Abstract
Purpose
Inflammatory bowel diseases (IBD) are chronic disorders affecting psychological well-being, quality of life (QOL), social interactions, and close interpersonal relationships of patients affected. The attachment theory provides a theoretical framework to evaluate the quality of close interpersonal relationships in the context of chronic disorders. The aims of this study were to compare the attachment dimensions between IBD patients and healthy controls and to evaluate the impact of these dimensions on QOL in IBD patients.
Methods
One hundred three consecutive IBD outpatients (70 with Crohn’s disease and 33 with ulcerative colitis) were recruited in the IBD Unit of the University of Bologna. They were clinically evaluated and filled out the questionnaire Short Form health survey-36 (SF-36), assessing QOL, and the attachment style questionnaire (ASQ), assessing attachment dimensions. One hundred three matched healthy subjects filled out the same questionnaires and represented the control group.
Results
IBD patients exhibited worst scores in the QOL measures (both physical and mental health) and in the attachment dimensions Relationships as secondary and Preoccupation with relationships. In IBD, the significant predictors of physical health were disease activity and disease type, while the significant predictors of mental health were disease activity and type, surgery, and the attachment dimensions Confidence and Preoccupation with relationships.
Conclusions
Compared to controls, in IBD patients, the close interpersonal relationships are characterized by attachment insecurity that, in turn, is a significant predictor of QOL. These findings suggest plausible insights for psychological interventions in IBD patients with deterioration in QOL.
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References
Lix LM, Graff LA, Walker JR et al (2008) Longitudinal study of quality of life and psychological functioning for active, fluctuating, and inactive disease patterns in inflammatory bowel disease. Inflamm Bowel Dis 14:1575–1584. doi:10.1002/ibd.20511
Pizzi LT, Weston CM, Goldfarb NI et al (2006) Impact of chronic conditions on quality of life in patients with inflammatory bowel disease. Inflamm Bowel Dis 12:47–52
Janke K-H, Raible A, Bauer M et al (2004) Questions on life satisfaction (FLZM) in inflammatory bowel disease. Int J Colorectal Dis 19:343–353. doi:10.1007/s00384-003-0522-z
Agostini A, Rizzello F, Ravegnani G et al (2010) Parental bonding and inflammatory bowel disease. Psychosomatics 51:14–21
Agostini A, Rizzello F, Ravegnani G et al (2010) Adult attachment and early parental experiences in patients with Crohn’s disease. Psychosomatics 51:208–215
Fonagy P, Luyten P (2009) A developmental, mentalization-based approach to the understanding and treatment of borderline personality disorder. Dev Psychopathol 21:1355–1381. doi:10.1017/S0954579409990198
Stein H, Koontz AD, Fonagy P et al (2002) Adult attachment: what are the underlying dimensions? Psychol Psychother 75:77–91
Brennan KA (1988) Self report measurement of adult attachment: an integrative overview. In Simpson JA, Eholes WS editors Attachment theory and close relationships. Guilford press, New York, 46–76 pp
Nolte T, Guiney J, Fonagy P et al (2011) Interpersonal stress regulation and the development of anxiety disorders: an attachment-based developmental framework. Front Behav Neurosci 5:55. doi:10.3389/fnbeh.2011.00055
Sbarra DA, Hazan C (2008) Coregulation, dysregulation, self-regulation: an integrative analysis and empirical agenda for understanding adult attachment, separation, loss, and recovery. Personal Soc Psychol Rev 12:141–167. doi:10.1177/1088868308315702
Mikulincer M, Shaver PR (2010) Attachment in adulthood: structure, dynamics, and change (Google eBook)
Bifulco A, Moran PM, Ball C, Lillie A (2002) Adult attachment style: II. Its relationship to psychosocial depressive-vulnerability. Soc Psychiatry Psychiatr Epidemiol 37:60–67
Meredith PJ, Strong J, Feeney JA (2006) The relationship of adult attachment to emotion, catastrophizing, control, threshold and tolerance, in experimentally-induced pain. Pain 120:44–52
Meredith PJ, Strong J, Feeney JA (2007) Adult attachment variables predict depression before and after treatment for chronic pain. Eur J Pain 11:164–170. doi:10.1016/j.ejpain.2006.01.004
Meredith P, Strong J, Feeney JA (2006) Adult attachment, anxiety, and pain self-efficacy as predictors of pain intensity and disability. Pain 123:146–154. doi:10.1016/j.pain.2006.02.025
