Abstract:
 |
Ulcerative colitis and Crohn's disease are two chronic inflammatory
bowel disorders of unknown ethiology and unpredictable evolution that usually result in
diarrhoea and /or abdominal pain sometimes associated with fever, weight loss and other
extra-intestinal symptoms. Specialised literature often reports the main role of
psychosocial factors in the breaking out and evolution of this disease. These factors,
that clinically and subjectively seem utterly important, in some ways nevertheless remain
untouched by a methodological and systematic investigation, as their results seem
contradictory, uncertain and not at all specific.
This work was designed to approach this set of problems through a global and integrated
model of psychosocial exploration, in order to pursue some specificity of the
psychological and social phenomena as they may be present in the chronic inflammatory
bowel disease(s). The study was meant to relate the intensity of the symptoms with the
adaptation towards them as a function of the personality and of the simultaneous
psychosocial events. The last goal was to achieve one or more discriminatory patterns of
behavioural and situational variables that would prove to be somehow specific, or at least
characteristic of such adaptation from these patients.
Bearing this intent in mind we first noted that these patients' personality tends to come
out of the C cluster (DSM), and that it could be peculiarly described as characterised by
the avoidance of potentially harmful situations. And the more outstanding the harm
avoidance it may be, the more dysfunctional the respective family can be recognised.
However, more than any idiosyncrasy from these patients, what comes out from this study is
a possible association of a noxious action, or on the contrary propitiator of a better
quality of life, that some aspects may assume whenever actually present. And we place in
such a context the behavioural style, that we would say "toxic", characterised
by resorting to coping strategies of escape / avoidance; such a style is related with an
external locus of control and may be found among the alexithymics and/or the more
dysphoric: anxious, depressed, irritable. On the contrary, thus clearly opposing to
alexithymia and dysphoria, stands out the group characterised by an internal locus of
control, the sub-group that resorts to emotional control. And this in so far as it has the
particularity of not to resort to strategies such as seeking support, what can also prove
to be rather inadequate, such as, postponing a clinical intervention that should be
otherwise considered necessary. Except for a more prominent anxiety observed among women
with ulcerative colitis, we found no significant differences between the nosographic
groups in relation to the considered psycho-affective variables. The main discrepancies
towards the observed variables between the two involved nosographic groups are essentially
summarised by a difference of ten years less in the age / age of first outburst for
Crohn's disease, as well as a much more use of health services in the part of these
patients.
With a more active disease we can also notice, naturally, a bigger number of physician's
visits in the last 6 months, but a lesser number of hospitalisation days in the last year.
Also related with patients with a more active expression of their disease, and for both
nosographic groups, we can observe that they have been submitted to a higher stressfulness
due to a bigger sum of adaptive demands in the last year. As in the case of alexithymia,
among with other characteristics that also get more evident along with morbidity, if on
one hand it doesn't properly collide with the stability of the trace required by the
construct - in their independence towards other socio-demographic variables -, it comes on
the other hand to suggest some secondary reinforcement.
We do have to understress as already noted, and for both nosographic groups, the bigger
number of adaptive demands considered of an important kind during the last year among
patients with a more active expression of their disease. Furthermore, such a situation of
accumulated stress as it may result from environmental factors, more than in the disease
activity itself, it comes to disclose a worst quality of life. We also have to emphasise
on this matter the positive correlation of this summation of life events with dysphoria -
depression and anger in particular - and difficulty identifying feelings, and with a
lesser emotional control.
In relation with the inflammatory bowel diseased patients functional status and well
being, and thus with what has been called health related quality of life, we can say
according to the final considerations that an external locus of control / chance prevents
planful problem-solving. While an internal locus promotes confrontive coping, seeking
social support, accepting responsibility, planful problem-solving, and positive
reappraisal, preventing inadequate solutions of escape-avoidance type. These assume a
particular importance in dysphoric situations - anxiety, depression, anger -, while
positive affects are more related with seeking social support, planful problem-solving and
confrontive coping. Alexithymia in turn has a significant inverse relation with the
aforementioned positive affects, as well as with sensation seeking, what is mainly due to
the also mentioned bigger anxiety apparent when there is a bigger difficulty in
identifying feelings. As a matter of the fact, be it the difficulty in identifying
feelings, or else to describe them, they have an inverse relation with positive affects,
but only the difficulty in identifying feelings prevents the coming into operation of
mechanisms intended to reduce or else to resolve negative feelings. To a better quality of
life among these patients we would then say that it corresponds naturally a less active
disease, but also clearly an internal locus of control, lesser alexithymia / difficulty
identifying feelings, and less dysphoria. |
