Defense mechanisms in inflammatory bowel disease

Although psychiatric disturbances and personality features are possibly involved in inflammatory bowel disease, little attention has been given to the potential role of defense mechanisms in the formation, course, or prognosis of the disease. The purpose of the present study was to determine whether certain defense styles and ego mechanisms of defense are associated with inflammatory bowel disease, including both ulcerative colitis and Crohn's disease. Seventy-six consecutive unselected outpatients participated in the study. The sample consisted of 39 patients with Crohn's disease, 33 with ulcerative colitis, and 4 with an intermediate form of inflammatory bowel disease. The Symptom Distress Checklist (SCL-90-R), Defense Style Questionnaire (DSQ), and Hostility and Direction of Hostility Questionnaire (HDHQ) were used. Crohn's disease patients presented a more immature defensive profile than ulcerative colitis patients, using a "maladaptive action" style, as well as "consumption" and "pseudo-altruism" defense mechanisms more often. These differences were statistically significant and they were independent of age, sex, educational level, disease extension, and pharmacologic treatment. A significant positive correlation was also found between disease activity and defensive profiles in both ulcerative colitis and Crohn's disease patients. In contrast, there was no statistically significant difference between ulcerative colitis and Crohn's disease patients in terms of psychiatric symptoms. Crohn's disease patients presented a different and more immature defensive profile than patients with ulcerative colitis. In addition, the more psychologically mature inflammatory bowel disease patients had lower rates of relapses and surgical operations, providing evidence that these aspects of personality are likely to influence the patients' adaptation to the disease.