HEALTH, ILLNESS

AND ILL BEHAVIOR

Dr. Santosh kumar
Assistant Professor
Dept. of Psychiatry
12/27/15

PATIENT
Importance of Patient
Primary importance
in our life

All learning &

teaching

PATIENT

Ultimate goal
To treat patient

Treat the patient--Not the illness

12/27/15

HEALTH
WHO definition :
Health is a state of complete physical, mental
and social well being and not merely the
absence of disease or infirmity.
Important components of health are :
Physical fitness
Psychological well being
Appropriate social relationships
Expected level of functioning
12/27/15

Disease , Illness and Ill

behavior

Disease is a characteristic grouping of

physical signs and symptoms, it is given a
specific name and can often be traced to a
specific causal agent.
Eg. Viral Hepatitis

12/27/15

Disease , Illness and Ill

behavior

Illness is a broader term that involves

peoples beliefs about the state of their
physical or psychological well being.
Eg : Viral Hepatitis causing Jaundice.
A person of hepatitis believes that
jaundice is due to some supernatural /
non human factors.
12/27/15

Disease , Illness and Ill

behavior

Illness behavior refers to the way, the symptoms are

perceived, evaluated, and acted upon by the patient.
Examples
Same patient of hepatitis seeking spiritual treatment from
faith healers, instead of going to doctor.
A person, diagnosed as a case of Angina pectoris,
refuses to take treatment with a belief that he has got no
illness and does not require any treatment.
A person suffering from mild chest pain due to skeletal
muscle spasm paying frequent visits to a cardiac
emergency, inspite being told by doctors that he has no
cardiac problem
12/27/15

Disease , Illness and Ill

behavior
It includes:
Consulting doctors
Taking medications
Giving up inappropriate activities
Seeking help from relatives and friends

12/27/15

Disease , Illness and Ill

behavior
These behaviours are adaptive in the early
stages of illness, but may become
maladaptive if persist into the stage of
recovery, when the patient should be
becoming independent.
Illness beh: results from the persons conviction
that he is ill rather than from the objective
presence of disease, and it may develop
when no disease is not present.
12/27/15

Disease , Illness and Ill

behavior

Illness beh: without disease is an important

problem in the general practice, and once
firmly established it is difficult to treat.
The concept of illness beh: overlaps with that
of sick role but two are described separately
b/c they have different origins.

12/27/15

Disease , Illness and Ill

behavior
Sick role:
Society bestows a special role for the people
who are ill, which is made up of two privileges
and two duties:
Exemption from certain social responsibilities
The right to expect help and care from others
The obligation to seek and cooperate with
treatment
The expectation of a desire to recover
12/27/15

10

Disease , Illness and Ill

behavior

While the person ill, the sick role is adaptive.

If people continue in the sick role after illness
is over, recovery is delayed since they
continue to avoid responsibilities and depend
on others instead of becoming independent.

12/27/15

11

Case No. 1
A young man consults his family physician for the
complaints of :

cough since one week

fever since three days

chest pain since one day

After examination, the doctor reveals that he is suffering
from chest infection. He prescribes certain drugs and
asks him to pay a follow up visit after two days.

12/27/15

12

Case No. 2

A 30 yrs old man seeks treatment from a doctor for three

months history of nonspecific symptoms like headache,
body aches, weakness, exhaustion, a feeling of
giddiness. He has been treated by a number of doctors
but his symptoms still persist. He has also had several
investigations done in this regard. After a thorough
physical examination and a detailed view of his reports,
the doctor concludes that there is no physical
abnormality.. The patient does not get satisfied and
decides to go for a second opinion to another specialist

12/27/15

13

What is the difference in illness of the patient in case

no 1 & case no 2?
Is there a difference between disease, illness and ill
behavior ?

12/27/15

14

SOMATIZATION
Somatization is the psychological mechanism
whereby psychological distress is expressed in
the form of physical symptoms.
In somatization, distress is referred to, and
expressed by, the body mostly due to
underlying psychological factors.

12/27/15

15

FACTS ABOUT
SOMATIZATION

The prevalence of somatization at the clinic of a

primary care physicians ranged from 10% to 30%
Somatization is considered to be more prevalent in
our culture as compared to developed nations--reasons being---low socio economic status, illetracy,
lack of awareness about psychological illnesses,
paucity of verbal expression of stresses
Somatization is more common in females and
children.
12/27/15

16

HYPOCHONDRIASIS

Wrong belief or preoccupation of mind with

the presence of a physical illness, which in
fact is not there.
No or minimal physical symptoms are
present but patient visits frequently to
different doctors, however a background may
be present.
Eg ; A man whose father had died of
myocardial infarction, recently, has got a
strong belief that he may die of same illness.
12/27/15

17

CONVERSION DISORDER
(Hysteria)
Conversion Disorder is a psychological disorder where

people experience motor or sensory symptoms that are

psychological in origin and cannot be explained by a
medical condition. Examples
Sudden but transient loss of speech
Sudden but transient but loss of vision
Loss of sensation in some parts of body
Loss of power in some parts of body
Atypical fits

Underlying psychological factors are responsible

12/27/15

18

Case No. 3

On getting up from bed and preparing to go

to school, a student of class two complains
that he is feeling severe pain in abdomen
and is unable to go to school. The parents
feel he is not well and ask him to take some
rest. After a while his pain subsides and in
an hour or two he is happily watching
cartoons..
12/27/15

19

MALINGERING

Malingering is the act of intentionally feigning

or exaggerating physical or psychological
symptoms for personal gain.
Person is likely to get some gains or
exemptions by adopting this fake behavior.
Very commonly seen phenomenon.

12/27/15

20

Our approach towards a

complaint
! a slight cramp in your
Imagine you have

stomachWhat attribution will you make? (why did it

occur?)
What will your self diagnosis be?
What will you do about it?
What factors that influence your perception
and interpretation of symptoms?
12/27/15

21

PERCEIVING & INTERPRETING

SYMPTOMS

Knowledge
Past experience
Personality
Expectations
Cultural beliefs
Mood
Discussion with someone
Differences in point of view
12/27/15

22

SOCIAL FACTORS:
Number of Doctor Visits Per Year

a) AGE

<5

5-14 15-44

12/27/15

45-64

65-74

75+

23

Percent Rating Health as

Excellent or Very Good

b) Gender

12/27/15
24

Other Variables

c) Marital Status ?
d) education- medical care increased with
education
e) family size - care decreases with increased
size
f) socio-economic status---low socioeconomic
status is proportionate with in increased
disease burden and less care
12/27/15

25

What factors determine

the healing process?

Cultural differences
Placebo effect
Beliefs
Faith healing

12/27/15

26

DELAYING VS.
TAKING ACTION
Notice
symptoms

Am I
ill?

Appraisal
delay

12/27/15

Do I need
professional
care?

Illness
delay

Is that care
worth the
cost?

Enter
treatment

Utilization
delay

27