A close relationship has been found between ulcera-tive and Crohn's colitis and psychological distress. Patients with active colitis showed higher scores for psychological distress, obsessive-compulsive symptoms, depression, phobic anxiety and psychosis . Why some patients with IBD have long periods of quiescence whereas others have frequent relapses remains an enigma: does major stress play a role in influencing clinical episodes? The results of a prospective study carried out in 124 IBD patients seem to support this hypothesis: stress-exposed subjects demonstrated increased risk of clinical episodes of disease when compared with unexposed subjects . Therefore, psychological stress may favour recurrences, and surgeons should be aware of that when discharging their patients after an operation for Crohn's disease.
Generally speaking, psychosomatic disorders, i.e. the onset of a disease involving the "target" organ, in this respect colitis, is the most frequent response to a stressful event or situation, the others being pathological behaviours such as alcoholism or drug dependence, psychosis, anxiety, depression or, the most unlikely, a structured cognitive and sensitive response leading to recovery of bodily and mental health. The aim of the surgeon, aided by the psychologist and/or psychiatrist, and, of course, by the gastroenterologist, is to make the patient well aware of his/her "brain-body" global disorder and remove the "target "organ only when indicated while adequately treating and modifying the related PNEI pattern, if altered. Most IBD patients have alexithymia and do not dream during sleep, or at least they do not remember their dreams, thus showing that the unconscious emotions are not likely to be adequately felt, processed and cleared and therefore might perhaps trigger a pathological visceral response.
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