gastroenterology & Hepatology, 7(3), 225-238. doi: 10.1586/egh.13.4. DOI: https://doi.org/10.1586/egh.13.4
Vicario, C.M., Nitsche, M.A., Salehienjad, M.A., Avanzino, L., & Martino, G., (2020). Time processing, interoception and insula activation: a mini review on clinical disorders. Frontiers in Psychology, doi: 10.3389/fpsyg.2020.01893. DOI: https://doi.org/10.3389/fpsyg.2020.01893
Viganò, C.A., Beltrami, M.M., Bosi, M.F., Zanello, R., Valtorta, M., & Maconi, G., (2018). Alexithymia and psychopathology in patients suffering from inflammatory bowel disease: arising differences and correlations to tailoring therapeutic strategies. Frontiers in Psychiatry 9:324. doi: 10.3389/fpsyt.2018.00324. DOI: https://doi.org/10.3389/fpsyt.2018.00324
Villoria, A., García, V., Dosa, A., Moreno, L., Montserrat, A., & Figuerola A., (2017). Fatigue in out-patients with inflammatory bowel disease: prevalence and predictive factors. PLoS ONE 12:e0181435. doi: 10.1371/journal.pone.0181435. DOI: https://doi.org/10.1371/journal.pone.0181435
Weber, R., Ehrenthal, J.C., Brock-Midding, E., Halbach, S., Würstlein, R., Kowalski, C., & Ernstmann, N. (2021). Defense mechanisms and repressive coping among male breast cancer patients. Frontiers in psychiatry, 12, 718076. doi: 10.3389/fpsyt.2021.718076. DOI: https://doi.org/10.3389/fpsyt.2021.718076
Viola, A., Demarzo, M.G., Abbruzzese, A., Muscianisi, M., Chiappetta, M.F., Costantino, G., Ksissa, O., Alibrandi A, Fries, W. (2023). Low adherence is associated with chronic active disease in Ulcerative Colitis: a retrospective study from a single referral center. Patient Preference and Adherence, in press. DOI: https://doi.org/10.2147/PPA.S390349

How to Cite

Martino, G., Viola, A., Vicario, C. M., Bellone, F., Silvestro, O., Squadrito, G., … Catalano, A. (2023). Psychological impairment in inflammatory bowel diseases: the key role of coping and defense mechanisms. Research in Psychotherapy: Psychopathology, Process and Outcome, 26(3). https://doi.org/10.4081/ripppo.2023.731

Similar Articles

1 2 3 4 5 6 7 8 9 10 > >> 

You may also start an advanced similarity search for this article.