title: Attachment, childhood abuse, and IBD-related quality of life and disease activity outcomes.
abstract: BACKGROUND
  This study examined attachment style as a moderator of the relationship between childhood abuse and inflammatory bowel disease (IBD)-related outcomes.
  
  
  METHODS
  Study participants were 205 patients with IBD from Mount Sinai Hospital in Toronto. Participants completed self-report questionnaires regarding personal relationships, abuse history, and IBD-related information. Multiple regression models were fit using 3 outcome variables: disease-related quality of life (QOL), disease activity for ulcerative colitis, and disease activity for Crohn's disease.
  
  
  RESULTS
  Patients reporting less severe abuse and low levels of avoidant attachment had the highest levels of QOL, whereas patients reporting high levels of avoidant attachment had the lowest levels of QOL, regardless of abuse severity. Patients reporting greater anxious attachment had lower QOL scores. Patients reporting less severe abuse and low levels of avoidant attachment had the lowest levels of disease activity, whereas patients reporting high levels of avoidant attachment had the highest levels of ulcerative colitis-related disease activity, regardless of abuse severity. However, for anxious attachment, there was no significant main effect or significant interaction of abuse by anxious attachment on ulcerative colitis-related disease activity. Childhood abuse and attachment style were not found to be associated with Crohn's disease-related disease activity.
  
  
  CONCLUSIONS
  Adult attachment style may moderate the relationship between childhood abuse and IBD-related outcomes, by impacting one's QOL and disease activity. Distinct types of insecure attachment styles may impact these relationships differently. Psychological interventions focusing on attachment styles of patients with IBD have the potential to improve IBD-related QOL and disease activity.
authors.affiliation: *Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, Toronto, Canada; †Department of Psychiatry, and ‡Division of Gastroenterology, Mount Sinai Hospital, Toronto, Canada; and §Department of Psychology, Ryerson University, Toronto, Canada.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Caplan
authors.forename: Robert G
authors.initials: RG
authors.lastname: Maunder
authors.forename: Joanne M
authors.initials: JM
authors.lastname: Stempak
authors.forename: Mark S
authors.initials: MS
authors.lastname: Silverberg
authors.forename: Tae L
authors.initials: TL
authors.lastname: Hart
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D001294:Attitude to Health; D002649:Child Abuse; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009769:Object Attachment; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult