Digestive Diseases and Sciences

, Volume 47, Issue 9, pp 2082–2087

Psychological Dimensions of Celiac Disease: Toward an Integrated Approach

  • Carolina Ciacci
  • Alessandro Iavarone
  • Monica Siniscalchi
  • Rita Romano
  • Antonio De Rosa
Article

Abstract

Psychic alterations have been reported in celiac disease. Our aim was to evaluate the emotional impact of celiac disease diagnosis in adulthood, the patient/doctor relationship, and the patients' cooperation with disease treatment and diet. The patients were 114 adult celiac patients on a gluten-free diet, there were 25 untreated celiac patients. Self-administered questionnaires aimed to evaluate the patients' level of knowledge of disease, the emotional impact at diagnosis, and feelings during follow-up. Celiac patients showed good knowledge of the disease, directly correlated to their socioeconomic level (P = 0.011). At diagnosis, relief was most intense feeling (Mean ± SD, 10.82 ± 7.63), demographics, time latency of diagnosis, and the duration of the disease had no effect on the intensity of all feelings. The scores of the self-rated emotions were entered into a principal component analysis that generated three factors: 1 (fear, anger, anxiety and sadness), 2 (reassurance and resignation), and 3 (relief); patients judged the clinicians presenting the disease “in the right way” (F = 33.279; P < 0.0001). The right way correlated with relief and reassurance (P = 0.0009; P = 0.0008 respectively). At follow-up, anger was the predominant emotion that induced patients to transgress. A positive correlation was observed between feeling different and the sadness, anger, fear (P < 0.0001 for all). Anger was inversely correlated with actual compliance to diet (P = 0.0005). In conclusion, in adult patients, adaptive and psychological aspects must be taken into account to understand the celiac patient and for better clinical management.

celiac disease follow-up psychology emotional impact intestine gluten-free diet adults 

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REFERENCES

  1. 1.
    Cooke WT, Holmes GKT: Celiac Disease. Edinburgh, Churchill Livingstone; 1984, pp. 157–160Google Scholar
  2. 2.
    Marsh MN: Celiac Disease. Oxford, Blackwell Scientific Publications, 1992Google Scholar
  3. 3.
    Corazza GR, Frisoni M, Treggiari EA, Valentini RA, Filipponi C, Volta U, Gasbarrini G: Subclinical celiac sprue: Increasing occurrence and clues to its diagnosis. J Clin Gastroenterol 16:16–21, 1993Google Scholar
  4. 4.
    Ciacci C, Cirillo M, Sollazzo R, Savino G, Sabbatini F, Mazzacca G: Gender and clinical presentation in adult celiac disease. Scand J Gastroenterol 30:1077–1081, 1995Google Scholar
  5. 5.
    Catassi C, Ratsch IM, Fabiani E, Bordicchia F, Candela F, Coppa GV, Giorgi PL: Celiac disease in the year 2000: exploring the iceberg. Lancet 343:200–203, 1994Google Scholar
  6. 6.
    Hallert C, Derefeldt T: Psychic disturbances in adult celiac disease. I. Clinical observations. Scand J Gastroenterol 17(1):17–19, 1982Google Scholar
  7. 7.
    Hallert C, Astrom J: Psychic disturbances in adult celiac disease II. Psychological findings. Scand J Gastroenterol 17(1):21–24, 1982Google Scholar
  8. 8.
    Hallert C, Astrom J, Sedvall G: Psychic disturbances in adult celiac disease. III. Reduced central monoamine metabolism and signs of depression. Scand J Gastroenterol 17(1):25–28, 1982Google Scholar
  9. 9.
    Hernanz A, Polanco I: Plasma precursor amino acids of central nervous system monoamines in children with celiac disease. Gut 32(12):1478, 1991Google Scholar
  10. 10.
    Goldberg D: A psychiatric study of patients with diseases of the small intestine. Gut 11(6):459–465, 1970Google Scholar
  11. 11.
    Pellegrino M, D'Altilia MR, Germano M: Untreated celiac disease and attempted suicide. Lancet 346(8979):915, 1995Google Scholar
  12. 12.
    Ciacci C, De Rosa A, de Michele G, Savino G, Squillante A, Iovino P, Sabbatini F, Mazzacca G: Sexual behaviour in untreated and treated celiac patients. Eur J Gastroenterol Hepatol 10(8):649–651, 1998Google Scholar
  13. 13.
    Addolorato G, Stefanini GF, Capristo E, Caputo F, Gasbarrini A, Gasbarrini G: Anxiety and depression in adult untreated celiac subjects and in patients affected B inflammatory bowel disease: A personality “trait” or reactive illness? Heptogastroenterology 43(12):1513–1517, 1996Google Scholar
  14. 14.
    Corvaglia L, Catamo R, Pepe G, Lazzari R, Corvaglia E: Depression in adult untreated celiac subjects: Diagnosis by the pediatrician. Am J Gastroenterol 94(3):839–843, 1999Google Scholar
  15. 15.
    Kokkonen J, Viitanen A, Simila S: Coping with a celiac diet after adolescence. Helv Pediatr Acta 43:261–265, 1989Google Scholar
  16. 16.
    Bentley AC: A survey of celiac-sprue patients: Effect of dietary restrictions on religious practices. J Gen Psychol 115(1):7–14, 1988Google Scholar
  17. 17.
    Hallert C, Grännö C, Grant C, Hultén G, Midaghen G, Strö M, Svensson H, Valdimarsson T, Wickström T: Quality of life of adult celiac patients treated for 10 years. Scand J Gastroenterol 33:933–938, 1998Google Scholar
  18. 18.
    Hallert C, Lohiniemi S: Quality of life of celiac patients living on a gluten-free diet Nutrition 15(10):795–797, 1999Google Scholar
  19. 19.
    Ciacci C, Iavarone A, Mazzacca G, De Rosa A: Depressive symptoms in adult celiac disease. Scand J Gastroenterol 33(3):247–250, 1998Google Scholar
  20. 20.
    Drossman DA, McKee DC, Sandler RS, Mitchell CM, Cramer EM, Lowman BC, et al: Psychosocial factors in the irritable syndrome. A multivariate study of patients and and nonpatients with irritable bowel syndrome. Gastroenterology 95:709–714, 1998Google Scholar
  21. 21.
    Pilowsky I, Spence ND: Patterns of illness behaviour in patients with intractable pain. J Psychosom Res 19:279–287, 1975Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Carolina Ciacci
    • 1
  • Alessandro Iavarone
    • 2
  • Monica Siniscalchi
    • 3
  • Rita Romano
    • 1
  • Antonio De Rosa
    • 4
  1. 1.Cattedra di GastroenterologiaUniversità di Napoli “Federico II”NaplesItaly
  2. 2.Divisione di Neurologia–Ospedale CTO, Azienda Sanitaria Locale Napoli 1, Naples, Italy. Corso di Laurea in PsicologiaII Università di NapoliNaples, Italy
  3. 3.Corso di Laurea in PsicologiaII Università di NapoliNaplesItaly
  4. 4.Servizio di PsicoterapiaSeconda Università di NapoliNaplosItaly

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