Introduction to Medical Psychology

What do you think about the following?

 What is Psychology & what do it studies?

 What is the goal of Psychology?
 Do you think that Psychology is related with Health Science?

- Yes, Why?
- No, Why?
 Then, what is Medical Psychology?
 1. Introduction to medical psychology
1. 1. Over view of Medical Psychology?
• Asken (1979) has provided the broadest definition. He has
defined medical psychology as "the study of psychological
factors related to any and all aspects of physical health, illness
and its treatment at the individual, group, and systems level.

• Gentry and Matarazzo have defined medical psychology as "the

practice of psychology within the medical school establishment.

• Medical psychology is a branch of psychology which studies the

psychology of the patient, the role of psychic factors in the origin
and development of the disease, the psychology of relationships
between doctor, staff and patient, as well as the use of a
psychological approach in medical practice.
 Cont...
• It uses psychological theories and interventions to
prevent damaging behaviours (such as smoking, drug
abuse and poor diet), and to change health-related
behaviour in community and workplace settings.
• Medical psychologists concerned with the application
of psychological principles to the practice of medicine
and both physical, as well as, mental disorders. They
apply psychological theories, scientific psychological
findings, and techniques of psychotherapy, behavior
modification, cognitive, interpersonal, family, and life-
style therapy to improve the psychological and
physical health of the patient.
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 Cont..
• Medical Psychology is the branch of Psychology that studies:
 the psychology of the patient, the role of psychic factors in the
origin and development of the disease,
 the psychology of relationships between doctor, staff and
patient; and
 the use of a psychological approach/theoretical principles in
medical practice.
 looking at the psychological impact of acute and chronic illness
on individuals, carers and families
 investigating the processes that can explain, predict and
change health and illness behaviours.
• Thus, it is connected with all medical specialties (therapy, surgery,
obstetrics, gynaecology, paediatrics, hygiene and others).
• In addition, it focused on physicians ethical conduct while treating
patients suffered from disorders/health problems.
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 Cont...
• The intent of Medical Psychology is to apply knowledge
from all branches of psychology and medicine in the
prevention, assessment, and treatment of all
forms of physical diseases .
• The main themes of medical psychology
► Psychological factors influencing the development or
progression of disease Etiology.
► Patient’s response to illness and disease Outcomes
► Communication with patients and colleagues- Relational
issues.
► Doctor-patient relationship,
► Patient’s attitude toward the disease and the health
problem
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 Medical psychology conti…

• To achieve its goal, Medical psychology uses such methods

including:
 Methods of Observation: a doctor or a psychologist passively
observes the patients' mentality.

 Method of Clinical Interview: a doctor or psychologist, make a

face to face contact with a patient to get information about the
patients’ problem.

 Experiment: examining the patient by controlling other variables.

 Psycho-diagnostic: testing the hypothesis and interviewing the

problem.
 1.2. Responsibilities of Medical Psychologists?

• Psychotherapy: helping patients to manage the emotional

aspects of chronic illnesses.
• Pain Management: finding ways to curb the physical
symptoms of a disease and minimize the side effects of
treatments.
• Pharmacology: prescribing psychotropic medications for
patients with mental issues or disorders, yet they need to have
prescriptive authority given by responsible body.
• Behavior Therapy: initiating and implementing behavioral
interventions and stress reduction techniques that will
positively affect patients' psychological states and their
immune systems.
 2. Human Development

• Developmental Psychology?
• Subfield of psychology that studies physical, cognitive, and
social changes throughout the life span.
• It is more than just child development!

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 Basic Terms in Human Development

• Growth:
o Physical change i.e growing in height, weight, hair e.t.c
o Quantitative change (it is visible, obvious and measurable).
• Maturation:
o explain changes in body or behaviour due to aging process.
o age-related physical, physiological or behavioural changes.
o comes from the individual’s genetic endowment and it is relatively
free from the influence of environment.
o represents the readiness or ripening of a certain growing body to
start its function, as ripening of the brain to begin to think, the
reopening of sex organs for reproduction and soon.
o “qualitative change” because of the unfolding of inherited
tendencies.
 Basic terms conti…
• Learning:
o Refers to a relatively permanent change in behaviour as a
result of experience or practice.
o Unlike maturation, learning strongly depends on
environmental influence.
o The concept of learning implies making practice and
experimentation or performing activities using the grown &
maturing body.
o Examples of learning can be ability to write, read, swim,
play a certain game etc.
o This change do not include change because of maturation, &
temporary change such as drugs usage, fatigue and illness.
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 Basic terms conti…
• Development:
o is a systematic change and continuities in the individual
that occur between conception and death or ‘womb’ to
‘tomb’.
o These are not accidental changes.
o It is a progressive series of changes that occur in an
orderly and predictable pattern.
o The change is not only continues but also gradual.
o It is a series of orderly progression of changes towards
maturity.

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 Aspects of Development
1. Physical Development (PD)
• Refers to any physical change in all aspects of the body in
terms of height weight, size, and /or amount.
• Includes changes in the height or weight of physique, in
the size of the brain, sensory capacities, motor skills, and
health.
• PD is considered as basic aspect of development since it
establishes foundation for any other aspect of
development.
• For example, a child’s language development depends on
the growth and maturity of body parts (the tongue, lips,
tooth, etc) important for speech.
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2. Cognitive Development

• Refers to changes in underlined cognitive processes or

mental abilities, such as thinking, perception, reasoning,
learning, language, memory, imagination that help us
interact with the world around us.
• Human cognitive development is highly related with the
function of the brain.

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3. Psycho-social Development
 It refers to changes in an individual’s psychology and
social relationship. It includes changes in:
• Personality a person’s unique and relatively stable
pattern of behaviour;
• Social Development implies relationships with other
people as friendship, love, obedience, power etc.
• Emotional Development change related with feelings
such as anger, joy, jealousy, fear, depression, surprise etc;
and
• Moral Development change in reasoning and evaluating
ethical issues, i.e., what is right or wrong, good or bad,
acceptable or unacceptable.
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 Stages of Human Development

 Stages of development is seen as prenatal & Postnatal.

1,Prenatal Development: it refers to the time period which
ranges from conception to birth.
 After fertilization of male’s sperm cell and female’s egg cell, a
single cell organism called “zygote” is formed .
 This growth is divided in to the following three stages.
1. Germinal /zygote period (conception up to two or three
weeks)
 The zygote continues to divide and subdivide into different
cells enclosed in a hollow ball of cells- called blastocyst, a
freely floating mass in the uterus.

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 Cont’d
2. Embryonic period (from two or three week up to three
month)
• Characterized by a rapid growth of body organs.
• Major body systems and organs formed and
differentiated .
3. Fetus period (from three month up to Birth)
• The final stage of gestation period.
• Advanced development of different body organs and
systems.
• Central nervous system develops very rapidly.

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 Determinants of Prenatal Development

1. Mother’s health
• Different diseases attacking the mother. It include STIs,
which result in retardation, deafness and even death of the
fetus.
2. Malnutrition of the mother
– It is related to fetal deformities and impaired physical,
intellectual, & behavioral development.
– These includes, Mental retardation, low birth weight,
susceptibility of various types of disease, premature
abortion.

