Ulcerative Colitis as an Anniversary Symptom: Emergency Psychotherapy With Remission of Symptoms

In recent years, there have begun to appear numerous case reports of ulcerative colitis, wherein psychotherapy has been a prime factor in obtaining remissions in this severe, difficult to treat, and debilitating disease. Attempts are being made to ascertain some common factor which could be labeled as specific to the disease, but thus far there has been no notable success. Stress has been laid (and this is usually agreed upon by most investigators) on the precarious emotional adjustment that most of these patients make, to the point where, at times, they readily become psychotic under the stress of usual life situations or even under superficial psychotherapy.

The case to be presented is a somewhat unusual one, not only because of its occurrence as an anniversary symptom (see Hilgard's paper (5)), but also because of the fact that psychotherapy was literally life-saving at a time when the patient was given up as hopeless by the medical service. When first seen in the hospital, the patient was considered moribund, and rectal hemorrhage was so severe that emergency surgical procedures were considered. In addition to various antibiotics and other medications under the direction of an experienced internist on the hospital service, she had received a total of 6,500 cc. of blood. It was at this point that a psychiatric consultation was requested, and although she was subsequently seen for only a relatively brief time, i.e., 50 hours, the results were quite dramatic. It has been over a year and a half now since her last visit without any recurrence of her symptoms.

The summary of her life history, obtained over some interviews was as follows: The patient was a 28-year-old married woman with an only child, a daughter, aged five. Her illness had begun about a year prior to the present hospitalization when, at the time, she recalled being afraid of having cancer of the breast. When she was reassured about this symptom after examination by a physician, the symptom disappeared bu