Psychological measurements in somatization and abnormal illness behavior.

Psychosocial factors have been examined in functional bowel disorders (FBD), including irritable bowel syndrome (IBS) and chronic idiopathic constipation (CIC). Abnormal illness behaviour (AIB) has been investigated in IBS patients as evidence of underlying psychological distress and as influencing health-care-seeking behaviour. Health locus of control may also contribute to health-care-seeking behaviour, as possession of an external locus of control places responsibility for health status onto professionals. Thus, external locus of control may also be more prominent in FBD patients. This study examined whether FBD patients displayed more AIB and an external health locus of control compared with organic disease and non-patient controls. A cross-sectional comparison group design was employed. Fifty-three CIC patients were compared with matched control groups of 50 IBS patients, 51 Crohn's disease patients and 53 non-patient participants. Questionnaire measures included the Illness Behaviour Questionnaire, the Multi-dimensional Health Locus of Control, the GHQ, and the SCL-90R. FBD patients did not differ from Crohn's disease patients on measures of AIB, but all three patient groups differed from non-patient participants. Crohn's disease patients possessed a higher external locus of control compared with FBD patients and non-patient controls. There was a general association between AIB and psychopathology. FBD patients did not report more AIB or a higher external locus of control regarding their health status, compared with organic disease controls, but did differ from non-patients. The presentation of AIB was related to increased psychopathology, suggesting that AIB may be related to psychological distress, irrespective of patient status.

OBJECTIVES: To examine the illness attitudes and beliefs known to be associated with abnormal illness behaviour (where symptoms are present in excess of objective signs and pathology) in elite middle...

Depressive symptoms and abnormal illness behavior in general hospital patients

Illness behaviour syndromes associated with intractable pain

This is a structured, evidence-based review of all available studies addressing the concept of nonorganic findings: Waddell signs (WSs). To determine what evidence, if any, exists for the various interpretations for the presence of WSs on physical examination. WSs are a group of eight physical findings divided into five categories, the presence of which has been alleged at times to have the following interpretations: Malingering/secondary gain, hysteria, psychological distress, magnified presentation, abnormal illness behavior, abnormal pain behavior, and somatic amplification. At the present time, there is, therefore, significant confusion as to what these findings mean. A computer and manual literature search produced 61 studies and case series reports relating to WSs. These references were reviewed in detail, sorted, and placed into tabular form according to the following subject areas: 1) Reliability (test-retest); 2) Reliability (inter-rater); 3) Reliability (factor analysis); 4) Validity, psychological distress; 5) Validity, correlation Minnesota Multiphasic Pain Inventory (MMPI); 6) Validity, correlation abnormal illness behavior; 7) Validity, other behaviors; 8) Validity, as a nonorganic phenomenon; 9) Validity, correlation pain drawing; 10) Validity, functional performance; 11) Validity, treatment outcome; 12) Validity, predicting surgical treatment outcome; 13) Validity, return to work outcome; 14) Validity, secondary gain correlation; and 15) Validity, pain correlation. Each study in each topic area was classified according to the type of study it represented according to the type of evidence guidelines developed by the Agency for Health Care Policy and Research (AHCPR). In addition, a list of 14 study quality criteria was used to measure the quality of each study. Each study was categorized for each criterion as positive, (criterion filled), negative (criterion not filled), or not applicable independently by two of the authors. A percent quality score was obtained for each study by counting the total number of positives obtained, dividing by 14 minus the total number of not applicables, and multiplying by 100. Only studies having a quality score of 75% or greater were used to formulate the conclusions of this review. The strength and consistency of the evidence represented by the remaining studies in each topic area (above) was then categorized according to the strength and consistency AHCPR guidelines. Conclusions of this review for each topic area are based on these results. Of the 61 studies, four had quality scores below 75% and were not used to generate the results of this review. According to the AHCPR guidelines for strength and consistency of the reviewed data, the following results were obtained: 1) There was consistent evidence for WSs being associated with decreased functional performance, poor nonsurgical treatment outcome, and greater levels of pain; 2) There was generally consistent evidence for WSs not being associated with psychological distress, abnormal illness behavior, or secondary gain; 3) There was also generally consistent evidence that WSs are an organic phenomenon and that they cannot be used to discriminate organic from nonorganic problems; 4) There was inconsistent evidence that WSs do demonstrate inter-rater reliability, do not correlate with the neurotic triad of the MMPI, are associated with poorer surgical treatment outcome, and are associated with nonreturn to work; 5) There was little or no evidence that WSs demonstrate test-retest reliability, or reliable factors, and are associated with self-esteem problems, catastrophizing, or the nonorganic pain drawing. Based on the above results, the following conclusions were made: 1) WSs do not correlate with psychological distress; 2) WSs do not discriminate organic from nonorganic problems; 3) WSs may represent an organic phenomenon; 4) WSs are associated with poorer treatment outcome; 5) WSs are associated with greater pain levels; 6) WSs are not associated with secondary gain; and 7) As a group, WS studies demonstrate some methodological problems.

