Higher Levels of Psychological Burden and Alterations in Personality Functioning in Crohn's Disease and Ulcerative Colitis

Front Psychol. 2021 Jun 24;12:671493. doi: 10.3389/fpsyg.2021.671493. eCollection 2021.

Felicitas Engel 1, Sabrina Berens 1 2, Annika Gauss 3, Rainer Schaefert 1 4, Wolfgang Eich 1, Jonas Tesarz 1


Author information

  • 1Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
  • 2Institute of Psychology, Heidelberg University, Heidelberg, Germany.
  • 3Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany.
  • 4Division of Internal Medicine, Department of Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland.


Aims: Is there evidence for increased psychological distress and alterations in personality functioning in patients with Crohn's disease (CD) and ulcerative colitis (UC) compared to healthy controls (HCs)? Background: In patients with CD and UC, perceived stress is closely associated with changes in disease activity. The stress response is influenced by psychological burden and personality functioning, but only little is known about these factors in inflammatory bowel diseases (IBD). Study: A total of 62 patients with an endoscopic ensured CD/UC without remission (n = 31 per group) and 31 HC were included. Patients with an active CD/UC and HC were individually matched (n = 93, 31 per group) for age, sex, education, and disease activity. Depression and anxiety were assessed to evaluate the effect of psychological burden (Patient Health Questionnaire-9/PHQ-9, Generalized Anxiety Disorder-7/GAD-7). Personality functioning was measured by validated questionnaires for psychodynamic structural characteristics, mentalization, and attachment (Operationalized Psychodynamic Diagnosis-Structure Questionnaire/OPD-SQ, Mentalization Questionnaire/MZQ, and Experiences in Close Relationships scale/ECR-RD 12). Results: Levels of depression and anxiety were higher in CD/UC patients than in HC with large effect sizes. Comparing personality functioning in CD/UC with HC, psychodynamic structural characteristics differed between CD/UC and HC with medium effect sizes, with structural differences occurring primarily in the domain of self-perception and regulation. Only minor differences were found regarding mentalization and attachment. CD and UC differed only with small effect sizes. Conclusion: Our data show that compared to HC, patients with CD/UC are characterized by a higher level of psychological burden and structural alterations in the domain of self.



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