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 Con’t
3. Emotional Disturbances of the Mother
• It is like stress and anxiety are found to produce turbulence in the
body chemistry.
• This is because they activate the autonomic nervous system causing
endocrine glands to discharge more amounts of certain chemicals
like cortisone, adrenaline and other hormones into the blood
stream.
• These substances pass through the placental barrier and affect
(irritate) the fetus.
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 Con’t
4. Age of the Parents
• The maternal ages commonly associated with abnormal prenatal
development are ages below 20 and over 35.
• The mother under age 20 faces:
– A greater risk of toxemia (a disorder involving high blood
pressure, excessive weight gain).
– Anemia (deficiency of red blood cells and iron )
– Labor complication and premature birth.
• Mothers beyond the age of 35
– Experience illness during pregnancy
– Face longer and difficult labor
– The chance of bearing underweight babies.
– Increased of bearing a child with chromosomal abnormalities
(e.g., Down’s syndrome - a genetically transmitted form of
mental retardation caused by the presence of an extra (47th)
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 Con’t….
 So, the safest period to give birth to a healthy (normal) child is
between the ages of 20 – 35.
5. Drugs
• It refers both prescribed and non prescribed drugs.
Prescribed drugs taken by pregnant woman like thalidomide
for the treatment of morning sickness in early pregnancy.
• Non prescribed drugs (drugs not prescribed by physicians)
are available either legally or illegally. Caffeine, alcohol,
and nicotine are legally taken drugs, where as marijuana,
cocaine, morphine, heroin, and etc. are illegally taken drugs
which all of them have negative impacts on the
development of a new life in the mother’s uterus ( such as,
mental retardation).
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2. Post natal Development
Post natal development refers to the whole development after
birth.

1.Infancy ( 0 to 2 years)

2. Early Child hood ( 2 to 6 year)

3. Late Childhood (7 to 11 years)

4. Adolescence (12 to 18 years)

5. Early Adulthood (18 to 40 years)

6. Middle Adulthood (40 to 65 years)

7. Old Age (> 65 years)

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Controversial Issues in Human Development

Nature Vs Nurture
Which has more impact on development?
Nature (also called nativity) – argues that development is
primarily influenced by biological inheritance (heredity).
 They argued that individuals are born with an inherited blue
print and also they believe that environment has little to do so
with individual development, the possibility is little to change
what nature has provided.
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 Con’t
Nurture (also called empiricists) – claim that environmental
experience are the most important to determine development.
 They believe that the child mind is a blank slate (tabula rasa) at
birth on which experience writes on it and determine our
knowledge.
• Recently, a new alternative view on this issue has developed
which is commonly termed interactions.
• By taking the middle ground, interactions it’s argued that nearly
all human development results from the interaction effect of
nature and nurture.
• This group assumed that both heredity and environment equally
play role in human development.
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 Continuity Vs Discontinuity

• Does change in development occur smoothly overtime or

through a series of pre-determined steps?
 Continuity
• They see development in terms of gradual, smooth,
cumulative and continues process.
• They see no stages.
• They argued that it is possible to predict later behavior
from previous one as development always governed by
the same process.

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 Con’t
 Discontinuity
• They believe that each person passes through a sequence of
stages.
• In each stage there is new ability and way of thinking and
responding occur.
• Each stage is characterized by distinct ways of functioning such
as children proceed from one stage to another stage of
development just like as they climb the rungs of the ladder.
• However, contemporary psychologists recognized the merit of
both sides of the controversy i.e both continuity and
discontinuity can be found in development.

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 Theories of Human Development
1. Psychoanalysis theory of Human Development
The father of this theory is S. Freud
He emphasized four important issues linked to human
behavior or development.
 Level of consciousness (consciousness, sub- consciousness
& unconsciousness).
 Personality structure (id, ego & the super ego).
 Psychosexual development (the five stages).
 Ego- defense mechanism (conflict resolution strategies).

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 Con’t
• In Freud’s theory, the parts of the body that have specially
strong pleasure giving qualities at each stage of development
are called erogenous zones.
• Is persons body part on which the person is sensitive in
sexuality.
• It become the center of new pleasure and conflicts.

• Fixation is a situation when an individual is stick to certain

activities as a result of unresolved conflicts of the demands of
the reality and the gratification need of an individual.
• Fixation occurs when a person unsatisfied or over satisfied
in psychosexual stages.
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 Freud's’ Psychosexual stages….
Stages Erogenous Characteristics‘ Consequence/
zone / behaviour Fixation
Oral mouth Oral activity -Over indulgence/over
(birth-1 such as sucking satisfaction/: leads the

year) and biting child to dependency,

inactivity.
Under indulgence /
under satisfaction /
leads to sadism,
aggression e.t.c.
 Con’t
- It is toilet training -Those who
Anal
Anus stage- babies enjoys develop anal retentive
(1-3 year) by sitting too much personality become rig
time on pooh-pooh.
id, excessively neat,
Anal Retentive and
clean and selfish.
anal Expulsive beha
-Those who develop
viours may develop.
anal expulsive
personality become
irresponsible, rebellion
and destructive.

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 Con’ttends
Children’s to False identification
Phallic Immature
have sexual attraction with the same sex
(3-6) genitals
towards opposite sex parent i.e. boys
/early tend to like what
parent. Oedipus
child the father likes and
complex _ Castration
hood) girls tend to like
anxiety for males.
what her mother
Electra complex – Pens
likes.
envy _ for females.
Gradually this
problem is solved vi
a identification.

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 Con’t
Latency A stage at which sex Sexual related Repression of
(7-11/12 ual desires become Desires are sexual desires
years) dormant (forgotten) directed to to solve
other non conflicts faced
sexual during phallic
behaviour like stage.
mastering
cultural &
school skills.

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 Con’t
Genital Matured Reappearance of Adult
(>=12years) sexual sexual desires in sexuality
organs socially accepted possibly
manner, as hetero- leads to
sexual with persons marital life.
outside the family. Or
establishing
relationship with
opposite sex peers.

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Psychosocial Theory of /E. Erikson

• Erikson attempt to modify and extend psychoanalytic theory

instead changing it.
• As to him personality development is the result of
continuously changed body and environment interaction.
• It is also the process of facing and successfully resolving the
various developmental crises that emerge at the eight different
periods /stages or crisis/ with respected “basic virtues” (basic
or adaptive strength, helpful personality development ).
• Each stage characterized by conflict between two
opposite position of attitudes or emotional forces and
disposition.

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Erikson's’ Psychosocial Stages
Basic Conflict Outcome
Or Stage
Trust vs. Mistr Children develop a sense of trust when
ust caregivers provide reliability, care, and affection.
Birth to 1 year A lack of this will lead to mistrust.

Autonomy vs. S Children need to develop a sense of personal

hame and control over physical skills and a sense of
Doubt independence including toileting, feeding,
1 year to 3 years walking and talking.
Success leads to feelings of autonomy, failure
results in feelings of shame and doubt.

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 Con’t
Initiative vs Guilt -If children’s self-initiated activities earn
3 to5 years approval and encouragement from their
parents, they develop a sense of initiative.

-Initiative is also supported when parents

answer their children’s questions. In contrast if
children action plans earn disapproval from
adults they develop guilt.

Industry vs. Concern for perfecting specific skills or

Inferiority competencies that they deem important.
6 to 11 years Success leads to a sense of competence, while
failure results in feelings of inferiority.

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 Con’t
Identity Vs Role- Teens need to develop a sense of self and
confusion personal identity. Success leads to achieve a
12 to 18 years sense of identity. They know who they are
and where they are going.
On the other hand, those who can’t get
answer for the questions of identity and
remained locked in doubt and develop a
sense of identity confusion.

Intemacy vs Young adults need to form intimate, loving

Isilation relationships with other people.
19 to 40 years Success leads to strong relationships, while
failure results in loneliness and isolation.
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 Con’t
Generatively vs Become concerned with guiding and
Stagnation contributing to the next generation. Often for
40 to 65 years their children or a positive change that benefits
other people.
Success leads to feelings of usefulness and
accomplishment, while failure results being
stagnate, and become concerned with personal
needs and being self-concerned.

Integrity vs. Older adults need to look back on life and feel a
Despair sense of fulfillment. Success at this stage leads
65 to death to feelings of wisdom, while failure results in
regret, bitterness, and despair.

