Ulcerative colitis gets emotional shake-up.

Ulcerative colitis gets emotional shake-up

A research review casts doubt on the popular assumption that ulcerative colitis stems largely from emotional disorders and traumas. Methodological flaws have marred most investigations of the emotional link, and the few studies that do withstand scrutiny suggest that ulcerative colitis is in fact not a "psychosomatic" disorder, according to a report in the August AMERICAN JOURNAL OF PSYCHIATRY.

"We may locate a psychosomatic association for ulcerative colitis in the future, but the best studies so far don't find one," says psychiatrist and project director Carol S. North of Washington University School of Medicine in St. Louis.

She and her colleagues reviewed all known English-language studies of links between emotional factors and ulcerative colitis, a severe, recurring inflammation of the large intestine and rectum. Among a total of 138 investigations dating back to the 1930s, only seven used "reasonably adequate" research methods, the St. Louis scientists maintain. Flaws included small, nonrandom samples, lack of control groups or comparisons with other chronic medical conditions, and absence of reliable psychiatric diagnoses.

The seven methodologically sound studies -- conducted between 1973 and 1987 -- revealed that psychiatric problems and traumatic losses, such as divorce or death of a loved one, occurred no more often among ulcerative colitis patients than among healthy individuals or people with other gastrointestinal illnesses. Only one of the four studies evaluating enduring personality features, such as anxiety or irritability, suggested a link to ulcerative colitis.

Researchers have yet to conduct a prospective study of traumatic events among ulcerative colitis patients, North says.

She notes that medical patients frequently suffer from psychiatric disorders -- particularly depression -- as a result of their physical conditions. Gastroenterologist Ray E. Clouse, who coauthored the new report, says the review indicates "psychiatric factors may play a role in the course, not the causation, of ulcerative colitis." The specific physiological causes of ulcerative colitis remain unknown, he adds.

Some psychosomatic theories, such as the view that ulcerative colitis reflects repressed rage, elude verification with scientific methods, North says. For now, she concludes, proposed psychological causes of the illness find no systematic support.