Differential Association Between Default Mode Network Connectivity and Attachment Styles in Healthy Individuals and Crohn's Disease Patients.

Crohn's disease (CD) is linked to psychological disorders and insecure attachment styles, but the brain mechanisms underlying attachment in CD are not well understood. In an fMRI study of 19 CD patients and 18 healthy controls, attachment style questionnaire scores were similar between groups. However, resting-state brain scans revealed opposite patterns in the default mode network (DMN): in healthy controls, higher attachment insecurity scores correlated with reduced DMN connectivity, while in CD patients they correlated with increased DMN connectivity, particularly in the superior frontal gyrus, posterior cingulate, and orbitofrontal regions. These DMN changes may reflect altered self-monitoring and relational processing, potentially contributing to psychological stress and reduced mentalization in CD. The findings suggest attachment dimensions should be considered in inflammatory bowel disease treatment and encourage mentalization-based psychotherapeutic approaches.

Study at a glance

Abstract

Crohn's disease (CD) is associated with psychological disorders and insecure attachment styles, potentially reflecting the long-lasting disease effect. Although functional magnetic resonance imaging (fMRI) studies revealed differences in CD patients relative to HC, the brain properties underlying the attachment dimensions in CD remain scarcely investigated. We carried out an fMRI study to investigate the neural substrate of the attachment dimensions in CD patients and healthy controls (HCs). Nineteen CD patients and 18 HC were included in this study. All participants filled out the Attachment Style Questionnaire (ASQ) widely used to evaluate the dimensions of the attachment style and underwent an MRI protocol including structural and functional scans. The ASQ scores were similar between groups. Concerning the resting fMRI data, we identified two opposite trajectories for the association between two ASQ subscales reflecting attachment insecurity and the default mode network (DMN) connectivity between the two study groups. For the HC, higher scores at the ASQ were associated with reduced DMN connectivity, whereas in CD patients were related to increased DMN connectivity. The significant clusters were located in the superior frontal gyrus, posterior cingulate, and orbito-frontal regions. DMN is involved in higher mental functions including self-consciousness and affective processes. In CD patients, the DMN modifications associated with attachment insecurity might reflect dysfunctional monitoring of the self and the significant relationships potentially involved in the development of psychological stress and decreased mentalization. Our study strengthens the notion that the attachment dimensions should be considered in the treatment of IBD and encourages novel psychotherapeutic approaches based on mentalization.