Medical Psychology & Chronic Illness

Today, chronic diseases are among the most prevalent, costly, and preventable of all health problems. Chronic diseases are now the major cause of death and disability worldwide and they account for 59% of the 57 million deaths annually and 46% of the global burden of disease.

Weight and obesity are affecting more than one billion adults worldwide, with 300 million of them clinically obese. Pelvic floor disorders (PFD) constitute a huge global health problem affecting hundreds of millions of women and man throughout the world. The prevalence of at least one form of PFD like pelvic pain, constipation, urinary and fecal incontinence, pelvic organ prolapse, has been reported to be as high as 46%. In 2011 366 million people worldwide were diagnosed with diabetes and by 2030 this will rise to 552 million.

When diagnosed with chronic illness each person goes through stages:

  • Denial: This can be one of the more dangerous stages of the grief process. It may not occur only once. Many individuals cycle back to this phase several times.

  • Anger: Any diagnosis feels unfair and provokes feelings of anger and questions such as: why me and feeling that life or God have been unfair.

  • Depression: Mild depressive feelings are a normal part of grieving and adaptation to changes realted to health.

  • Acceptance: Individuals achieve different degrees of acceptance and inner peace. Some will need to experience the denial, anger and depression several times as they move through different phases of life but some people move through a chronic disease to a state of much greater self-knowledge and deeper understanding of themselves and their relations to others.

Poor compliance with medication and/or treatment plan are very common in chronic illness.  The more complex and painful the treatment - the higher the chance that non-compliance will become an issue. It may therefore not be surprising that compliance rates have been found to be below 50% among chronic illness patients.

When a family has a member with a chronic illness, the family also has a chronic relationship with different medical and health professionals. Noncompliance is often located at the interface between the patient and the health/provider system, for example, effective communication and consistent and caring relationship were found to have major positive effect on patients' compliance rates. Multi-disciplinary team approach is found to be most effective in chronic condtions.

Emotions, Health & Somatic/Body Psychotherapy

A Health Psychology belief is with developing an understanding of how biological, sociological, environmental and cultural factors relate to physical and emotional health. The research is beginning to discover that negative feeling states such as sadness, anger, rage, anxiety, jealousy, and envy, have a direct association to a person’s physical condition. - See more at: http://healthpsychology.org/health-psychology-promotes-emotional-and-physical-health/#sthash.vn0gmo9i.dpuf
A Health Psychology belief is with developing an understanding of how biological, sociological, environmental and cultural factors relate to physical and emotional health. The research is beginning to discover that negative feeling states such as sadness, anger, rage, anxiety, jealousy, and envy, have a direct association to a person’s physical condition. - See more at: http://healthpsychology.org/health-psychology-promotes-emotional-and-physical-health/#sthash.vn0gmo9i.dpuf
A Health Psychology belief is with developing an understanding of how biological, sociological, environmental and cultural factors relate to physical and emotional health. The research is beginning to discover that negative feeling states such as sadness, anger, rage, anxiety, jealousy, and envy, have a direct association to a person’s physical condition. - See more at: http://healthpsychology.org/health-psychology-promotes-emotional-and-physical-health/#sthash.vn0gmo9i.dpuf

Health psychology or medical psychology is relatively new discipline that applies scientific knowledge of the interrelationships among behavioral, emotional, cognitive, social and biological components in health and disease to:

  • the promotion and maintenance of health;
  • the prevention, treatment and rehabilitation of illness and disability; and
  • the improvement of the health care system.

The distinct focus of clinical health psychology (also known as medical psychology and psychosomatic medicine) is at the connection between physical and emotional aspects and  understanding and treating the overlapping challenges.

A Health Psychology belief is with developing an understanding of how biological, sociological, environmental and cultural factors relate to physical and emotional health. The research is beginning to discover that negative feeling states such as sadness, anger, rage, anxiety, jealousy, and envy, have a direct association to a person’s physical condition. - See more at: http://healthpsychology.org/health-psychology-promotes-emotional-and-physical-health/#sthash.vn0gmo9i.dpuf
A Health Psychology belief is with developing an understanding of how biological, sociological, environmental and cultural factors relate to physical and emotional health. The research is beginning to discover that negative feeling states such as sadness, anger, rage, anxiety, jealousy, and envy, have a direct association to a person’s physical condition. - See more at: http://healthpsychology.org/health-psychology-promotes-emotional-and-physical-health/#sthash.vn0gmo9i.dpuf

A vast scientific literature has detailed how negative emotions harm the body. Serious, sustained stress or fear can alter biological systems in a way that, over time, adds up to “wear and tear” and, eventually, illnesses such as heart disease, stroke, and diabetes. Chronic anger and anxiety can disrupt cardiac function by changing the heart’s electrical stability, hastening atherosclerosis, and increasing systemic inflammation as well as causing digestive disorders and infection.

