Psychological factors and inflammatory bowel disease: A review of a decade of literature

The present review examines the English-language literature published between the years 1990 and 2000 concerning psychological factors and their relationship with the course of Inflammatory bowel disease (IBD). The literature is concerned with: (1) the relationship between psychological stress and symptom exacerbation or relapse in patients with IBD; (2) the relationship between psychological distress (anxiety, depression) and symptomatology of IBD; and (3) the impact of psychological treatment of IBD. Methodology of the studies was critically examined and two main conclusions are made. First, there is a trend emerging such that daily hassles are more significantly associated with exacerbation of symptoms in IBD than major life events. The second conclusion, which is less secure as a result of a lack of appropriate research, is that such increases in disease activity appear to influence mood and this is demonstrated in the intensity of anxiety and depression experienced by participants. It is, therefore, tentatively suggested that a bi-phasic process is evident where perceived stress, typically in the form of daily hassles, increases disease activity which in turn induces psychological distress in IBD patients. The implications of the findings are discussed with reference to future research methodology.