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 Class Discussion
• How do you associate human development with the
overall health status?
• Do think that health care providers are sensitive to
deliver developmentally appropriate health and care
services for patients?
• Share with class the knowledge and skills you
acquired from this course that you hope to apply in
your future career?

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2. Piaget’s Cognitive Development

• A Swiss psychologist who is regarded one of the major

contributors in terms of cognitive development.
• Cognition implies all the mental activities associated with
thinking, knowing, and remembering using schema.
• Piaget believes that children pass through a series of sequential,
universal, and invariant stages.
• Cognitive functioning begins as babies respond to what they
can touch, taste, or see.

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 Con’t
• As per him, we need to focus on what is going on our head,
b/se our actions are a direct result of the way we process
information from our environment. ‘’We are what we think’’
• A Cognitive therapist attempts to change the way you think.

Then ,what are some of

the thoughts John may
John meets a girl… be having?
She rejects him & he
He has high hopes.
doesn’t even get her
number.
 Principles of cognitive development

• Piaget suggested two psychological mechanisms that are

responsible for the development of our cognitive knowledge.
A. Organization
• It refers to the connection among the cognitive structures.
• It refers to a process of logical arrangement of thoughts and actions
in to a meaningful pattern.
B. Adaptation
• In order to survive, and individual must adapt to the demands of
the environment.
• It refers to changing the existing cognitive structure to suit to a
new situation or changing a new situation to suit to the existing
cognitive structure.
• Such adaptation takes place through the processes of assimilation
and accommodation.
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 Five stages of CD…

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 3. Health, Behavior and
Psychology and certain aspect of
health
 Cont...
• The importance of psychology for health and
medicine is increasingly recognised, and
psychological topics are now part of most
training programmes in medicine and other
healthcare professions

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 Health and Behaviour
 How do you know when you are healthy/unhealthy?
• To answer this question, let’s first consider what illness is.
• Illness beliefs may be the result of a specific disease or just the
way we feel when we say we are ill (even when there is no
evidence of a disease).
• A disease is what the physician recognizes as a specific disorder
based on known signs and symptoms.
• Health is the absence of disease.
• World Health Organization (1946) defined health as ‘a state of
complete physical, mental, psychological and social well-being
and ... not merely the absence of disease or infirmity’.
 Cont…..
 A key element of the wellness model is striving for balance.
When all of the seven dimensions are at high levels and in
balance, we have optimal health and well-being.
i. Physical Health: is reflected in how well the body performs
its intended functions.
ii. Intellectual well-being - The ability to learn and use
information effectively for personal, family, and career
development. It is the ability to process information
effectively. It involves the capability to use information in a
rational way to solve problems and grow. This dimension
includes issues such as creativity, spontaneity, and openness to
new ways of viewing situations.
 Con’t
iii. Emotional: Emotional well-being means being in touch with
your feelings, having the ability to express them, and being able
to control them when necessary. Optimal functioning involves the
understanding that emotions are the mirror of the soul.
iv. Social: Social well-being involves being connected to others
through various types of relationships.
v. Spiritual: Spirituality is a belief in or relationship with some
higher power, creative force, divine being, or infinite source of
energy (Fowle; 1986).
vi. Environmental: Environmental well-being involves high-level
of functioning on two levels.
a. Micro-environment, consists of your school, home,
neighborhood, and work site.
b. Macro-environment, the level of wellbeing at a larger level
—state, country, and the world at large.
 Con’t
vii. Occupational/Vocational: Occupational/vocational well-
being involves issues related to job wellness. It encompasses
everything from the safety of your particular work site to the
nature of your career.
-Work-site well-being includes both
a. physical (e.g., air, water, physical plant, machinery) and
b. social (e.g., relationships with coworkers, management,
health and wellness facilities and activities) factors.

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 Cont..,
In general Health operates on many levels such as
the physical, subjective, behavioural, functional,
and social. One survey of around 9,000 people
found that people think of health in six different
ways (Blaxter, 1990):
• 1. Not having symptoms of illness.
• 2. Having physical or social reserves.
• 3. Having healthy lifestyles.
• 4. Being physically fit or vital.
• 5. Psychological wellbeing.
• 6. Being able to function.
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 Models of Health and Illness
• Biomedical Model
• The biomedical model of health and illness
maintains that;
– Historically, dominant paradigm.
– Health and illness are qualitatively different. You are either
healthy or ill; there is no continuum between them.
– Illness may have psychological consequences, but not
psychological causes.
– Individuals are not responsible for their illnesses, which are
from biological changes beyond their control. People who
are ill are victims.
 Cont...
• Diseases either come from outside the body
and invade it, causing internal physical
changes, or originate as internal involuntary
physical changes; such diseases can be caused
by chemical imbalances, bacteria, viruses or
genetic predisposition.
• Treatment should consist of pharmacotherapy,
vaccination, surgery, radiotherapy, all of which aim to
change the physical state of the body.
• Responsibility for treating the illness is placed solely on the
medical profession

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 Why the Biomedical Model no longer
applies?
• The influence of lifestyle factors is incompatible with the
biomedical model. (Stroebe, 2000).
• Conceptualization of disease in purely biological terms means
that the model has little to offer the prevention of chronic
diseases through efforts to change people’s health beliefs,
attitudes and behavior.
• The biomedical model has a reactive attitude towards illness.
Traditional medicine is more focused on disease than on health.
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 Con’t

• Bio psychosocial Model

o Current dominant paradigm
o It developed as a reaction to the biomedical one.
• The causes of the illness are seen as multi-factorial.
• Psych cannot be separated from body.
• Focus on both health and illness.
• Focus on both treatment and prevention.
• Organ damage generates the person’s distress.
• Medical staff, society and the sick person are regarded as
responsible for prevention, treatment and recovery.
 Con’t
• Illness is often caused by a combination of biological ( e.g.
viruses, bacteria..) and psychological (e.g. behavior and
beliefs) and social (e.g. poor housing, unemployment) factors.
• The Bio psychosocial model offers a holistic approach.
- The person as a whole has to be looked after. Both at micro-
level e.g. causes, such as chemical imbalance and at macro-
level, such as the extent of social support need to be taken into
account. These processes interact to determine someone’s
health status.

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 …Con’t
• The Bio-psychosocial Model
• The bio psychosocial model adopts a more proactive
attitude towards health.
• Bio: genetic, viruses, bacterial, lesions, structural defects,
gender….
• Psycho: Cognitions (e.g. expectations of health),
Emotions (e.g. fear of treatment),
Behavior (e.g smoking, exercise, diet,
alcohol consumption, stress, pain).

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 Cont......
• The biopsychosocial model takes into account the
psychological, interpersonal and societal influences
in the diagnosis and treatment of patients. The
components of the biopsychosocial model add to
the purely biomedical model of clinical care which
focuses on pathology and the mechanisms of
disease and therapeutics. A medical man had to
pay attention to the biopsychosocial aspects in
conjunction with the biomedical principles in
delivering clinical care, providing education,
community service and conducting research.
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 Cont...
• Any comprehensive framework for understanding
health and health care services must embrace both
psychological and sociological aspects of well-being
and their interactions with biological processes .
Health depends on our perceptions, beliefs and
behaviour and how these interact with physical
systems such as the endocrine, immunological and
cardiovascular systems. At the same time our
perceptions and behaviours are shaped by our social
context. Understanding how social, psychological and
biological processes interact to create differences in
health is what is meant by adopting a biopsychosocial
perspective.
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 Key Beliefs that inform the Bio-psychosocial
Model
• Individuals are not just passive victims, but are responsible for
taking their medication and changing their beliefs and
behaviour.
• Health and illness exist on a continuum-people are not either
healthy or ill, but progress along a continuum in both directions.
• Psychological factors contribute to the a etiology (causes) of
illness. They are not just consequences of illness.
• According to Ogden (2002) health psychology aims to:
• Evaluate the role of behaviour in the a etiology of illness, such
as the links between smoking, coronary heart disease,
cholesterol level, high blood pressure.
• Predict unhealthy behaviours- for example, smoking, alcohol
consumption and high fat diets are related to beliefs and belief
about health and illness can be used to predict behaviour.
Illness-wellness Continuum

