Psychological Factors Affecting Medical Conditions and Stress Responses

Abdullah S AlSubaie F.R.C.P. (C)Professor of Psychiatry

Introduction

• What is Stress?– Too little stress– Too much stress– Adequate stress?

• Stress & health: Scientific evidnce…

Stress & Medical Illness

• Stressful life events are correlated with increased risk of becoming medically ill.

• Stressors can be perceived positively or negatively, as mediated by cognitive ''coping'' mechanisms.

• Maladaptive ways of coping, such as smoking, and substance abuse, may alter susceptibility to illness.

Stress & Medical Illness

• A strong network of social support seems to buffer against effects of stress.

• The central nervous, endocrine, and immune systems are interconnected.

• Response to physical and psychological illness depends both on genetic and acquired factors.

Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

• ''Psychological Factors Affecting Medical Condition'‘ to include psychological processes influencing the initiation or exacerbation of physical disease.

• The category is used to describe conditions that in the past have been deemed to have a ''psychosomatic'' or ''psycho-physiological'' component.

STEESSFUL LIFE EVENTS

PERCEPTIONCOGNITIVE COPING AND DEFENSE MECHANISMS

GENETIC AND ACQUIRED VULNERABILITYTO PHYSIOLOGICAL AND PSYCHOLOGICAL

ILLNESSSOCIAL SUPPORT

PSYCHOPHYSIOLOGIC CHANEGES

ACUTE ILLNESS OR DECOMPENSATOINOF CHORNIC ILLNESS

STRESSOR TO FAMILY. VOCATIONAL ECONOMIC LIFE, SELF ESTEEM

(i.e. illness is itself a stress)

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIP

• current concepts are products of a long evolutionary process.

• Followed the socio-cultural, scientific, and philosophical trends of each historical period.

• Our early ancestors:– Same diseases we know of today– without aid of today’s scientific method or

knowledge of anatomy, physiology, and behavior.

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIP

• Theological explanations were frequently invoked, such as:– Possession, evil eye, witchcraft…– Rituals were used to rid the body of evil

influences.– The powerful attraction of these early beliefs as

explanatory models is apparent in their continued appeal in our era.

THE HISTORICAL DEVELOPMENT OF THE MIND-BODY RELATIONSHIP

• Hippocrates believed that many diseases and mental states were caused by emotions

• Mind-body physiology is based on combinations of:– Four basic humors (yellow bile, black bile, phlegm, and

blood)– With the four basic elements (air, earth, fire and water). – Various combinations produced different diseases and

mental states.

A New Era…

• In seventeenth century. • Body-mind division• Misunderstanding led to rigid dualism.• Confused thinking of many modern physicians:

''organic'' from ''psychological'' disease.

Another Step…

• late nineteenth century by Sigmund Freud and his contemporaries.

• Confusing “Hysterics”.• The belief that stress and psychological

conflict could not only influence but actually produce specific physical diseases became a focus of many of these physicians then.

New Thinking…

• chronic suppression of emotional tension leads to discharge in autonomic nervous system pathways.

• Causes structural change in specific tissues and organs.

• The so-called organic neuroses (essential hypertension, bronchial asthma, ulcerative colitis, peptic ulcer, rheumatoid arthritis…

Contribution…

• Type A behavior pattern-characterized by a sense of urgency, striving for achievement, and hostility-is a risk factor for coronary artery disease.

• Researchable…• Recent critiques found that not all type-A

personality characteristics are equally associated with this increased risk.

No more dualism…

• In the Mid-twentieth century, a new model of causality was developed by Bertilanffy and Bateson, who saw the universe from a systems perspective:– Systems have self-regulating, homeostatic

properties.– That create a circular cause-effect.– Life pends on this type of homeostatic equilibrium,

nesting systems within systems to maintain life.

Bio-Psycho-Social Paradigm

George Engel, an internist with training in psychoanalysis, proposed the bio-psycho-

social model as a paradigm for explaining the multiple ways in which physical health could be modified not only by physical pathogens

but also by learning, cultural norms, and mental processes.

The Bio-Psycho-Social Model

STRESS AND ITS INFLUENCE OF DISEASE ?

• ''stress'‘ (Hans Selye) refers to:1. Stressor: An aversive stimulus event.2. Response:• Psychological response: feelings of threat, harm, or

loss...• Physiological response Stress responses (physiological,

psychological, or social).

3. Transaction between the person and the environment.

Stressors

• Those life events that induce change in routine.

• The persistence of positive or negative environmental conditions, or specific types of situations of monotony where no change has occurred when change might have been expected (i.e., not getting an anticipated promotion at work).

Death of a spouse100

Divorce73Marital separation65Jail term 63Death of a close family member63Personal injury or illness 53Marriage 50

Fired at work47

Marital reconciliation45

Retirement 45

Life Events Scale (Holmes & Rahe)

Death of a spouse100Change in health of family member44Pregnancy40Sex difficulties39Gain of new family member 39Business readjustment 39Change in financial state38Death of a close friend 37Change in number of arguments with spouse

36

Foreclosure of mortgage or loan35Change in responsibilities at work30Son or daughter leaving home29Trouble with in-laws29Outstanding personal achievement29Spouse began or stopped work28Begin or end school26Change in living conditions 26

Death of a spouse100Revision of personal habits 25Trouble with boss 24Change in work hours or conditions23Change in residence 20Change in schools20Change in recreation20Change in church activities 19Change in social activities18Change in sleeping habits 16Change in number of family get-togethers

15

Change in eating habits 15Vacation13Christmas12Minor violations of the law11

STRESS & PERCEPTION OF THREAT

• Lazarus: “a stimulus can evoke a stress reaction by psycho-physiological means only if it is interpreted by the individual as harmful or threatening”

• Hinkle and Wolff: – 25% of the people had 50% of the episodes of illness over

a 20-year period.– Illnesses often appeared in a cluster during life, when

individuals perceived that they were having difficulty adapting to the environment.

Coping and Defense Mechanisms

• ''struggling'' or ''contending'‘• It describes behavior involving special physical

and emotional energy and attention that is required to deal with some difficult circumstances.

• Lazarus:– ''direct action'‘ type: Preparation…– “palliation” type: Keep living (ego defenses; taking

tranquilizes, alcohol, or sleeping pills;

Social Support

• Support buffers the individual from potentially negative effects of crisis and facilitates coping and adaptation.

• Patients with social supports and assets live longer and have a lower incidence of somatic illness, as well as more positive mental health.

• Those who are married have lower mortality rates than those who are single, widowed, or divorced.

إعداد

النجاح فريق مجتمع

www.najahteam.com