ORIGINAL ARTICLE Attachment and quality of life in patients with inflammatory bowel disease Alessandro Agostini & Marco Moretti & Carlo Calabrese & Fernando Rizzello & Paolo Gionchetti & Mauro Ercolani & Massimo Campieri Accepted: 13 July 2014 /Published online: 19 July 2014 # Springer-Verlag Berlin Heidelberg 2014 Abstract Purpose Inflammatory bowel diseases (IBD) are chronic dis- orders affecting psychological well-being, quality of life (QOL), social interactions, and close interpersonal relation- ships of patients affected. The attachment theory provides a theoretical framework to evaluate the quality of close inter- personal relationships in the context of chronic disorders. The aims of this study were to compare the attachment dimensions between IBD patients and healthy controls and to evaluate the impact of these dimensions on QOL in IBD patients. Methods One hundred three consecutive IBD outpatients (70 with Crohn’ s disease and 33 with ulcerative colitis) were recruited in the IBD Unit of the University of Bologna. They were clinically evaluated and filled out the questionnaire Short Form health survey-36 (SF-36), assessing QOL, and the at- tachment style questionnaire (ASQ), assessing attachment dimensions. One hundred three matched healthy subjects filled out the same questionnaires and represented the control group. Results IBD patients exhibited worst scores in the QOL mea- sures (both physical and mental health) and in the attachment dimensions Relationships as secondary and Preoccupation with relationships. In IBD, the significant predictors of phys- ical health were disease activity and disease type, while the significant predictors of mental health were disease activity and type, surgery, and the attachment dimensions Confidence and Preoccupation with relationships. Conclusions Compared to controls, in IBD patients, the close interpersonal relationships are characterized by attachment insecurity that, in turn, is a significant predictor of QOL. These findings suggest plausible insights for psychological interventions in IBD patients with deterioration in QOL. Keywords Inflammatory bowel disease . Quality of life . Attachment Introduction Crohn’ s disease (CD) and ulcerative colitis (UC), collectively labeled as inflammatory bowel diseases (IBD), are chronic disorders affecting psychological well-being and quality of life (QOL) of patients affected [1–3]. In particular, IBD have a considerable impact on social interactions and close interper- sonal relationships [4, 5]. The attachment theory provides a theoretical framework to evaluate the quality of close interpersonal relationships in the context of chronic disorders. This developmental theory states that infants, through the interactions with caregivers, develop cognitive schemas of interpersonal relationships named at- tachment styles that guide affects and behavior during the life span [6, 7]. If infants experience their caregivers as reliably available and responsive, a secure attachment style develops, character- ized by a sense of safety and effective regulation of affects. In contrast, if the caregivers are inconsistently responsive, un- available, or abusing, an insecure attachment style develops characterized by two fundamental dimensions: (i) anxiety over relationships and (ii) avoidance or discomfort with close- ness [8]. Anxiously attached individuals tend to hyperactivate the attachment system. They experience constant worry about being abandoned, resulting in hypervigilance, seeking prox- imity, and dysfunctional stress and affect regulation. On the A. Agostini : M. Ercolani Department of Psychology, University of Bologna, Bologna, Italy A. Agostini (*) : M. Moretti : C. Calabrese : F. Rizzello : P. Gionchetti : M. Campieri Department of Clinical Medicine, IBD Unit, St. Orsola-Malpighi Hospital, University of Bologna, via Massarenti 9, 40138 Bologna, Italy e-mail: alessandro.furey@tiscali.it Int J Colorectal Dis (2014) 29:1291–1296 DOI 10.1007/s00384-014-1962-3