Toward empirically based criteria for the classification of somatoform disorders

Temporo-mandibular joint dysfunction: Pain and illness behaviour

Concepts of illness and related beliefs and behaviours are often inappropriate to health state. They develop in childhood and we review the processes that are often involved, which are influenced by ethnic, cultural, demographic, social, psychological and biological factors. Unusual patterns of care experienced by some children and the inappropriate illness behaviours of those with particular influence over them play a central part in the development of the most extreme disorders. Prospective studies are limited but indicate that patterns of illness behaviour in childhood are often persistent and continue or recur in adult life. Inappropriate patterns of invalidism are common in children and adults and the poor prognosis, considerable costs and personal distress indicate the need for primary prevention as well as more active intervention for those who are at particular risk.

It has long been observed that people sometimes fake or exaggerate symptoms of physical illness or injury. These gratuitous symptom complaints, together with doctor visits, medication use, and so forth, are collectively called Abnormal Illness Behavior (AIB). In this article we examine some associated features of extreme cases of AIB, which suggest that these behaviors may reflect attempts at self-definition and self-esteem management. Four specific hypotheses are offered to explain the mechanisms through which these motives might maintain severe forms of AIB. We then consider the utility of looking for the operation of these mechanisms in less extreme cases. Studies are reviewed which suggest that identity and self-esteem motives do affect AIB in non-clinical samples. Finally we discuss the potential for our self-enhancement theory to integrate extant theories of the causes of AIB, as well as the clinical implications of our approach.

Pain, depression, and illness behavior in a Pain Clinic population

To analyse the relationship between dental anxiety and illness behaviour. Dental anxiety was assessed in 165 patients from private practice using the Dental Anxiety Scale (DAS), aspects of illness behaviour were evaluated by the Illness Attitude Scale (IAS), and aspects of general anxiety were analysed by the State Trait Anxiety Inventory (STAI). Dental status was documented using the DMFS index and Bleeding-on-Probing index (BOP). Multiple regression analysis (explained proportion of variance = 32%) showed that dental anxiety was significantly correlated with female gender (t = 3.109, p < 0.002) and IAS health habits (t = -2.210, p < 0.03). In addition, a correlation trend was found between dental anxiety and BOP index (t = -1.789, p < 0.08). Dental anxiety appears to be a gender-specific phenomenon. Results indicate a tendency towards abnormal illness behaviour (i.e. denial of dental anxiety) in a considerable proportion of subjects and as a consequence display of poor health habits (i.e. counterphobic behaviour). The latter may lead to an increased tendency to develop gingivitis as indicated by the correlation trend between dental anxiety and BOP index.

Patients presenting with illness behaviours which are not congruent with the objective evidence for the presence of illness may be suffering from psychopathologically-based illness behaviour, i.e., “abnormal” illness behaviour. The relevant terms are defined, and the implications for the medical care system are discussed in this chapter.