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 Cont...
• According to the BPS mode, disease can be
comprehensively understood only when taking into
account the 4 systems:
• a) biological system - anatomical, cellular and
biochemical factors;
• b) personality system - motivations, habits and cognitive
performance:
• c) social system - the characteristics of large groups of
people (e.g. family, country) influence the dynamics of
various diseases;
• d) culture system - customs, beliefs, behaviours of the
group the individual lives with, affect their health and
disease.
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 Psychological aspects of Health: Motivation

 Motivation is a force that initiates someone to do or not to do

something.
 It is a behavior that initiates, directs and sustains a person to satisfy
his/her physiological or psychological needs.
 Psychologists see motivation as an important part of human nature.
 Connects observable behavior to internal states

 Accounts for variability in behavior

 Creates determination despite hardship

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 Cont...
• Motivation refers to the force that energizes, directs,
and sustains behaviour. Motivation is a force that serves
three functions: It energizes, or causes people to act; it
directs behaviour toward the attainment of specific
goals; and it sustains the effort expended in reaching
those goals.
• Motivation is the will to do, and the will to do well.
Motivation can also be seen as a source of positive
energy influencing people’s lives, whether at their
workplace or in their private life.
• Motivation is the force behind human performance. It
can arise from physiological or psychological needs,
thoughts, or emotions.
 Motivation

 There are concepts which are related to motivation.

i.e.
• Needs: Are specific states within the organism which is
based on some deficit and that may elicit behavior.

• Drives: these are internal states within the organism

which pushes the organism in to action toward a
particular goal.

• Incentives: these are an external stimuli that motivates

behavior such as money, fame e.t.c.

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 Classification of motivation
• Motivation can be classified based on the presence and absence
of secondary gain and based on their source.

• Based
on the presence and absence of secondary gain, motivation
can be :

1.Intrinsic Motivation: is a desire of one to perform a task for it’s

own sake and because it is satisfying or pleasurable for
him/herself.

2) Extrinsic Motivation: is the desire to perform behavior in order to

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obtain an external reward such as praise, money, grades.
 Motivation

• Based on there source generally there are two kids of motives.

1) Primary Motives:

 Are motives based on physiological needs

 These critical level are regulated by homeostatic mechanism

 These mechanism sense imbalances in the body and

stimulate actions that restore the proper balance.

2) Secondary Motives:

 They are motives that are learned in the social environment.

06/23/2024
 Cont...
• Clearly, motivation is relevant to health and
healthcare professionals. Understanding biological
motivations can help us treat abnormal extremes of
biological drives, such as obesity, eating disorders,
smoking, addiction, risky sexual behaviour, and
insomnia. Understanding social motivations can help
us comprehend our own behaviour and what
motivates us to work as healthcare professionals. It
can also help us empathise and deal better with other
people’s behaviour that we might not understand.
Knowing more about another person’s motives means
we can address situations more constructively.
06/23/2024
 Cont...
motivated behaviours affect the health of a
person in different ways. For instance;
 motivation to seek medical attention or
information,
 motivation to adhere/ follow doctor’s orders,
 Motivation for pain management, and
 Motivation to use complementary and
alternative forms of medical care and
practices.

06/23/2024
 Personality and health
• Personality of the patient with its inherent
character, temperament, attitudes, interests, etc.
largely determines not only the type of psychotic
symptoms, but also the subjective attitude to the
disease and the characteristics of the advancing
psychogenic reactions to the disease.
• It has been reported that complaint behaviour is
related to personality .In headache cases, muscle
tension , the pain reported, the pain behaviour and
the level of complaint may reflect personality rather
than the muscular state.
06/23/2024 69
 Personality and health
• The concept of personality refers to the profile of stable
beliefs, moods, and behaviors that differentiate among
children (and adults) who
live in a particular society.
• Type A personality'" is supposedly hypertension - and
coronary heart disease-prone. They are characterized by
competitiveness and achievement orientation; aggressiveness
and hostility; sense of time urgency.
• Type C personality" is supposedly cancer-prone. They have
difficulty expressing emotion; tends to suppress or
inhibit emotions, particularly negative ones such as anger;
display ‘pathological niceness', conflict avoidance, high social
desirability, over compliance and over-patience.
06/23/2024 70
 Cont....
• There are five main personality traits: openness to new
experience, conscientiousness, extraversion, agreeableness,
and neuroticism . Of these, conscientiousness and
neuroticism are considered more fully here because they are
most consistently
linked with health (Heilmayr & Friedman, 2018).
Conscientious people are defined as having self-discipline
and being efficient, organised, reliable, responsible, etc.
Evidence suggests conscientious people live longer, although
this is probably due to the fact that
conscientious people are more likely to practise positive
health behaviours, such as exercising, and less likely to
practise negative health behaviours, such as smoking.

06/23/2024 71
 Cont...
• Neuroticism is the personality trait with the most obvious
emotional component.
People who are high in neuroticism experience a wide
range of negative emotions, such as
low mood, anxiety, guilt, hostility, and fear. People high in
neuroticism report more
somatic symptoms and are more at risk of psychological
disorders.
• As compared to Pessimism, Optimism is associated with
better psychological wellbeing and with some measures
of physical wellbeing, such as better recovery from
myocardial infarctions and heart surgery

06/23/2024 72
 Attitude and health
• Attitudes can be defined as a measure of people’s like or dislike of an object.
The ‘object’ may be a real object, a person, or a behaviour such as ‘healthy eating’.
Attitudes reflect what we think and feel about something and how we plan to behave

The psychological factors of beliefs and attitudes about illness and treatment are
major determinants of health outcomes.

• Attitudes of pessimism, sense of being trapped, problems personal failure, or lacking

a worthwhile future

• Attitudes toward health, illness, and health

care providers; perceived threat of illness; perceived control over psychological and
physical symptoms
• The Theory of Planned Behaviour (TPB) suggests that healthy behaviour can be
promoted by changing attitudes, normative beliefs, and feelings of control over
behaviour.

06/23/2024 73
 Typology of the attitude to illness

1. Normal, that is corresponding to a condition of the patient or

that reported to it about disease.
2. Scornful (disrespectful), when the patient underestimates
gravity of disease, it is not treated.
3. Denying, at which the patient " does not pay attention " to
illness, drives away from itself ideas about it, does not address
to the doctor.
4. Nosophobic, when the patient disproportionately is afraid of
the illness, it is repeatedly surveyed, changes doctors, his fears
are exaggerated, but cannot struggle with them.
5. Hypochondriac, at which the patient is convinced that suffers
serious disease.
6. Nosophilic, connected with "the certain calm and pleasant
feelings at illness.
06/23/2024 74
 Emotion and health
• Our emotions have a huge impact on the quality of our
life. When feelings are negative, such as severe
depression, this can motivate people to end their life. In
healthcare settings where people face stress and
personal difficulties, emotion has a huge impact on
people’s attitude, recovery, and quality of life. For
example, one person with terminal cancer may cope
with humour and a renewed zest for life, whereas
another person with curable cancer may feel devastated,
depressed, and convinced they will die. Emotional
disorders such as depression are one of the leading
causes of burden of disease in the world and are
projected by the World Health Organisation to be the
top.
06/23/2024
 Cont...
• When feelings are negative, such as severe
depression, this can motivate people to end
their life. In healthcare settings where people
face stress and personal difficulties, emotion has
a huge impact on people’s attitude, recovery,
and quality of life. For example, one person with
terminal cancer may cope with humour and a
renewed zest for life, whereas another person
with curable cancer may feel devastated,
depressed, and convinced they will die.

