In the preceding chapter, the putative effects of psychosocial factors on the cause or exacerbation of Crohn 's disease as well as the psychosocial concomitant factors of the disorder are discussed In this chapter, the psychosocial impact of Crohn's disease and its measurements are reviewed. The distinction relating to cause and effect, however, is made for convenience; from a systems or biopsychosocial perspective, these factors mutually interact
For the most part, clinicians and investigators have learned that the physical examination, laboratory studies, pathology reports, and endoscopic and radiological fmdings do not adequately explain the patient's experience and behavior in the face of illness. Two patients with ileitis may have the same degree of inflammation and the same size stricture of the ileum, yet they respond quite differently. One person may be disabled with chronic pain, and the other may only note an occasional ache, not worthy of further consideration. One may be paralyzed with fears, and the other may ignore them. One may feel helpless and victimized, and the other may seem in full control and able to get on with life. Although symptoms are frequently attributed directly to the degree of pathological change or disease activity, this concept is somewhat simplistic and does not explain the wide range of responses among persons to other medical diseases such as cancer, arthritis, or acquired immunodeficiency syndrome (AIDS). The combination of attributes and behaviors related to illness is unique for every individual and results from several psychosocial factors (a) sociocultural influences that shape attitudes beginning early in life, (b) predisposing psychiatric or personality traits, (c) previous experiences with medical illness, (d) current psychological state (e.g., anxious or sad), and (e) the social network and coping strategies that can "buffer" adverse experiences ( 1 ). These factors are particularly important for chronic disorders such as Crohn 's disease (2).