Skip to main content

Psychomaintenance of Chronic Physical Illness

Clinical Assessment of Personal Styles Affecting Medical Management

  • Chapter
Handbook of Clinical Health Psychology

Abstract

Psychomaintenance refers to the psychologic and behavioral perpetuation and exacerbation of physical illness (Dirks, 1978; Jones, Kinsman, Dirks, & Dahlem, 1979). In this regard, it should be noted that psychomaintenance does not address the etiology of illness as an area of interest but instead focuses on how psychologic and behavioral factors maintain and increase both perceived severity and medical intractability of the illness once it has already developed. How is it that the patient continues to be functionally incapacitated by illness, despite medical treatment that is effective in most other cases? How is it that the patient appears to require a disproportionately intense medication regimen? How is it that the patient continues to be hospitalized longer and more frequently than would be indicated by the objective medical parameters of the illness? What is the patient doing to contribute adversely to his or her medical response? What is the patient not doing in relation to the illness, and what negative effects does that have on medical management and treatment? These are questions whereby the specific mechanisms of psychomaintenance can be isolated. The mechanisms of psychomaintenance appear to be general across illness types and often so commonplace as to be overlooked.

Supported in part by grants AM0398, HL-22065, and AI-15392 from the National Institutes of Health.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Addington, W. W. Patient compliance: The most serious remaining problem in the control of tuberculosis in the United States. Chest, 1979, 6, 741–743.

    Google Scholar 

  • American Psychological Association Task Force on Health Research. Contributions of psychology to health research: Patterns, problems, and potentials. American Psychologist, 1976, 31, 263–274.

    Google Scholar 

  • Barron, F. An ego-strength scale which predicts response to psychotherapy. Journal of Consulting and Clinical Psychology, 1953, 17, 327–333.

    Google Scholar 

  • Bellak, L. Introduction. In L. Bellak (Ed.), Psychology of physical illness: Psychiatry applied to medicine, surgery, and the specialties. New York: Grune & Stratton, 1952.

    Google Scholar 

  • Bierman, C. W., & Pierson, W. E. Hand nebulizers and asthma therapy in children and adolescents. Pediatrics, 1974, 54, 668–673.

    PubMed  Google Scholar 

  • Canon, H. S., & Roth, H. P. Patients’ cooperation with a medical regimen. Journal of the American Medical Association, 1968, 203 (11), 120–124.

    Google Scholar 

  • Comroe, J. H., Forster, R. E., DuBois, A. B., Briscoe, W. A., & Carlsen, E. The lung: Clinical physiology and pulmonary function tests. Chicago: Year Book Medical Publishers, 1962.

    Google Scholar 

  • Cummings, N. A. The anatomy of psychotherapy under national health insurance. American Psychologist, 1977, 32, 711–718.

    Article  PubMed  Google Scholar 

  • Dahlem, N. W., Kinsman, R. A., & Horton, D. J. Panic-Fear in asthma: Requests for as-needed (PRN) medications in relation to pulmonary function measurements. Journal of Allergy and Clinical Immunology, 1977, 60, 295–300.

    Article  PubMed  Google Scholar 

  • Dahlem, N. W., Kinsman, R. A., & Horton, D. J. Requests for as-needed (PRN) medications by asthmatic patients: Relationships to prescribed oral corticosteroid regimens and length of hospitalization, Journal of Allergy and Clinical Immunology, 1979, 63, 23–27.

    Google Scholar 

  • Dirks, J. F. The psychomaintenance of bronchial asthma: A review and preliminary theoretical integration of Panic-Fear research in asthma. Report No. 54. Denver, Colo.: Psychophysiology Research Laboratories, National Jewish Hospital and Research Center, July 1978.

    Google Scholar 

  • Dirks, J. F. An automated Bayesian model for predicting psychomaintenance: As-needed (PRN) medication usage patterns and the Battery of Asthma Illness Behavior. Report No. 86. Denver, Colo.: Division of Psychobiology, National Jewish Hospital and Research Center, August 1980. (a)

    Google Scholar 

  • Dirks, J. F. An automated Bayesian model for predicting psychomaintenance: Rehospitalization and the Battery of Asthma Illness Behavior. Report No. 85. Denver, Colo.: Division of Psychobiology, National Jewish Hospital and Research Center, August 1980. (b)

    Google Scholar 

  • Dirks, J. F., & Kinsman, R. A. Death in asthma: A psychosomatic autopsy. Report No. 72. Denver, Colo.: Psychophysiology Research Laboratories, National Jewish Hospital and Research Center, January 1980.

