Eating-related psychological burden and self-concordance in adults with inflammatory bowel disease: an online cross-sectional survey

Food-related quality of life, food avoidance, fear of food, and restrictive eating are increasingly recognized in inflammatory bowel disease (IBD), but the emotional and motivational processes surrounding everyday dietary decisions remain less well characterized. Eating-related psychological burden and self-concordance were examined in adults with IBD, together with exploratory refinement of a theory-informed item pool. A cross-sectional online survey was conducted among adults with self-reported, physician-confirmed IBD. After an eligibility review, 304 complete responses were analyzed. Exploratory factor analysis (EFA) of the initial 68-item pool was performed using polychoric correlations, minimum-residual extraction, and oblique rotation. A 25-item, five-factor exploratory solution was retained. Internal consistency was assessed using Cronbach’s alpha and McDonald’s omega; associations were examined with FDR correction. The analytic sample included 184 respondents recruited through Hungarian and 120 through international channels. The EFA-derived domains were guilt, social stress, dietary conflict and frustration, uncertainty, and self-concordance. Primary factor loadings in the final solution ranged from 0.61 to 0.92. The four burden domains were positively intercorrelated ( r = 0.30–0.54; all FDR-adjusted p < 0.001), whereas self-concordance was not significantly correlated with any burden domain after FDR correction. No Crohn’s disease-versus-ulcerative colitis or sex difference remained significant after FDR correction. Disease-duration analyses were exploratory because duration was collected categorically. Eating-related psychological burden in IBD comprises related emotional, social, and uncertainty-related experiences. In this sample, self-concordance showed no statistically significant linear correlation with the burden domains after correction for multiple testing; this should not be interpreted as established discriminant validity. The 25-item EFA-derived questionnaire is exploratory and requires independent confirmatory validation in a clinically characterized cohort.