Psychological reactions of the patient to the disease

Reflection of a disease in a person's experiences is usually determined by the concept of an internal picture of the disease (WKB). It was introduced by the national therapist R.A. Luria and is now widely used in medical psychology. This concept, by the definition of a scientist, unites in himself everything that "the patient feels and experiences, the whole mass of his sensations, his general state of health, introspection, his ideas about his illness, about its causes - the whole vast world of the patient, which consists of Very complex combinations of perception and sensation, emotions, affects, conflicts, mental experiences and traumas. "

As a complex structured education, the internal picture of the disease includes several levels: sensitive, emotional, intellectual, strong-willed, rational. WKB is defined not by a nosological unit, but by the personality of a person, it is also individual and dynamic, like the inner world of each of us. At the same time, there are a number of studies that reveal the characteristic features of the experience of patients with their condition.

So, in the basis of the concept of V.D. Mendelevich ("Terminological foundations of phenomenological diagnosis") is the idea that the type of response to a particular disease is determined by two characteristics: the objective severity of the disease (determined by the criterion of lethality and the probability of disability) and the subjective severity of the disease (self assessment of the patient's condition).

The notion of the subjective severity of the disease consists of socio-constitutional characteristics, including the sex, age and profession of the individual. For each age group, there is a register of the severity of the disease - a peculiar distribution of diseases by socio-psychological significance and severity.

So, in adolescence, the most severe psychological reactions can be caused not by diseases that are objectively threatening the health of the body from a medical point of view, and those that change its appearance make it unattractive. This is due to the existence in the adolescent's mind of the basic need - "satisfaction with one's own appearance."

Persons of mature age will react more psychologically to chronic and disabling diseases. "This is connected with the value system and reflects the aspiration of a mature person to satisfy such social needs as the need for well-being, welfare, independence, independence, etc." In this regard, the most intense experiences are associated with cancer diseases. For the elderly and the elderly, the most significant are diseases that can lead to death, loss of work and working capacity.

To the individual psychological characteristics that affect the specificity of the experience of the disease include the features of temperament (with respect to the following criteria: emotionality, tolerance of pain, as a sign of emotionality, and limitation of movement and immobility), as well as features of the character of a person, his personality (ideological attitudes, the level of education).

There is a typology of ways of responding to the disease by the patient. Knowing the type of patient response helps to choose an adequate strategy of interaction with him and his family, use appropriate ways of communication, motivation for treatment.

Types of psychological response to severe medical illness

Typology of response to the disease AE Lichko and N.Ya. Ivanova ("Medico-Psychological Examination of Somatic Patients") includes 13 types of psychological response to the disease, identified on the basis of an assessment of the influence of three factors: the nature of the somatic disease itself, the type of personality in which the most important component determines the type of character accentuation and attitudes Disease in the reference (significant) for the sick group.

In the first block are those types of attitude towards the disease, in which there is no significant violation of adaptation:

Harmonious : for this type of response is characterized by a sober assessment of their condition without a tendency to exaggerate its severity and without reason to see everything in a gloomy light, but without underestimating the severity of the disease. The desire to actively promote the success of treatment in all. Unwillingness to burden others with the hardships of caring for themselves. In the case of an unfavorable prognosis in the sense of disability, the transfer of interests to those areas of life that will remain accessible to the patient. With an unfavorable forecast, attention, cares, interests on the fate of relatives, their business are concentrated.

Ergopathic : characterized by "withdrawal from illness to work." Even with the severity of the illness and suffering, they try to continue to work, no matter what. They work with bitterness, with even greater zeal than before illness, work is given all the time, they try to be treated and undergo research so that it leaves an opportunity for continuing work.

Anosognosic : characteristic is the active rejection of the thought of the disease, of its possible consequences, the denial of the obvious in the manifestation of the disease, attribution to accidental circumstances or other non-serious diseases. Refusal from examination and treatment, the desire to do with their means.