    Google Scholar 

  • Dirks, J. F., & Kinsman, R. A. Clinical prediction of medical rehospitalization: Psychological assessment with the Battery of Asthma Illness Behavior. Journal of Personality Assessment, 1981, 45, 608–613.

    Article  PubMed  Google Scholar 

  • Dirks, J. F., Fross, K. H., & Evans, N. W. Panic-Fear in asthma: Generalized personality trait vs. specific situational state. Journal of Asthma Research, 1977, 14, 161–167. (a)

    Google Scholar 

  • Dirks, J. F., Jones, N. F., & Kinsman, R. A. Panic-Fear: A personality dimension related to intractability in asthma. Psychosomatic Medicine, 1977, 39, 120–126. (b)

    Google Scholar 

  • Dirks, J. F., Kinsman, R. A., Jones, N. F., Spector, S. L., Davidson, P. T., & Evans, N. W. Panic- Fear: A personality dimension related to length of hospitalization in respiratory illness. Journal of Asthma Research. 1977, 14, 61–71. (c)

    Article  PubMed  Google Scholar 

  • Dirks, J. F., Horton, D. J., Kinsman, R. A., Fross, K. H., & Jones, N. F. Patient and physician characteristics influencing medical decisions in asthma. Journal of Asthma Research, 1978, 15, 171–178. (a)

    Article  PubMed  Google Scholar 

  • Dirks, J. F., Kinsman, R. A., Horton, D. J., Fross, K. H., & Jones, N. F. Panic-Fear in asthma: Rehospitalization following intensive long-term treatment. Psychosomatic Medicine, 1978, 40, 5–13. (b)

    Google Scholar 

  • Dirks, J. F., Kinsman, R. A., Jones, N. F., & Fross, K. H. New developments in panic-fear research in asthma: Validity and stability of the MMPI panic-fear scale. British Journal of Medical Psychology, 1978, 51, 119–126. (c)

    Article  PubMed  Google Scholar 

  • Dirks, J. F., Fross, K. H., & Paley, A. Panic-Fear in asthma: State-trait relationship and rehospitalization. Journal of Chronic Disease, 1978, 31, 605–609. (d)

    Article  Google Scholar 

  • Dirks, J. F., Jones, N. F., & Fross, K. H. Psychosexual aspects of the Panic-Fear personality types in asthma. Canadian Journal of Psychiatry, 1979, 24, 731–739. (a)

    Google Scholar 

  • Dirks, J. F., Kinsman, R. A. Staudenmayer, H., & Kleiger, J. H. Panic-Fear in asthma: Symptomatology as an index of signal anxiety and personality as an index of ego resources. Journal of Nervous and Mental Disease, 1979, 167, 615–619. (b)

    Google Scholar 

  • Dirks, J. F., Paley A., & Fross, K. H. Panic-Fear research in asthma and the nuclear conflict theory of asthma: Similarities, differences, and clinical implications. British Journal of Medical Psychology, 1979, 52, 71–76. (c)

    Google Scholar 

  • Dirks, J. F., Schraa, J., Brown, E. L., & Kinsman, R. A. Psychomaintenance in asthma: Hospitalization rates and financial impact. British Journal of Medical Psychology, 1980, 53, 349–354.

    Article  PubMed  Google Scholar 

  • Drake, L. E. A social I-E scale for the MMPI. Journal of Applied Psychology, 1946, 30, 51–54.

    Article  PubMed  Google Scholar 

  • Engel, G. L. The need for a new medical model: A challenge for biomedicine. Science, 1977, 196, 129–136.

    Article  PubMed  Google Scholar 

  • Engel, G. L. The clinical application of the biopsychosocial model. American Journal of Psychiatry, 1980, 137, 535–544.

    PubMed  Google Scholar 

  • Follette, W., & Cummings, N. A. Psychiatric services and medical utilization in a prepaid health plan setting. Part I. Medical Care, 1967, 5, 25–35.

    Google Scholar 

  • Fross, K. H., Dirks, J. F., Kinsman, R. A., & Jones, N. F. Functionally determined invalidism in chronic asthma, Journal of Chronic Disease, 1980, 33, 485–490.