06/23/2024 76
 Cont....
• patients may have specific emotional and behavioural
responses like:
– Irritability or anger.
– Partial or total denial of disease.
– Depression.
– Anxiety.
– Resignation.
• Feelings of helplessness, hopelessness
– Emotional and behavioral regression (egocentrism,
social dependence, affects, aggression, depression,
etc
– Evasion and responsibility escape.
06/23/2024 77
 Stress

• Stress is the way human beings react both physically and

mentally to changes, events, and situations in their lives.
• State of tension that arises when you experience demands
from your environment or from inside yourself

Can be a real OR perceived threat

OR
 Cont…

1) Frustration Due to Conflict of Motives

 Frustration: is a result of being unable to satisfy a

motive.

 Conflict occurs when two or more motive cannot be

satisfied because of they interfere with one another.

 There are four major kind of intra- conflicts that

leads to stress.
06/23/2024
 Intrapersonal conflict as source of
Stress
I) Approach – Approach Conflict
 It is a conflict between two positive goals that are
equally attractive.

II) Approach – Avoidance Conflict

 This conflict arises when there are both pleasant and
unpleasant feelings associated with a single goal.
 When you are approaching you lose something but
you don’t want to lost that thing.

06/23/2024
 Stress
III) Avoidance – Avoidance Conflict

 This is a conflict between two equally

undesirable or unpleasant goals

 Here, you are forced to chose the one you dislike .

IV) Multiple Approach – Avoidance Conflict

 In this kind of conflict a person simultaneously

faces a number of conflicts.

 In one situation many positive and negative goals

06/23/2024
 Other Causes of Stress Con’t…

Pressure
• The term pressure is used to describe the stresses that
arise from treats of negative events.
• In hospital, there is always a possibility that you will
not recover early and you will be admitted.
• Some unhappy marriage are sources of pressure
because one spouse always seems to displease the other,
no matter how hard he or she tries to a void it.
06/23/2024 82
 Causes of Stress….
3) Life Event

• Major life events create stress because they

required adjustment and copying.
• Interestingly, major events in our life are
often stressful whether they are positive or
negative.

06/23/2024 83
 The most stressful negative events
include the following:
 Crime, Sexual assault and  Financial problem

Violence  Breakup of relationship

 Loss of a family member  Lower grade than

expected
 Natural disaster
 Personal injury or illness
 Terrorism
 Change in eating habit
 Daily hassle
 Too many missed classes
 Accident
 Roommate problem
 Loss of job or property
Positive life events are also believed
to create stress such as
 Unexpected fortune  New school or job
 Birth of a child  Elected to leadership
 Graduation position

 Lovely marriage  Outstanding

 Ownership of house achievement

or car  Pregnancy

 Job promotion  Raising children

 Causes of Stress...

4) Environmental Conditions
 Temperature
 Air pollution
 Noise
 Humidity e.t.c. can be source of stress.

06/23/2024
 Consequence of Stress (Negative)
Type of consequence Examples
Physiological • Elevated blood pressure
Consequence • Decreased immune system
• Increased hormonal activity
Behavioral Consequence • Addiction with alcohol and drug e.g. cigarette, chat,
cocaine and hashish
• Malnutrition
• Speech difficulty
• change in appetite
• Difficulty in making decision
Health related problem • Depression /silence/
• Anxiety
• Emotional breakdown or poor control over emotions
• Forgetfulness or mental disorganization
• Headaches
• Tense muscles
• Abnormal sleep
• Fatigue

Socio Economic • Decreased task performance

• Loose social relation (even social isolation )
• Lower income
Cont...
Cont..
 Stress management techniques
1. Relaxation Techniques
•Meditation
•Deep Breathing
•Massage Therapy
2. Exercise
•Aerobic activities
•Running
•Swimming
•Walking
•Stretching
•Yoga
 Cont....
3. Nutrition
• Eat a balanced diet.
• Stay hydrated with plenty of water.
• Reduce caffeine consumption.
• Avoid alcohol.
• Take appropriate nutritional supplements.
4. Sufficient Rest
• Get plenty of sleep.
• Take a few short breaks throughout the day.
• Allow your mind to rest periodically.
 Cont.....
5. Learn to Avoid Procrastination
• Stay on top of your priorities and stop
procrastinating
• This can cause stress which negatively impacts
health and sleep quality
• Make realistic deadlines and work down your list
• Work on things that need to get done today
6. Live a healthy lifestyle and promoting wellness.
 Get plenty of exercise. Eat healthy foods. Allow
time for rest and relaxation. Look for the humor
in life, and enjoy yourself.
 Laugh!!

• Find ways to add laughter in your life

– Buy tapes of comedians you like and listen to them
during your commute or whenever you need a boost.
– Read joke books or funny books
– Watch your favorite comedy on television
– Buy movies that are sure to make you laugh
– Don’t take yourself too seriously
 Cont.....
7. Learn to accept change as a part of life.
 Nothing stays the same. Develop a support
system of friends and relatives you can talk to
when needed.
•Believe in yourself and your potential. Remember
that many people from disadvantaged backgrounds
have gone on to enjoy great success in life.
8. Examine your expectations.
 Try to set realistic goals. It’s good to push yourself
to achieve, but make sure your expectations are
realistic. Watch out for perfectionism. Be satisfied
with doing the best you can.
12. Improve work- life balance
 Cont...
13. Apply Effective Time Management Skills
• Take the time to get organized.
• Prioritize your to-do list.
• Avoid scheduling too many appointments
• Leave time for yourself in your schedule.
• Decide what is really important to get done today, and
what can wait.
14. Seek Counselling or Therapy
•Seeking professional assistance when needed is a sign of
strength.
•Working with a qualified therapist, counselor or other
qualified mental health professional can be one of the best
ways to learn how to deal with stress.
 Other Techniques
• Changing perceptions and expectations
• Break jobs/tasks into manageable parts
• Set reasonable/realistic goals
• Set boundaries
• Telecommuting
• Job Sharing
• Receive social support
• Don’t compromise your values/beliefs
• Avoid caffeine, and remove hazardous
In general to manage your stress;
• Fix the fixable
• Accept the inevitable
 Benefits of Stress Management
 Physical health gets better
more energy and stamina
 Emotions stabilized
positive attitude
hopeful/happier
 Ability to focus improved
able to learn and achieve
 4. Psychological Disorders
 There are three main criteria for determining whether a person has a
psychological disorder: abnormality, maladaptiveness, and personal
distress.
1. Abnormality (What Is Normal? )
 Abnormal behavior is a behavior that deviates from the behavior of the
“typical” person or the norm.
 A society’s norm can be qualitative and quantitative.
 When someone’s behavior violates the norm, standards, rules &
regulations of the society, it is more likely to be a psychological disorder.
 The context in which “abnormal” behavior occurs must also be
considered before deciding that it is symptomatic of psychological
disorders.
Statistical Abnormality: Having extreme scores on some
dimension, such as intelligence, anxiety, or depression
2. Maladaptiveness
 Maladaptive behavior creates a social, personal and occupational
problem.
 These behaviors seriously disrupt the day-to-day activities of
individuals.
3. Personal Distress
 Our subjective feelings of anxiety, stress, tension and other
unpleasant emotions determine whether we have a psychological
disorder.
 But, the criterion of personal distress, is not sufficient for the presence
of psychological disorder. Because some people’s feeling looks like
distressed by its own.
 Hence, behavior that is abnormal, maladaptive, and personally
distressing might indicate that a person has a psychological disorder.
Psychological Disorders are also called mental illness, or mental
health disorders, refers to a wide range of mental health
disorders that affect your mood, thinking and behavior.
According to DSM-IV, a mental disorder is a clinically significant
behavioral or psychological syndrome or pattern that occurs in an
individual and that is associated with present distress or disability
or with a significantly increased risk of suffering death, pain,
disability or loss of freedom.
Diagnostic and Statistical Manual (DSM): is the primary set of rules
used for diagnosing (labeling) psychological disorders.
DSM—Diagnostic & Statistical Manual of Mental Disorders -
Published by American Psychiatric Association used by clinicians
and researchers to diagnose and classify mental disorders
4.2. Causes of Psychological Disorders
Prehistoric times:
• Abnormal behavior as demonic possession
• Early societies viewed the human body and mind as a
battleground between external forces of good and evil.
• Abnormal behavior was typically interpreted as a victory
by evil spirits and the cure for such behavior was to
force the demons from a victim’s body. Example:
• Trephination: is a kind of traditional surgery system
where the persons digging out the skull of the victims so
as to relies out the evil spirit from the head.
 The emergence of the scientific model
Ancient Greece and Roma
• Even though their theories now may seems strange,
early Greek philosophers established the foundation for
the systematic approach to psychological disorders.
• Hippocrates (460-377 B.C) believed that, there were
four important bodily fluids that influences physical and
mental health. These are, black bile, yellow bile,
phlegm, and blood.
• An excess of any of these fluids could account for
changes in an individual’s personality and behavior.
 4.2. Causes of Psychological Disorders
(Based on Perspectives)
4.2.1 The Biological Perspective
Abnormalities in the work of neurotransmitter chemicals in the
brain is found to contribute to many psychological disorders.
E.g., over activity of the dopamine has been linked to the
bizarre symptoms of schizophrenia
Biological causes also include genetic inheritance, medical
conditions, brain damage, exposure to environmental stimuli,
and hormonal imbalances etc.
Figure 12.8

