Psychosocial aspects of Crohn's disease

In clinical practice, significant discrepancies occur between disease activ ity and severity, and the patient's symptom experience and behaviour. Discr epancies cannot be explained by biologic or morphologic findings, and usual ly are considered to be related to psychosocial factors. Recent advances in the scientific understanding of the relationship between environmental str ess and the neural, endocrine, and immune systems, combined with new method ologies in clinical research, provide a challenging opportunity for clinici ans and researchers to establish a more comprehensive understanding of Croh n's disease. This article reviews the important relationship of psychosocia l factors, pathogenesis, clinical expression, response to treatment, and ou tcome of Crohn's disease, and presents a comprehensive model of illness, di sease, and ways to integrate psychosocial factors with diagnosis and patien t care.