Ciechanowski PS, Katon WJ, Russo JE, Walker EA (2001) The patient-provider relationship: attachment theory and adherence to treatment in diabetes. Am J Psychiatry 158:29–35
Feeney JA (2000) Implications of attachment style for patterns of health and illness. Child Care Health Dev 26:277–288
Maunder RG, Hunter JJ (2012) A prototype-based model of adult attachment for clinicians. Psychodyn Psychiatry 40:549–573. doi:10.1521/pdps.2012.40.4.549
Maunder RG, Hunter JJ (2009) Assessing patterns of adult attachment in medical patients. Gen Hosp Psychiatry 31:123–130. doi:10.1016/j.genhosppsych.2008.10.007
Iglesias-Rey M, Barreiro-de Acosta M, Caamaño-Isorna F et al (2014) Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease. Inflamm Bowel Dis 20:92–102. doi:10.1097/01.MIB.0000436955.78220.bc
Stjernman H, Grännö C, Järnerot G et al (2008) Short health scale: a valid, reliable, and responsive instrument for subjective health assessment in Crohn’s disease. Inflamm Bowel Dis 14:47–52. doi:10.1002/ibd.20255
Nordin K, Påhlman L, Larsson K et al (2002) Health-related quality of life and psychological distress in a population-based sample of Swedish patients with inflammatory bowel disease. Scand J Gastroenterol 37:450–457. doi:10.1080/003655202317316097
Clearfield HR (2008) How does IBD affect quality of life? Inflamm Bowel Dis 14(Suppl 2):S45–S46. doi:10.1002/ibd.20556
Thirlby RC, Sobrino MA, Randall JB (2001) The long-term benefit of surgery on health-related quality of life in patients with inflammatory bowel disease. Arch Surg 136:521–527
Best WR, Becktel JM, Singleton JW, Kern F (1976) Development of a Crohn’s disease activity index. National Cooperative Crohn’s Disease Study. Gastroenterology 70:439–444
Farup PG, Hinterleitner TA, Lukáš M et al (2001) Mesalazine 4 g daily given as prolonged-release granules twice daily and four times daily is at least as effective as prolonged-release tablets four times daily in patients with ulcerative colitis. Inflamm Bowel Dis 7:237–242
Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36) I. Conceptual framework and item selection. Med Care 30:473–483
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. doi:10.1002/ibd.20462
Wang JY, Hart SL, Wilkowski KSY et al (2011) Gender-specific differences in pelvic organ function after proctectomy for inflammatory bowel disease. Dis Colon Rectum 54:66–76. doi:10.1007/DCR.0b013e3181fd48d2
Sperling MB, Berman WH (1994) Attachment in adults: clinical and developmental perspectives. Guilford Press, New York, 360 pp
Maunder RG, Hunter JJ (2008) Attachment relationships as determinants of physical health. J Am Acad Psychoanal Dyn Psychiatry 36:11–32. doi:10.1521/jaap.2008.36.1.11
Ercolani M, Farinelli M, Agostini A et al (2010) Gastroesophageal reflux disease (GERD) and inflammatory bowel disease (IBD): attachment styles and parental bonding. Percept Mot Skills 111:625–630
Farinelli M, Ercolani M, Trombini G, Bortolotti M (2007) Gastroesophageal reflux disease: alexithymia and attachment style. Percept Mot Skills 105:347–350
Agostini A, Filippini N, Cevolani D et al (2011) Brain functional changes in patients with ulcerative colitis: a functional magnetic resonance imaging study on emotional processing. Inflamm Bowel Dis 17:1769–1777. doi:10.1002/ibd.21549
Agostini A, Benuzzi F, Filippini N et al (2013) New insights into the brain involvement in patients with Crohn’s disease: a voxel-based morphometry study. Neurogastroenterol Motil 25:147–e82. doi:10.1111/nmo.12017
Agostini A, Filippini N, Benuzzi F et al (2013) Functional magnetic resonance imaging study reveals differences in the habituation to psychological stress in patients with Crohn’s disease versus healthy controls. J Behav Med 36:477–487. doi:10.1007/s10865-012-9441-1
Muller KR, Prosser R, Bampton P et al (2010) Female gender and surgery impair relationships, body image, and sexuality in inflammatory bowel disease: patient perceptions. Inflamm Bowel Dis 16:657–663. doi:10.1002/ibd.21090
Larson DW, Pemberton JH (2004) Current concepts and controversies in surgery for IBD. Gastroenterology 126:1611–1619
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Agostini, A., Moretti, M., Calabrese, C. et al. Attachment and quality of life in patients with inflammatory bowel disease. Int J Colorectal Dis 29, 1291–1296 (2014). https://doi.org/10.1007/s00384-014-1962-3
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DOI: https://doi.org/10.1007/s00384-014-1962-3