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هوالحکیم Psychosomatic Research Center [email protected] Disease/Illness Disease – biological event with pathology – disease as a specific entity Illness – subjective experience – devalued changes Disease does not exist as a social phenomenon until we agree it does, who labels this: Dr? Patient? Science? Disease Vs. Illness Disease illness Doctor’s view Patient’s view More objective More subjective Generalized Individualized Abstract Concrete Categorical Narrative Biomedical Bio-psychosocial Rational/ Experimental Phenomenological Psychosomatic Approach to Disease & Illness A medical model which is based on multilevel interactions, from molecule to society. Multilevel assessment/ intervention The scope of psychosomatic medicine? Person – centered not disease - oriented Cognitive Model Thoughts & Images Physiology (Central Chemistry) Behaviour Environment Emotions Cognitive Model of Somatisation Triggers stress, distress, anxiety, illness, symptoms Physical symptoms Emotional response Anxiety Depression Meaning/interpretation Threat, loss, inability to cope Behaviour: rest, checking, reassurance seeking, medication, treatments Cognitive behavioural approach to understanding health anxiety Probability x (perceived cost) awfulness Anxiety = Perceived ability to cope + chance of help (rescue) Factors involved in the maintenance of health anxiety Bodily variations Medical information Physiological & biological Symptoms (Arousal) (Selective attention) Beliefs about being ill (Prevent •Probability disconfirmation) (Alters perception) •Cost •Coping Reassurance •Rescue Mood changes seeking, • anxiety Checking, safety • depression behaviours Approach to patients: disease or illness oriented ? Ideas, Beliefs Cognitive styles Emotion Function Expectation Concerns, questions What is sick role? The protective role given an individual who is physically or mentally ill or injured; it may be assumed by the individual or it may be imposed as a part of social custom. A behavior pattern in which a person adopts the symptoms of a physical or mental disorder to be cared for, sympathized with, and protected from the demands and stresses of life.