MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

1. Introduction
The main objective of this paper is to define chronic health disorders and the
strategies people instil in order to manage these disorders. The aim will be to explore
4 different chronic health disorders and how individuals approach treatment,
compliance and different coping methods whilst living with the disorder.
In order to understand the strategies people use to manage different disorders one
needs to define the meaning of disorders. The American Heritage Stedman's
Medical Dictionary defines disorder as A disturbance or derangement that affects
the function of mind or body, such as an eating disorder or the abuse of a drug. To
disturb the normal physical or mental health of. On the other hand the World Health
Organisation defines a disorder as a noncomminicable disease (NCDs)
Noncommunicable diseases (NCDs), also known as chronic diseases, are not
passed from person to person. They are of long duration and generally slow
progression. The four main types of noncommunicable diseases are cardiovascular
diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such
as chronic obstructed pulmonary disease and asthma) and diabetes. Following on
the aforementioned definitions of a chronic disorders one could add that a chronic
disorder last over a long duration and tends not to have a cure.
Considering that chronic disorders influence so many people around the world one
must consider some of the facts pertaining to these disorders and how they influence
society. NCDs such as heart disease, stroke, cancer, chronic respiratory diseases
and diabetes, are the foremost causes of death globally and unfortunately most
NCDs is the imperceptible widespread cause of poverty within families and
communities. NCDs affect all age groups in all countries all over the globe, some
however are regularly related with older age groups. In January 2015 WHO updated
the following key facts regarding NCDs:

38 million people are killed each year due to NCDs

Low- and middle-income countries contribute almost three quarters of NCD
deaths - 28 million
16 million NCD deaths occur before the age of 70; 82% of these "premature"
deaths occurred in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17.5 million people
annually, followed by cancers (8.2 million), respiratory diseases (4 million),
and diabetes (1.5 million).
These 4 groups of diseases account for 82% of all NCD deaths.
Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy
diets all increase the risk of dying from an NCD.

Following on the above facts one could draw conclusion that NCDs do not acquire
enough support and recognition in low- and middle income countries, however more
importantly, is the question why these deaths are still occurring and why individuals
that suffer from NCDs are not coping better in todays day and age?
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MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

2. Psychology theories and coping strategies

People are often inclined to develop customary characteristics and methods to
manage upsetting emotions and/or unwanted situations. Apart from a persons
personality personae, one often use these customary approaches to calm oneself in
stressful situations. Due to the individualism and different circumstances and
environment, these coping mechanisms does not always succeed in assisting the
person with dealing with the problem or the situation. There is a definite affiliation
between ones emotional quotient (EQ) and the type of coping methods one prefers.
Individuals with low EQ are inclined to select relatively simple and often inefficient
coping methods, often reactive and unconscious rather than well though through.
Whilst individuals with a higher EQ often lean to more refined methods, responding
more deliberate and conscious which leads to more proactive methods in most
cases. These methods are often called defence mechanisms as described by
psychotherapists, through their psychology theories. Before looking at the possible
ways individuals could act and link their reactions to these psychology theories, one
needs to have a brief over view of these theories.

Behavioural Psychology Theory based on behaviourism - An individuals

behaviour can be measured, trained and changed and all behaviours are
acquired through conditioning. There are 2 types of conditioning: Classical
conditioning and operant conditioning. Classical conditioning works on the
principle of two elements conditional stimulus and conditional responses
whereas operant conditioning occurs through reinforcement or punishment.
Cognitive Psychology Theory - How we process information, considering how
the information comes to the person and how the management of this
information leads to response, processes include, perception, attention,
language, memory and thinking.
Developmental Psychology Theory - provide a framework for thinking about
human growth throughout its lifespan including development and learning in
two major fields: growth in cognitive and social competence.
Humanist Psychology Theory focus on the basic goodness of human
beings.
Social Psychology Theories assist in understanding and explaining social
behaviour, it is centred on exact social behavioural incident, including group
behaviour, social influence and love to name but a few.