    Google Scholar 

  • Jones, N. F., Kinsman, R. A., Dirks, J. F., & Dahlem, N. W. Psychological contributions to chronicity in asthma: Patient response styles influencing medical treatment and its outcome. Medical Care, 1979, 17, 1103–1118.

    Article  PubMed  Google Scholar 

  • Jones, N. F., Dirks, J. F., & Kinsman, R. A. Assessment in the psychomaintenance of chronic physical illness. Journal of Psychiatric Treatment and Evaluation, 1980, 2, 303–312.

    Google Scholar 

  • Kaplan De-Nour, A., & Czacakes, J. W. Personality factors in chronic hemodialysis patients causing noncompliance with medical regimens. Psychosomatic Medicine, 1972, 34, 333–344.

    Google Scholar 

  • Kinsman, R. A., Luparello, T. J., O’Banion, K., & Spector, S. L. Multidimensional analysis of the subjective symptomatology of asthma. Psychosomatic Medicine, 1973, 35, 250–267. (a)

    Google Scholar 

  • Kinsman, R. A., O’Banion, K., Resnikoff, P., Luparello, T. J., & Spector, S. L. Subjective symptoms of acute asthma within a heterogeneous sample of asthmatics. Journal of Allergy and Clinical Immunology, 1973, 52, 284–296. (b)

    Google Scholar 

  • Kinsman, R. A. Spector, S. L., Shucard, D. W., & Luparello, T. J. Observations on patterns of subjective symptomatology of asthma. Psychosomatic Medicine, 1974, 36, 129–143.

    Google Scholar 

  • Kinsman, R. A., Jones, N. F., Matus, I., & Schum, R. A. Patient variables supporting chronic illness: A scale for measuring attitudes toward respiratory illness and hospitalization. Journal of Nervous and Mental Disease, 1976, 163, 159–165.

    Article  PubMed  Google Scholar 

  • Kinsman, R. A., Dahlem, N. W., Spector, S. L., & Staudenmayer, H. Observations on subjective symptomatology, coping behavior, and medical decisions in asthma. Psychosomatic Medicine, 1977, 39, 102–119.

    PubMed  Google Scholar 

  • Kinsman, R. A., Dirks, J. F., Dahlem, N. W., & Heller, A. S. Anxiety in asthma: Panic-Fear symptomatology and personality in relation to manifest anxiety. Psychological Reports, 1980, 46, 196–198. (a)

    Google Scholar 

  • Kinsman, R. A., Dirks, J. F., & Jones, N. F. Levels of psychological experience in asthma: General and illness-specific concomitants of Panic-Fear personality. Journal of Clinical Psychology, 1980, 36, 552–561. (b)

    PubMed  Google Scholar 

  • Kinsman, R. A., Dirks, J. F., & Dahlem, N. W. Noncompliance to prescribed as-needed (PRN) medication use in asthma: Usage patterns and patient characteristics. Journal of Psychosomatic Research, 1980, 24, 97–107. (a)

    Article  PubMed  Google Scholar 

  • Kinsman, R. A., Dirks, J. F., Jones, N. F., & Dahlem, N. W. Anxiety reduction in asthma: Four catches to general application. Psychosomatic Medicine, 1980, 42, 397–405. (b)

    PubMed  Google Scholar 

  • Kleiger, J. H., & Dirks, J. F. Medication compliance in chronic asthmatic patients, Journal of Asthma Research, 1979, 16, 93–96.

    Article  PubMed  Google Scholar 

  • Kristein, M. M., Arnold, C. B., & Wynder, E. L. Health economics and preventive care. Science, 1977, 195, 457–462.

    Article  PubMed  Google Scholar 

  • Ley, P. Memory for medical information. British Journal of Social and Clinical Psychology, 1979, 18, 245–255.

    Article  PubMed  Google Scholar 

  • Michaux, W. W. Side effects, resistance, and dosage deviations in psychiatric patients treated with tranquilizers, Journal of Nervous and Mental Disease, 1961, 133, 203–212.

    Article  PubMed  Google Scholar 

  • Minden, P., & Farr, R. S. The management of allergic disorders in children. Pediatric Clinics of North America, 1969, 16, 305–320.

    PubMed  Google Scholar 

  • Nadel, J. A. Structure-function relationships in the airways: Bronchoconstriction mediated via vagus nerves on bronchial arteries, peripheral lung constriction mediated via pulmonary arteries. Medical Thoracics, 1965, 22, 231–238.

