Introduction
Psychological comorbidities such as anxiety and depression are common in patients with inflammatory bowel disease (IBD). Alexithymia, defined by difficulty in identifying and describing emotions, may increase symptom perception and impact disease outcomes. Its relationship with psychological distress and clinical activity remains unclear, particularly across IBD phenotypes.
Aims & Methods
This study aimed to explore the correlations between alexithymia, clinical variables, and psychopathological symptoms in patients with inflammatory bowel disease (IBD), and to compare profiles between Crohn’s disease (CD) and ulcerative colitis (UC). Patients aged 18–70 years with confirmed CD or UC were recruited from outpatient and day-hospital settings. Exclusion criteria included diagnosed psychiatric or neurological disorders, malignancy, or recent head trauma. Participants completed the Toronto Alexithymia Scale (TAS- 20), the Symptom Checklist-90-Revised (SCL-90-R) for psychological distress, and the Hospital Anxiety and Depression Scale (HADS), including both anxiety (HADS-A) and depression (HADS-D) subscales. A cut-off score of ≥51 on the TAS-20 was used to define the presence of alexithymia. Clinical and demographic data were collected, including disease activity indices, disease phenotype, endoscopic findings, extraintestinal manifestations, and current therapies. Descriptive statistics were reported as mean ± standard deviation. Analyses included t-tests, Pearson correlations, ANCOVA, and multivariate linear regression. p<0.05 considered significant.
Results
A total of 103 patients with IBD were included (CD = 45; UC = 58). The mean TAS-20 score was 45.0 ± 11.0 in CD and 42.7 ± 10.4 in UC, with no significant difference between groups. The overall prevalence of alexithymia (TAS-20 ≥ 51) was 24.3%, with comparable rates in CD (22.2%) and UC (25.9%, p = 0.845). In CD, TAS-20 scores were significantly correlated with endoscopic disease activity (CDEIS: r = 0.35, p = 0.023) and with the presence of fistulas or abscesses (r = 0.38, p = 0.042). No significant correlations were observed with CDAI, disease phenotype, or perianal disease alone. In UC, clinical disease activity independently predicted alexithymia (SCCAI: β = 7.29, p = 0.023). With regard to psychological symptoms, TAS-20 scores were significantly correlated in CD with HADS-D (r = 0.58, p < 0.001), HADS-A (r = 0.34, p = 0.021), SCL-90 GSI (r = 0.37, p = 0.012), and paranoid ideation (r = 0.43, p = 0.003). In UC, significant correlations were also observed with HADS-A (r = 0.52), HADS-D (r = 0.39), and SCL-90 GSI (r = 0.45), all with p < 0.005. In multivariate analysis, the SCL-90 GSI score independently predicted alexithymia in UC (β = 11.78, p < 0.001). The effect of diagnosis (CD vs UC) on TAS-20 scores was not significant (p = 0.079) after adjusting for anxiety and depression.
Conclusion
Alexithymia is a common trait in IBD, with comparable prevalence in CD and UC. In CD, it is associated with endoscopic disease severity and fistulizing complications, while in UC, with clinical activity. In both groups, psychological distress, especially depression, is a key correlate. These findings underscore the value of assessing emotional processing in patients with active or complicated IBD to support more targeted multidisciplinary care.