The second block includes the types of response to the disease, characterized by the presence of mental maladaptation:

Alarming : for this type of response, continuous anxiety and suspicion regarding the unfavorable course of the disease, possible complications, ineffectiveness and even the dangers of treatment. Search for new ways of treatment, thirst for additional information about the disease, possible complications, methods of treatment, continuous search for "authorities". Unlike hypochondria, objective data about the disease (the result of analyzes, conclusions of specialists) are more interesting than their own sensations. Therefore, they prefer to listen more to the statements of others than to submit their complaints without end. The mood is above all alarming, oppression - due to this anxiety).

Hypochondriac : characterized by concentration on subjective painful and other unpleasant sensations. The desire to constantly talk about them to others. On their basis, the exaggeration of the real and the search for nonexistent diseases and sufferings. Exaggerated side effect of drugs. The combination of the desire to be treated and the lack of faith in success, the requirements of a thorough examination and fear of harm and painful procedures).

Neurasthenic : behavior is typical of the type of "irritable weakness". Outbreaks of irritation, especially with pain, with discomfort, with treatment failure, adverse survey data. Irritation is often poured out on the first one and ends often with repentance and tears. Intolerance to pain. Impatience. Inability to wait for relief. In the future - remorse for anxiety and incontinence.

Melancholic : characterized by dejection of the disease, lack of faith in recovery, in possible improvement, in the effect of treatment. Active depressive statements down to suicidal thoughts. Pessimistic view of everything around, disbelief in the success of treatment, even with favorable objective data.

Euphoric : characterized by an unreasonably high mood, often faked. Neglect, frivolous attitude towards illness and treatment. Hope that "everything will be all right". The desire to receive from life everything, despite the disease. The ease of violation of the regime, although these violations can adversely affect the course of the disease.

Apathetic : characteristic of a complete indifference to his fate, the outcome of the disease, to the results of treatment. Passive submission to the procedures and treatment with persistent motivation from the outside, loss of interest in everything that previously excited.

Obezivno-phobic : characterized by alarming suspiciousness, first of all concerns fears of not real, but unlikely complications of the disease, failure of treatment, and possible (but little-grounded) failures in life, work, family situation due to illness. Imaginary dangers worry more than real. Signs and rituals become protection from anxiety.

Sensitive : there is an excessive concern about a possible adverse impression that can produce information about your illness on others. Fears that others will be avoided, deemed inferior, disregarded or cautious, to dissolve gossip or unfavorable information about the cause and nature of the disease. Fear of becoming a burden for loved ones due to illness and the disreputability of the relationship on their part in connection with this.

Egocentric : characteristic of "Care in the disease," exposing to loved ones and others their suffering and experiences in order to completely take hold of their attention. The requirement of exceptional care - everyone should forget and abandon everything and take care only of the patient. Conversations surrounding quickly translated "on yourself." In others, also requiring attention and care, see only "competitors" and treat them with hostility. A constant desire to show their special position, their exclusiveness in relation to the disease.

Paranoiac : it is characteristic of the belief that the disease is the result of someone's malicious intent. Extreme suspicion of drugs and procedures. The desire to ascribe possible complications of treatment and side effects of medication to negligence or malicious intent of doctors and staff. Charges and demands for punishments in this regard.

Dysphoric (characteristically melancholy, embittered mood).

Interaction with some of these patients can bring the doctor a pronounced psychological discomfort. But knowing the psychological basis of this type of patient behavior will help the doctor better understand his needs, expectations, fears and emotional responses, optimally organize the process of interaction with him, use certain instruments of influence.

It is important to understand that, even showing complete indifference to the outcome of treatment, the patient most wants to hear the words of hope and needs to strengthen his faith in the best.

Patients constantly worried about their condition need a calm, optimistic and attentive conversation with the doctor, and patients demonstrating the reactions of aggression to others and the doctor - the authoritative confident position of the doctor, which will help to cope with the deepest fear in his life that is hidden in his soul.

Thus, understanding the type of patient's response to the disease will help make the doctor's and patient's union more effective, contributing to the psychological well-being of both participants in the treatment process.

Source: www.oncology.ru.