This study reports psychological symptoms assessed in 327 patients with fibromyalgia (FS) in a multicenter investigation. Two self-report scales, in their validated Italian translations, were used for screening: the CES-D (the Center of Epidemiologic Studies-Depression) developed at the NIMH for measuring depression and the Illness Behavior Questionnaire (IBQ) developed by Pilowsky and Spence. The cutoff point of 23 in the CES-D scores revealed about 49% of the fibromyalgic patients as depressed. In analyzing patterns of illness behavior patients with FS showed a high score on IBQ scales of disease conviction, psychological versus somatic focusing and denial. CES-D scores showed significant correlations with illness behavior scales. These results and their implications for the treatment of fibromyalgic patients are discussed.

Objective: In patients affected by masked hypertension psychological variables have been poorly investigated so far. Some authors found an association of masked hypertension with hypochondria and/or depression. Studies on the relationship between masked hypertension and stress focused on stressors at work ignoring chronic/acute stressful life events related to other contexts. This research aims to understand psychological, psychosomatic and well-being characteristics among patients with masked hypertension. Design and method: 10 patients with masked hypertension, enrolled at the Division of Internal Medicine, were assessed. They were administered both observer- (interviews on clinical psychological distress and psychosomatic syndromes) and self-rated (questionnaires on subclinical distress and well-being) measures. Results: 40% of patients reported at least one depressive disorder (30% past major depressive episode and 20% persistent depressive disorder) and 40% at least one anxiety disorder (30% generalized anxiety, 10% panic and 10% social anxiety). 50% showed illness behaviour, 20% psychological manifestations and 20% personality syndrome. Only 30% of patients did not report a diagnosis of either Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or Diagnostic Criteria for Psychosomatic Research (DCPR). 20% of the sample reported only one psychosomatic syndrome (somatization and conversion syndromes). The mean levels of psychological well-being were significantly lower in masked hypertension patients than those of the general population: autonomy (29.9 ± 6.87 versus 37.14 ± 6.96), environmental mastery (26.70 ± 2.75 versus 38.15 ± 7.41), personal growth (32.10 ± 3.93 versus 38.40 ± 6.93), positive relations (31.20 ± 4.92 versus 40.57 ± 6.96), purpose in life (26.72 ± 5.32 versus 38.40 ± 6.98) and self-acceptance (25.80 ± 5.37 versus 38.12 ± 8.20). The mean scores Psychosocial Index subscales were significantly higher than those reported by the general population: psychological distress (13 ± 6.43 versus 5.54 ± 3.60), abnormal illness behavior (1.10 ± 1.20 versus 0.50 ± 0.82) and stress (4.40 ± 1.51 versus 2.30 ± 1.81). On the contrary, the mean scores of well-being dimension were significantly lower (6 ± 1.33 versus 7.42 ± 1.64). Conclusions: A high percentage of patients with masked hypertension showed high levels of psychological and psychosomatic distress. A psychosomatic assessment including both distress and psychological well-being impairments should be implemented in patients with masked hypertension in order to recognize potential vulnerability factors for both medical and psychiatric syndromes.

Pain is the most common symptom which brings the patient to a doctor. Not all pain is indicative of disease. Even where disease does exist pain does not always require specific therapy. Women with chronic dyspareunia form a group of patients which engenders much frustration in many practising gynaecologists. Since many reasons for a woman to perceive pain in her pelvis are predominantly physiological, the doctor who pronounces, ‘I can find nothing wrong with you’, creates a very ambivalent and confused patient as a consequence. She leaves thinking that this doctor, and those beforehand, all believe she is imagining the pain, yet the pain is very real to that person. The primary approach in managing such problems should not be with the scalpel, and an impassioned plea is made to avoid surgery. To perform a laparotomy on such a woman is merely pandering to her possible abnormal illness behaviour and in so doing the doctor may be displaying abnormal treatment behaviour. The consequences of such retr...