    Google Scholar 

  • Nadel, J. A. Airways: Autonomic regulation and airway responsiveness. In E. B. Weiss & M. S. Segal (Eds.), Bronchial asthma: Mechanisms and therapeutics. Boston: Little, Brown, 1976.

    Google Scholar 

  • Navran, L. A rationally derived MMPI scale for dependence. Journal of Consulting and Clinical Psychology, 1954, 18, 192.

    Google Scholar 

  • Olbrisch, M. E. Psychotherapeutic intervention in physical health. Effectiveness and economic efficiency. American Psychologist, 1977, 32, 761–777.

    Google Scholar 

  • Pilowsky, I. Abnormal illness behavior. British Journal of Medical Psychology, 1969, 42, 347–351.

    Article  PubMed  Google Scholar 

  • Read, J. The reported increase in mortality from asthma: A clinicofunctional analysis. Medical Journal of Australia, 1968, 1, 879–884.

    PubMed  Google Scholar 

  • Rosen, J. C., & Weins, A. N. Changes in medical problems and use of medical services following psychological intervention. American Psychologist, 1979, 34, 420–431.

    Article  PubMed  Google Scholar 

  • Sackett, D. L. The magnitude of compliance and noncompliance. In D. L. Sackett & R. B. Haynes (Eds.), Compliance with therapeutic regimens. Baltimore: Johns Hopkins University Press, 1976.

    Google Scholar 

  • Schraa, J. C., Dirks, J. F., Jones, N. F., &: Kinsman, R. A. Bender-Gestalt performance and recall in an asthmatic sample, Journal of Asthma Research, 1981, 18, 7–9.

    Google Scholar 

  • Spector, S. L., Kinsman, R. A., &: Farr, R. S. A scheme to characterize asthma. In M. Stein (Ed.), New directions in asthma. Park Ridge, III.: American College of Chest Physicians, 1975.

    Google Scholar 

  • Staudenmayer, H., Kinsman, R. A., & Jones, N. F. Attitudes toward respiratory illness and hospi-talization in asthma: Relationships with personality, symptomatology, and treatment response. Journal of Nervous and Mental Disease, 1978, 166, 624–634.

    Article  PubMed  Google Scholar 

  • Staudenmayer, H., Kinsman, R. A., Dirks, J. F., Spector, S. L., & Wangaard, C. Medical outcome in asthmatic patients: Effects of airways hyperreactivity and symptom-focused anxiety. Psychosomatic Medicine, 1979, 41, 109–118.

    Google Scholar 

  • Vincent, P. Factors influencing patient noncompliance: A theoretical approach. Nursing Research, 1971, 20, 509–516.

    Article  PubMed  Google Scholar 

  • Watkins, J. D., Williams, T. F., Martin, D. A., Hogan, N. D., & Anderson, E. A. A study of the diabetic patient at home. American Journal of Public Health, 1967, 57, 452–459.

    Article  PubMed  Google Scholar 

  • Wilder, C. S. Health characteristics of persons with chronic activity limitation. (U.S. Department of Health, Education, and Welfare, Publication No. (HRA) 77-1539 ). Washington, D.C.: U.S. Government Printing Office, 1976.

    Google Scholar 

  • Zaki, M. H., Edelstein, S., Josephson, R. A., & Weisberg, S. R. Regularity of drug administration among hospitalized and ambulatory tuberculosis patients. American Review of Respiratory Disease, 1968, 97, 136–139.

    Google Scholar 

  • Zeballos, R. J., Shturman-Ellstein, R., McNally, J. F., Hirsch, J. E., & Souhrada, J. F. The role of hyperventilation in exercise-induced broncho-constriction. American Review of Respiratory Disease, 1978, 118, 877–884.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1982 Plenum Press, New York

About this chapter

Cite this chapter

Kinsman, R.A., Dirks, J.F., Jones, N.F. (1982). Psychomaintenance of Chronic Physical Illness. In: Millon, T., Green, C.J., Meagher, R.B. (eds) Handbook of Clinical Health Psychology. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-3412-5_19

Download citation

  • DOI: https://doi.org/10.1007/978-1-4613-3412-5_19

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4613-3414-9

  • Online ISBN: 978-1-4613-3412-5

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics