Severity of Psychologic Stressors Reflects Course of Crohn’s Disease in Two Siblings

A significant rise in Crohn’s disease (CD) cases amongst first-degree relatives strongly suggests that inflammatory bowel disease (IBD) has a genetic component. Adherence to medical management is at the forefront for preventing disease relapse. However, given the role that stress places on the immune system, it is imperative to implore an individual’s psychologic stressors to prevent future disease complications. This case of CD in two siblings, male and female, highlights the unique stress experienced by each patient at the time of symptom onset, the severity of their inflammatory symptoms, and their course of disease over several years. The male patient suffered from gender dysphoria and social anxiety for over a decade and had more chronic stress and severe complications of his disease. On the other hand, the stressors faced by his sister were periodic in nature and symptoms resided once stressful periods ended. For select patients, it is indicative that referral for psychotherapy should be considered as an ongoing mainstay of management. This case is intended to highlight the need for including psychotherapy in addition to medical management in order to treat IBD holistically.