FIGURE 12.8 Dopamine normally crosses the synapse between two neurons, activating the second cell.
Antipsychotic drugs bind to the same receptor sites as dopamine does, blocking its action. In people
suffering from schizophrenia, a reduction in dopamine activity can quiet a person’s agitation and
psychotic symptoms.
 4.2.2 Psychological Perspectives
A. Psychodynamic theory of abnormality
• All behavior, thoughts, and emotions, whether normal or
abnormal are influenced to a large extent by unconscious
process.
• Behavior is affected by childhood experiences and particularly
within the family
• Abnormal behavior happens when the intra psychic conflicts
are beyond the ego defense mechanism strategies. Behavior
is the result of early fixations
B. Behavioral theory of abnormality
• Abnormal behavior as the product of learning and association.
Example: depression may in part due to extinction.
 .
C. Humanistic theory of abnormality
• Failure or challenges while some one strives to fulfill
his/her potential
• Incongruence between the real or actual and ideal
self.
D. Cognitive theory of abnormality:
• Traumatic life experiences and stressful life events
• Distorted perceptions
• Faulty way of thinking (irrational thinking)
• Faulty way of information processing
Other Theoretical Causes of Anxiety Disorders
• Humanistic-Existential: Unrealistic self-image
conflicts with true self
 4.2.3 Socio-cultural perspective

 Disturbance in intimate relationships or marital problems

 Social Conditions: Poverty, homelessness, overcrowding,
stressful living conditions
 Family Factors: Parents who are immature, mentally ill,
abusive, or criminal; poor child discipline
 Problems in extended relationships
 Political or social unrest
 Discrimination towards one’s social group
 Social labeling
 4.3. Types of Psychological Disorders
A psychological disorder is a condition characterized by abnormal
thoughts, feelings, and behaviors.
Psychopathology is the study of psychological disorders, including
their symptoms, etiology (i.e., their causes), and treatment. The
term psychopathology can also refer to the manifestation of a
psychological disorder.
DSM-IV Classification of Major Types of Psychological Disorders

1. Anxiety disorders: Feelings of fear, apprehension, anxiety, and distorted behavior

2. Somatoform disorders: Complaints about physical symptoms, affecting different
areas of the body with no physical cause
3. Mood(affective) disorders: Being dominated by emotional extremes
4. Dissociative disorders: Disturbances or changes in memory, consciousness, or
identity
5. Personality disorders: When normal traits become extreme
6. Schizophrenia (the Most Severe Mental Illness): a group of psychological disorders
characterized by hallucination and delusion, grossly impaired social, emotional,
cognitive, perceptual functioning.
7. Sexual Dysfunctions and Deviations (paraphilia): trouble in engaging and enjoying
sexual relationships
8. Eating disorders – Wrong eating pattern or behaviour
9. Substance use disorders – abuse and dependence
 In this section we will try to see only mood disorder, anxiety disorder and personality disorder.

1) Mood Disorders
 Mood disorders are characterized by a serious change in mood from
depressed to elevated feelings causing disruption of life.
 Depressive disorder is characterized by overall feelings of desperation and
inactivity. Elevated moods are characterized by mania or hypomania. The
cycling between both depressed and manic moods is characteristic of
bipolar mood disorders.
 If you have a mood disorder, your general emotional state or mood is
distorted or inconsistent with your circumstances and interferes with your
ability to function. You may be extremely sad, empty or irritable
(depressed), or you may have periods of depression alternating with being
excessively happy (mania)
 .
The type of mood disorder include Major Depression, Dysthymic Disorder,
Bipolar Disorder, and Cyclothymia.
1) Major Depression (also known as depression or clinical depression) is
characterized by depressed mood, diminished interest in previously enjoyed
activities, weight & sleep disturbance, loss of energy, difficulty concentrating,
and often includes hopelessness and thoughts of suicide.
• 2) Dysthymia (Persistent depressive disorder) is often considered a lesser,
but more persistent form of depression. Many of the symptoms are similar
except to a lesser degree. Dysthymia is steadier rather than periods of normal
feelings and extreme lows. Presence, while depressed, of two (or more)
of the following:
• 1. Poor appetite or overeating.
• 2. Insomnia or hypersomnia.
• 3. Low energy or fatigue.
 Cont...
4. Low self-esteem.
5. Poor concentration or difficulty making decisions.
6. Feelings of hopelessness
3) Bipolar Disorder (previously known as Manic-
Depression) is characterized by periods of extreme
highs (called mania) and extreme lows as in Major
Depression.
4) Cyclothymia: Like Dysthymia and Major Depression,
Cyclothymia is considered a lesser form of Bipolar
Disorder
 Cont