In aid to understand the above mentioned theories, Table 1 will illustrate some
application to the different theories. A hypothetical example: ABC has just been
informed that he has chronic obstructed pulmonary disease (COPD) and needs
to stop smoking immediately.
Psychological
Approach

Possible explanation for

ABC smoking

Possible ways of
reducing/elimination ABCs
smoking

MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

Behavioural
Psychology
focuses on the
immediate
consequences of
behaviour
Cognitive
Psychology the
explanation is
based on incorrect
believes
Social Psychology
emphases on the
way people relate to
each other

Developmental
Psychology the
ways individuals
change as they
mature in their
lifespan

ABC finds smoking

relaxing and satisfying

Find another way of relaxing

that is also satisfying

ABC does not believe that

smoking could cause this
much harm as his mother
and grandmother has and
still smokes and are in
perfect health
ABC enjoys smoking with
his work colleges and his
friends, it is time they all
spend together and makes
him feel like being part of
something
ABC started smoking at
the age of 14 and enjoyed
engaging in risk
behaviours such as
smoking. This behaviour
has now developed into
everyday living.
There may be some
fundamental reason
unknown that drives ABC
to smoking

Help ABC to re-examine his

believes about the effects of
smoking

Assist ABC to find a way to be

able to cope with social
situations where others are
smoking

Help ABC understand that he

needs to start viewing smoking
differently due to his diagnosis
of COPD

Humanistic
Offer help and support to assist
Approach assist
ABC in the exploration of his
people to develop
feelings about quitting and
own inner
maybe look at the reasons why
resources to realise
hes smoking and other ways to
their potential
overcome the habit and need
Table 1: Psychological explanations and interventions for ABCs smoking
In addition to the above listed theories individuals often react in different ways to
protect themselves against the situation or upsetting emotions they find themselves
in, these may include:

Denial The individual has either the inability or chooses to refuse to accept
the reality of a specific event/situation.
Passive-aggression The individual has chosen to that the thought or feeling
is not acceptable enough to be allowed direct expression.
Fantasy The individual will often daydreaming about how things should be
rather than doing something about the actual reality.

MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

Displacement The individual has an unacceptable feeling or thought about a

person, place or thing and redirected this feeling or thought towards a safer
objective.
Isolation - Overwhelming feelings or thoughts about an event are handled by
isolating their meaning from the feelings accompanying the meaning, and
focusing on the meaning in isolation.
Reaction Formation - react to uncomfortable, unacceptable feelings or ideas
that you have (but aren't quite conscious of really), by forming the opposite
opinion.
Suppression - a conscious form of repression, where one chooses not to
engage or talk about difficult feelings or thought and decide to put off dealing
with them till a later stage
Altruism - converting uncomfortable feelings and thoughts, by helping others
suffering from similar feelings and thoughts who are less far along in dealing
with them than myself.
Distraction - intentionally deciding to put off thinking or feeling distressing
thoughts or feelings by briefly focusing your attention towards something less
intimidating.

Reaction / Defence
Mechanism
Denial ABC thinks
there must a
mistake

Possible explanation for

reaction
His mother and
grandmother both smoke
(even more than him) and
are both in good health
ABC finds that going out
with his friends helps him
forget about the COPD

Possible ways of helping

ABC to cope
Suggesting a stop smoking
programme and providing ABC
with more information
regarding COPD.
Distraction ABC
Going out is a great distraction
goes out more often
but the smoking isnt helping,
now with his friends
try to suggest to ABC that he
to bars and clubs
needs to find healthier ways of
spending time with his friends
Isolation ABC
ABC thinks that having
Give ABC some information on
never leaves the
COPD means not having a
how to cope with COPD and
house any more
life and not being able to do the things he could do in order
anything
to cope better and be able to
do all the things he want
These are but a few coping mechanisms that individuals use to cope with unsettling
or threatening information. In Table 2 we explore different possible reactions or
defence mechanisms that ABC could have had to the unsettling or threatening
information with regards to his COPD.
Table 2: ABCs possible reactions, explanations and coping strategies

