Disease course, stress, attachment, and mentalization in patients with inflammatory bowel disease
Disease course, stress, attachment, and mentalization in patients with inflammatory bowel disease
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DOI：
10.1016/j.mehy.2020.109665
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发表时间：
2020-07-01
影响因子：
4.7
通讯作者：
Agostini, Alessandro
中科院分区：
文献类型：
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作者：
Colonnello, Valentina;Agostini, Alessandro
炎症性肠病 (IBD)，包括克罗恩病和溃疡性结肠炎，是需要终生治疗的慢性肠道疾病。 IBD 与感知压力、生活质量差和精神病理障碍有关。先前的研究表明，心理困扰和抑郁是 IBD 的危险因素。另一方面，IBD 本身也可能是心理压力的一个来源。 IBD 对个人的日常社交互动和密切的人际关系产生负面影响。尽管 IBD 对生活质量产生不利影响，但患者对药物的依从性仍然很低，增加了复发和随后临床状况恶化的风险。利用依恋和心智化理论，我们的目标是帮助理解 IBD 患者社会关系质量差和不依从药物的倾向所涉及的机制。我们假设IBD与依恋风格和相关心智化能力之间存在双向联系，其中个体的依恋风格是指与自我和他人相关的复杂且特有的模式，而心智化是指推断自己和他人的精神和身体状态的过程。 IBD 与不安全依恋风格之间的这种假设联系（由心智化能力降低介导）可能是发生 IBD 相关心理障碍和药物依从性降低的危险因素，从而可能导致疾病管理和病程预后恶化。药物依从性在这里被认为既是这种恶性循环的结果，也是危险因素。我们同意这样的观点：通过考虑 IBD、依恋和心理化之间的循环关系，并通过从疾病发作时起促进 IBD 患者的反思功能，可以防止 IBD 病情恶化并促进患者的药物依从性。
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, are chronic intestinal disorders that requires lifelong treatments. IBD are associated with perceived stress, poor quality of life, and psychopathological disorders. Previous studies have documented that psychological distress and depression are risk factors for IBD. On the other hand, IBD itself might be a source of psychological stress. IBD negatively affect individuals' daily social interactions and close interpersonal relationships. Despite IBD's detrimental effects on quality of life, patients' adherence to medicaments remains low, increasing the risk of relapses and the subsequent worsening of the clinical condition.Drawing on attachment and mentalization theories, we aim to contribute to understanding of the mechanisms involved in the poor quality of social relationships and the tendency for medication non-adherence in patients with IBD. We hypothesize a bidirectional link between IBD and attachment style and related mentalization abilities, where an individual's attachment style refers to a complex and characteristic pattern of relating to self and others and mentalization refers to the process of inferring one's own and others' mental and physical states. This hypothesized link between IBD and insecure attachment style, mediated by reduced mentalizing abilities, may be a risk factor for developing both IBD-related psychological disorders and reduced medication adherence, which could then lead to worsening disease management and prognoses for the disease course. The medication nonadherence is here considered as both an outcome and a risk factor of this vicious circle.We share the view that preventing the worsening of the IBD condition and promoting patients' medication adherence would be possible by considering the circular relationship between IBD, attachment, and mentalization and by promoting reflective functioning in patients with IBD, from the onset of the disease.