Psychosomatic Medicine 30:255-276 (1968)
© 1968 American Psychosomatic Society

The Response to Psychotherapy in Chronic Ulcerative Colitis

I. Pretreatment Factors

¹ Psychoanalytic Clinic for Training and Research, Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, N. Y.

The outcome of psychotherapeutic treatment of 30 patients with chronic ulcerative colitis was compared with 6 pretreatment factors: psychiatric diagnosis, precipitating stress, psychologic defenses, nature of object attachments, secondary elaboration of colitis symptoms, and ego strength. Somatic and psychologic states were reevaluated 1-11 years after the end of psychotherapy.

Schizophrenia nearly doubled the likelihood of a poor prognosis for the colitis. Precipitating stress was frequently reported but was more common in nonpsychotic patients. There were no defenses characteristic of colitis although every patient showed a significant degree of regression. Chronic hostility coexisted with anxiety about loss of control. Patients with depression mixed with paranoid distrust had a poorer prognosis than did those with reactive depression to loss of an important dependency object. Secondary gain from the illness perpetuated the colitis and worsened the prognosis.

Patients with strong symbiotic needs and attitudes of passive helplessness had a poorer prognosis than those who tried to remain active and relatively independent. Severe ego impairment almost always led to a poor prognosis although ego weakness did not necessarily prevent somatic improvement. Patients who began treatment with greater ego strength, however, had complete remissions of their colitis for as long as 11 years.