As demonstrated there are a huge number of factors, theories and defence

mechanisms that lead to acceptance and management of health. Now that one has a
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MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

basic understanding of how an individual might react or deal with a situation we can
evaluate the different coping strategies individuals might apply in order to manage
chronic health disorders. As mentioned in the introduction, this paper will only
explore addition 3 health disorders and possible coping strategies. Throughout the
different health disorders we will explore 5 key coping strategies;
education/information, medication, triggers, health and wellbeing as well as support.
Bearing in mind that these ae the suggested coping strategies and not necessarily
the way that all people cope with chronic disorders.
Asthma - Asthma attacks all age groups but often starts in childhood. It is a disease
characterized by recurrent attacks of breathlessness and wheezing, which vary in
severity and frequency from person to person. In an individual, they may occur from
hour to hour and day to day. This condition is due to inflammation of the air passages
in the lungs and affects the sensitivity of the nerve endings in the airways so they
become easily irritated. In an attack, the lining of the passages swell causing the
airways to narrow and reducing the flow of air in and out of the lungs. definition of
Asthma according to WHO (http://www.who.int/respiratory/asthma/definition/en/).
Individuals who suffer from asthma are not often thought of as an individual that has
a chronic health disorder due to the way people have been managing their asthma in
order to enjoy everyday life. Chronic asthma however could cause pain, fatigue,
stress and a great disruption to everyday life.
As with any other chronic disorder, no one should be in denial about having asthma.
All treatment and management of asthma starts with the individual taking
responsibility of their own health and wellbeing with the support of those around
them. There are various coping methods one could use to manage the disorder

Education - The best way to manage chronic asthma is through education on

and how the disorder works. The most important questions to ask would be;
what triggers the individuals asthma? How are they affected by the triggers?
Do they require medication to relieve the attack? Are there factors that could
be avoided in order to prevent the attacks?
Medication Most people use inhalers as asthma relievers. Practitioners will
describe different type of inhalers to different patients depending on the
diagnosis. There are other preventer medicines that could also be
administered in the form of a tablet (leukotriene receptors antagonists and
theophyllines), that assist with the inflammation of the airways. One could also
be prescribed oral steroids that are powerful anti-inflammatory preventer that
assists one the individual to regain control over the asthma. Long term use of
steroids have serious side effect and are only used for short term periods to
reduce the inflammation of the airways and gain control over the asthma
again. Apart from the aforementioned there are more medication and medical
treatments that could assist in the control or temporary relief of asthma.
Triggers Triggers are generally things that causes irritation to the lungs.
There is a range of triggers that could affect individuals, these differ from
person to person. Irritations such as respiratory tract infections, allergens,
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MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

airborne irritants, medication, emotions, foods containing sulphides, weather

conditions, food allergies and exercise. Individuals should be encouraged to
identify their triggers that sets attacks off and attempt to avoid such triggers.
Health and Wellbeing Keeping fit and healthy is essential to asthma. Eating
healthy and taking additional supplements could assist in preventing minor
ailments. Most asthma sufferers are prone to attacks during exercise and
must be aware of their limitation, however this does not mean that individuals
are not able to enjoy sport and exercise. Swimming for instance could be a
key exercise that could improve lung capacity.
Support There are some valuable support groups available for people who
suffer from asthma; Asthma UK, EFA (European Federation of Asthma and
Allergy Association), the Aspergillums website, British Lung Foundation and
BOHRF (British Occupational Health Research Foundation). All of the stated
groups have websites that are highly informative, apart from professional
bodies, support starts at home. Having ones family understand and support
ones asthma is probably the best support one could get. Informing ones
friends on how to handle a situation is just as important.

Diabetes With more than 3.2 million people (Diabetes UK) in the United Kingdome
being diagnosed with diabetes there is still an additional 630 000 people who has the
disorder but unknowingly. When an individuals pancreas doesnt produce insulin or
not enough of it, to assist the bodys cells with glucose absorption. The management
of diabetes would depend on whether the individual has type 1 or type 2 diabetes.