A person with major depressive disorder may experience a

loss of energy, too much or too little sleep, decreased
appetite and weight loss, an increase or slowdown in mental
and physical activity, difficulty concentrating, irrational guilt,
and recurrent thoughts of death or suicide.
 2) Anxiety Disorders
• Anxiety is a feelings of apprehension, dread, or uneasiness
normal in reaction to stress and can be beneficial in some situations.
It can alert us to dangers and help us prepare and pay attention.
• Anxiety disorders, and involve excessive fear or anxiety. Anxiety
disorders are the most common of mental disorders and affect
nearly 30 percent of adults at some point in their lives.
• However, anxiety disorders are treatable and a number of effective
treatments are available. Treatment helps most people lead normal
productive lives.
• In general, for a person to be diagnosed with an anxiety disorder, the
fear or anxiety must:
 Be out of proportion to the situation or age inappropriate
 Hinder your ability to function normally
 .
Anxiety Disorders categorize a large number of disorders where the
primary feature is abnormal or inappropriate anxiety. The disorders in
this category include
 Panic Disorder,
 Agoraphobia,
 Specific Phobias,
 Social Phobia,
 Obsessive-Compulsive Disorder,
 Posttraumatic Stress Disorder, and
 Generalized Anxiety Disorder.
a) Panic Disorder ( may be with or without Agoraphobia): is a sudden
state of anxiety for brief moments, intense, unexpected panic (panic
attack) occur in the absence of actual danger. Panic attack includes
feelings like one is having a heart attack, going to die, or is going
insane.
 Cont---
b) Agoraphobia ( fear of public places). It refers to a series of
symptoms where the person fears, and often avoids, situations
where escape or help might not be available. Marked fear or
anxiety about two (or more) of the following five
situations:
1. Using public transportation (e.g., automobiles, buses,
trains, ships, planes).
2. Being in open spaces (e.g., parking lots, marketplaces,
bridges).
3. Being in enclosed places (e.g., shops, theaters, cinemas).
4. Standing in line or being in a crowd.
5. Being outside of the home alone.
 Cont
• c) Specific or Simple Phobia and Social Phobia
represent an intense fear and often an avoidance of
a specific situation, person, place, or thing. To be
diagnosed with a phobia, the person must have
suffered significant negative consequences
because of this fear and it must be disruptive to
their everyday life.
Cont..
 .
d) Obsessive-Compulsive Disorder (OCD) is
characterized by obsessions (thoughts which seem
uncontrollable) and compulsions (behaviors which act
to reduce the obsession). Most people think of
compulsive hand washers or people with an intense
fear of dirt or of being infected. These obsessions and
compulsions are disruptive to the person's everyday
life, with sometimes hours being spent each day
repeating things, which were already completed such
as checking, counting, cleaning, or bathing.
 Cont...
e) Posttraumatic Stress Disorder (PTSD) occurs only after a
person is exposed to a traumatic event such as war, natural
disasters, major accidents, and severe child abuse. Once
exposed to such incidents, the disorder develops into an
intense fear of related situations, avoidance of these situations,
reoccurring nightmares, flashbacks, and heightened anxiety to
the point that it significantly disrupts their everyday life.
f) Generalized Anxiety Disorder is diagnosed when a person has
extreme anxiety in nearly every part of their life. It is not
associated with just open places (as in agoraphobia), specific
situations (as in specific phobia), or a traumatic event (as in
PTSD). The anxiety must be significant enough to disrupt the
person's everyday life for a diagnosis to be made.
 Cont...
Generalized Anxiety Disorder is characterized by Excessive anxiety and
worry ,occurring more days than not for at least 6 months, about
a number of events or activities (such as work or school
performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the
following six symptoms (with at least some symptoms having
been present for more days than not for the past 6 months):
1. Restlessness or feeling keyed up or on edge.
2. Being easily fatigued.
3. Difficulty concentrating or mind going blank.
4. Irritability.
5. Muscle tension.
6. Sleep disturbance (difficulty falling or staying asleep, or
restless, unsatisfying sleep).
 3) Personality Disorders
• A personality disorder is a type of mental disorder in which you have a rigid
and unhealthy pattern of thinking, functioning and behaving. A person with a
personality disorder has trouble perceiving and relating to situations and
people.
• Personality Disorders are characterized by an enduring pattern of thinking,
feeling, and behaving which is significantly different from the person's culture
and results in negative consequences. This pattern must be longstanding and
inflexible for a diagnosis to be made.
• There are around nine types of personality disorders, all of which result in
significant distress and/or negative consequences within the individual:
1) Paranoid (includes a pattern of distrust and suspiciousness).
2) Schizoid (pattern of detachment from social norms and a restriction
of emotions).
3) Schizotypal (pattern of discomfort in close relationships and
eccentric thoughts and behaviors).
 Cont…
4) Antisocial (pattern of disregard for the rights of others, lacks a
conscience (superego) including violation of these rights and the failure
to feel empathy), selfish, many are delinquents or criminals.
5) Borderline (pattern of instability in personal relationships, including
frequent bouts of clinginess and affection and anger and resentment,
often cycling between these two extremes rapidly).
6) Histrionic (pattern of excessive emotional behavior and attention
seeking).
7) Narcissistic (pattern of grandiosity, exaggerated self-worth, and need
for admiration).
8) Avoidant (pattern of feelings of social inadequacies, low self-esteem,
and hypersensitivity to criticism).
9) Obsessive-Compulsive (pattern of obsessive cleanliness, perfection,
and control).
Cont...
 somatic
symptom disorder
• Soma means “body.” People with somatic
symptom disorders experience bodily symptoms
that cause them significant psychological distress
and impairment. (1) hypochondriasis, (2)
somatization disorder, and (3) pain disorder have
all now disappeared. Most of the people who
would in the past have been diagnosed with any
one of these disorders will now be diagnosed
with somatic symptom disorder
 Dissociative Disorder
• Dissociation can be defined as “a disruption of
and/or discontinuity in the normal, subjective
integration of one or more aspects of psychological
functioning, including—but not limited to—
memory, identity, consciousness, perception and
motor control. The DSM-5 recognizes several types
of pathological dissociation. These include
• Depersonalization/ derealization disorder,
• Dissociative amnesia, and
• Dissociative identity disorder
 Cont....
• Depersonalization: Experiences of unreality,
detachment, or being an outside observer with
respect to one’s thoughts, feelings, sensations,
body, or actions (e.g., perceptual alterations,
distorted sense of time, unreal or absent self,
emotional and/or physical numbing).
• 2. Derealization: Experiences of unreality or
detachment with respect to surroundings (e.g.,
individuals or objects are experienced as
unreal, dreamlike, foggy, lifeless
 Dissociative amnesia
• dissociative amnesia refers to inability to
recall important autobiographical information
usually of a traumatic or stressful nature. It
can exist in the form of Retrograde amnesia is
the partial or total inability to recall or identify
previously acquired information or past
experiences; by contrast, anterograde
amnesia is the partial or total inability to
retain new information
 Dissociative identity disorder
• Dissociative identity disorder (DID), formerly
known as multiple personality disorder it was
required that the person manifest two or more
distinct identities (or personality states) that
alternated in some way in taking control of
• behavior. This was accompanied by an inability to
recall important personal information that could
not be explained by ordinary forgetting.
Eating Disorder
 Cont.....
• Eating disorders involve a serious disturbance in eating behaviour
- either eating too much or too little - in addition to great concern
over body size and shape.
• 1. anorexia nervosa individuals with anorexia nervosa has an
intense fear of gaining weight and have a distorted perception of
the shape or size of their bodies.
• 2. Bulimia nervosa- Individuals with bulimia nervosa undertake
excessive eating and then use compensatory methods to prevent
weight gain, such as induced vomiting, or excessive exercise.
They also place excessive importance on body shape and weight.
• 3. Binge eating disorder (BED) is eating excessively in the
absence of hanger eating is not followed by some compensatory
behaviour, such as vomiting, or excessive exercise. This disorder is
often associated with obesity.
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 Cont...
Desire disorder- hypoactive sexual desire
disorder is the common type of desire
disorder which is characterized by lack of
fantasies , motivation or desire for sexual
activities.
Disorder of arousal- refers to inability to
produce or maintain adequate lubrication and
genital swelling. erectile disorder is a type of
arousal disorder in men.
 Cont..
• Disorder of orgasm- delays or absence of
orgasm following normal stimulation and
duration. Lack of orgasm during sexual
intercourse is so common (one-third of women
report they do not receive sufficient stimulation
to reach orgasm during sexual intercourse), this
condition is not dysfunctional at all but is merely
a normal variation of female sexuality . Inhibited
ejaculation and anorgasmia are the two
common types for this disorder.
 Cont...
• Pain producing problem like;
• Dyspareunia – experiencing pain when
attempting penetrative sex.
• Vaginismus- powerful spasms of the muscles.
Whenever intercourse is attempted vaginal
opening closes so tightly.
 5. Pain
It is un pleasant sensory and emotional experience
resulting from actual or potential tissue damage.
 The stimulus can be physical and/or mental in
nature, where by damage may be to actual tissue or
to a person’s ego.
 Occurs with many disease processes or with
diagnostic tests or treatment.
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 Cont…
Pain is a protective physiological
mechanism.
It is the most common reason a person
seeks health care.
The cardinal rule in the care of patients with pain
is that all pain is real, even if its cause is
unknown.
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 Types of Pain

Pain is categorized according to its duration, location and

etiology.

1. Pain classified by duration as;

a.Acute pain:

 usually recent onset and is most commonly associated with a

specific injury, disease or surgical interventions.

 Has a rapid onset varying in intensity (mild to sever) and

lasting for a brief time usually less than 6 month.

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 Con’t…

b. Chronic pain:
Is a constant or intermittent pain that persists over a period of
time,
Lasts for 6 months or longer.
These pains are due to non-life treating cause & frequently the
cause is unknown.
2. Pain classified by location :
Pain is classified according to location of the pain as: - pelvic
pain, chest pain, Back pain, Abdominal pain, headache, etc.
 Types of pain

3. Pain classified by Etiology

 Categorizing pain according to etiology is another
way to think about pain and it includes:- burn pain,
pain associated with sickle cell disease, ADIS-
related pain, cancer related pain….

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 Pain
• Factors influencing the pain1
• There may be many factors and this factors may affect pain
perception, tolerance or persons response and those includes.
– Past experience

– Anxiety

– Culture

– Age

– Gender

– Placebo effect
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 Cont....
• Psychological factors are judged to have an important
role in the onset, severity or maintenance of the pain.
Pain may show adverse effect in relationship, social,
academic, occupational, recreational abilities or other
areas of functioning.
Distress, depression, anxiety and drug abuse is occurring
as a result of pain disorder. Pain is not false and also it is
not intentionally produced.
Pain associated with psychological factors is common in
many psychiatric conditions, especially mood and
anxiety disorders. Any part of the body may
be affected, but the back, head, abdomen, and chest are
probably the most common.
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 Management of Pain
1. None pharmacologic measures:-
 Positioning /Posture
 Education /Anticipatory Guidance
 Touch- Gentle pressure or massage
 Heat/cold treatment
 Relaxation/Distraction/Music Therapy
 Meditation /Guided imagery

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 Pain
Pharmacological intervention:-

A. analgesic medications

B. local and regional anesthetic agents

Surgical intervention

When a client’s pain persistent despite medical

treatment, surgical intervention may be needed.

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 Doctor- patient relationship
• Patient-practitioner communication does not always go
smoothly.
• The quality of communication with a provider is important to
patients, but it also affects care.
• For example, poor patient-practitioner communication has
been tied to non-adherence to treatment recommendations and
the initiation of malpractice.
• A warm, confident, friendly provider is judged to be both nice
and competent, whereas a cool, aloof provider may be
judged as both unfriendly and incompetent.
• In reality, the quality of care and the manner in which care is
delivered are unrelated.

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 Personality characteristics of Patients
1- A “good” patient characterized by;
 preparing carefully for meetings with his practitioner.
 A well-organized and prepares questions ahead of appointments, and sticks to the facts.
 Will ask the meaning of words and concepts he doesn‘t understand.
 If interrupted, will ask the doctor to stop and listen respectfully.
 Will ask his doctor what to expect next.
 Will know which questions to ask the doctor, and which to save for others.
 Keep careful records

2. Difficult patients- demanding unnecessary tests and medication. Others

monopolize your time and energy or they verbally abuse the staff. While numerous
classifications of difficult patients actually exist,
some types are widespread as following
 A universal pain” patient. “These patients do take a lot of time
and energy
 The fearful patient.

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 Cont....
 The “drug seeker”. Some patients are difficult to manage because they’ve
become dependent on pain medication or another controlled substance.

 The angry patient- these are patients who feel impotent either in life or in
the doctor-patient relationship
 The no-can-doer patient- (non-compliant patient) Patients ignore
healthcare advice for a variety of reasons, including fear of possible side
effects, cost concerns, a belief that the treatment will be ineffective.
 Emotionally needy patient - These patients want your attention all the
time until it becomes suffocating. They feel they’re the
most important person in the world. They go from doctor to doctor until
they find you and they eventually leave you, too, when you can’t be there
for them all the time

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 Types of errors most frequently
encountered doctor-patient relationship
• Types of errors during the establishment and
development of doctor-patient relationship:
– Inappropriate attitude features of the doctor: rush,
impatience, fatigue, boredom, raised voice.
– Acceptance of insufficient communication with the
patient.
– Excess of or lack of authority with the patient.
- Engaging in conflict situations.
– Underestimating difficult patients, with increased
psychogenic tendencies.

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 Cont....
• Role conflicts in the doctor/patient relationship:
– Psychological resistance of some patients to the
doctor’s authority.
– Affective ambivalence of the patient.
– Refusal or inability to communicate of certain
patients.
Deficiencies in doctor-patient communication:
– Failure to appropriately greet the patient, introducing
oneself and explaining one’s actions.
– Failure to get easily accessible information, mainly
due to fears and expectations.
– Accepting imprecise information, failure in seeking
clarifications.
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 Cont...
• Failure to verify with the patient what the doctor
understood from the situation
• Directive style with closed questions, frequent
interruption and failure to make the patient speak freely.
– Rushed focusing without testing theories.
– Failure to provide appropriate information concerning
the diagnosis, treatment, side effects or prognosis, or in
verifying the patient’s understanding of these issues.
– Failure to understand the patient’s viewpoint.
• The goal of any patient-doctor relationship should be
one of mutual respect and collaboration, working
together to achieve your best possible medical outcomes

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 Practitioner Behaviors that Contribute to Poor
Communication

• Inattentiveness –not listening.

• Use of Jargon –complex vocabulary
• Baby Talk –simplistic explanations due to underestimating
patients.
• Nonperson Treatment- depersonalization of the patient.
• Stereotypes of Patients -Negative stereotypes of patients.

153
Results of Poor Patient-Practitioner Communication
• Dissatisfied patients are;
–less likely to comply with treatment
recommendations or to use medical services in the
future;
–they are more likely to turn to alternative services
that satisfy emotional rather than medical needs;
–they are less likely to obtain medical checkups; and
–they are more likely to change doctors and to file
formal complaints.

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 How to Improve Patient-provider Communication and
Increase Adherence to Treatment?
• What Can Providers Do to Improve Adherence?
- Listen to the patient.
- Ask the patient to repeat what has to be done.
- Keep the prescription as simple as possible.
- Give clear instructions on the exact treatment regimen,
preferably in writing.
- Make use of special reminder pill containers and calendars.
- Call the patient if an appointment is missed.
- Prescribe a self-care regimen in concert with the patient’s daily
schedule.
- Emphasize at each visit the importance of adherence.
- Gear the frequency of visits to adherence needs.
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 Con’t…
- Acknowledge at each visit the patient’s efforts to adhere.
- Involve the patient’s spouse or other partner.
- Whenever possible, provide the patient with instructions and
advice at the start of the information to be presented
- When providing the patient with instructions and advice, stress
how important they are.
- Use short words and short sentences.
-Use explicit categorization where possible. (E.g., divide
information clearly into categories of etiology, treatment, or
prognosis.)
- Repeat things, where feasible.
- When giving advice, make it specific, detailed, & concrete.

156
 Con’t…
- Find out what the patient’s worries are. Do not confine yourself
merely to gathering objective medical information.
- Find out what the patient’s expectations are. If they cannot be
met, explain why.
- Provide information about the diagnosis and the cause of the
illness.
- Adopt a friendly rather than a businesslike attitude.
- Avoid medical jargon.
- Spend some time in conversation about nonmedical topics.

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