Education Making sure one is aware of the type (Type 1 or Type 2) of

diabetes one has is very important, with type 1 the body produces no insulin
to unlock the cells and with type 2 diabetes there is not enough insulin or the
insulin in the body is not working properly. When newly diagnosed with
diabetes, one might have a number of questions about how it works, what
happens when your blood sugar gets too high and various other question. The
best way to understand how to manage the disorder is to know as much as
possible about the disorder. Knowing the facts and being able to ignore the
myths that surround diabetes is extremely important. The NHS offer suitable
courses on diabetes that will assist in education and support.
Medication People with type 2 diabetes will require medication and/or
insulin. The medication assist the individual to maintain a low blood glucose
level. The type of medication you require will depend on your own individual
needs and situation.
Health and Wellbeing Seeing that Type 2 diabetes is a progressive condition
, many individuals find that despite keeping to a healthy diet, physical activity
and taking your diabetes medication regularly, controlling diabetes becomes
harder and harder to manage and control their blood sugar levels
Emotional Support Living with diabetes might have a emotional impact on
an individual specifically when diabetic life event take place (diagnosis,
starting insulin, and on developing complications). Most individuals find a way
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MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

of coping with the emotional distress by talking to family and professionals.

They often educate themselves more in order to understand the new
diabetic life event. Others might not be this lucky, some individuals suffer from
depression. Speaking to a counsellor face-to-face might be of great help, then
the best route to take would probably be to go through your GP.
Diabetes UK suggests the following tips for living with diabetes
o Not to panic contacting the diabetes team will assist you with all your
queries and the steps that is needed on your part
o Always take insulin and / or diabetes medications even if you don't
feel like eating.
o Testing your blood more often and be aware of the sings of
hyperglycaemia.
o Avoid dehydration, and eat little and often.
o If you don't feel like eating, are feeling sick or can't keep any food
down, replace meals with snacks or drinks containing carbohydrates,
which will provide energy.

Multiple Sclerosis (MS) MS is a chronic condition of the central nervous system. The
myelin (the coating around the nerve fibres) are damaged, causing a variety of symptoms.
According the MS society there are more than 100 000 individuals in the United
Kingdom living with MS, with a woman to men ration of 3:1 . There are 5 different types

of MS: relapsing remitting MS (RRMS), secondary progressive MS (SPMS),

primary progressive MS (PPMS), benign MS (BMS) and MS in children. The coping
strategy will depend on the type of MS the individual has.
Disease modifying treatments Although theres no cure for MS, there are
some treatments (disease modifying drugs DMD) that could assist to reduce
the frequency and harshness of relapses, unfortunately this only works for
individuals with RRMS and not for PPMS. The NHS currently have 10
licensed DMDs listed, unfortunately all of them are not always available.
Exercise Staying healthy and doing regular exercise is always helpful and
could improve some of the symptoms and the effects of MS that some
individuals encounter. Exercise could improve your overall health, keep you
mobile and as active as possible, decrease the risk of heart disease in some,
improve muscle strength and assist with weight management in conjunction
with a healthy diet.
Physiotherapy With the assistance of a physiotherapist, individuals with
MS could improve their movement and other functions that they have physical
difficulties with. Physiotherapy could also assist in other health related issues
like - balance, posture and fatigue, bladder problems, pain and muscle
spasms and stiffness. The NHS might not offer you continued physiotherapy
but give you a limited number of sessions.
3. Conclusion

MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

Coping strategies are a daily necessity for individuals suffering with chronic
disorders. Taking control of ones life in such a manner that it makes a difference in
everyday experiences is the essence of coping with the disorder. Approaching the
disorder with adaptability and confidence allows one to develop new skills and habits
that works best for the individual. Making smart choices about where one focus ones
time and energy is essential to assist the individual to live a better life.

References

MONIQUE MAVRONICOLAS COPING WITH CHRONIC HEALTH DISORDERS

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