Chronic stress and negative attitude can upset the body's hormone balance and deplete the brain chemicals, as well as have a damaging impact on the immune system.

A research by Harvarad University found that early childhood stress and abuse - the sustained activation of the body’s stress response system resulting from early life experiences as chronic neglect, exposure to violence, or living alone with a parent suffering severe mental illness—has harmful effects on the brain and other organ systems.

When we experience emotions of sadness, anger, fear and frustration our body responds to the way we think, feel and act. This is called the “mind/body connection". Even our everyday language points to the effects emotions have on our body, metaphorically and literary: "that breaks my heart," "it's a pain in the neck" or "I just love it to death". When feelings are kept inside, they operate invisibly and eventually start inflicting damaging changes in the body. The following can be physical signs that your emotional health is out of balance: back pain, pelvic pain, constipation or diarrhea, chest pain, headaches, high blood pressure, heart racing, shortness of breath, upset stomach, weight gain or loss, often infections and colds, etc.

The somatic/body oriented psychotherapy addressess mind-body connection by focusing on clients' awareness of their physical body, and its relationship to mental and emotional habits. Somatic psychotherapy also teaches clients how to develop a positive relationship with one’s physical body and how to use body-mind connections to improve overall health.

Pelvic Floor Disorders

Pelvic floor problems include pelvic pain, constipation, pelvic organ prolapse, and incontinence of urine or feces. There are many causes of these problems, and their manifestations affect different people in different ways. Symptoms can range from minor inconveniences to causing major restrictions of lifestyle, ability to work, or sexual function. Feelings of helplessness, anger, and frustration are common. Many patients have visited multiple doctors or tried a number or treatments without relief of their symptoms.

In USA every ninth women will undergo surgery for a pelvic floor disorder in her lifetime, with 30 percent of those women requiring additional surgery for the same condition. There were 28.1 million woman diagnosed with pelvic floor disorder in 2010 and number will rise to 43.8 million in 2050. Twelve percent of people worldwide suffer from constipation while 20 percent of women experience chronic pelvic pain, and about 61 percent of the cases go undiagnosed. Sixty five percent of women and 30 percent of men sitting in a GP waiting room report some type of urinary incontinence, yet only 31 percent of these people report having sought help from a health professional. Women comprise over 70 percent of people affected by incontinence, with problems arising primarily after childbirth and menopause. There are no available statistics specifically for South Africa.

 

Pelvic Floor Disorder Units in South Africa

Although not a new field of medicine globally, the treatment of PFDs in SA is in its infancy as evinced by the fact that the first national meeting focusing on the field took place just five years ago. 

The Pelvic Floor Unit at the Wits Donald  Gordon Medical Centre (WDGMC) is the  only private practice center of its kind in  SA, with colorectal surgeon, Dr Brendan Bebington, as the chair of the pelvic floor unit. The multi-disciplinary approach and meetings include several other disciplines: urology, gynecology, radiography, a women’s health physiotherapy team and clinical psychology. Dr Marovic is a member of Donald Gordon multi-disciplinary team.

Psychology of Pelvic Floor

The majority  of people (40-80%) with pelvic floor disorders do not seek help or there is a delay obtaining help. Most common reasons given for not seeking treatment include: embarrassment, shame, fear of surgery, and hope of improvement without treatment. Dealing with constipation, diarhea, bladder or feces incontinence, pelvic pain or other embarrassing issues related to pelvic floor disorders eventually leads to depression, anxiety, social isolation, self-esteem & body-image problems.

There are valid physiological reasons why people have problematic bowel movements such as lack of exercise, poor diets, pregnancy, illness and others. However, root cause of bowel problems may be imbedded in the mind.

If you've ever had a headache after a stressful day, a sick feeling in your stomach before an interview, or felt anxiety before an exam, you have first hand experience with the undeniable connection between feelings and their ability to produce physical ailments. Similarly, a long history of suppressed feelings of anger, hatred, grief or anxiety, and the genetic predisposition to bowel disorders, may result in bowel problems. So our thoughts and emotions materialize into physical matter. The body-mind relationship has a direct effect on our state of health as well as our ability to heal. Long periods of unexpressed anger, grief and other stressful emotions directly affect bowel movements and lead to bowel problems.

Psychotherapy may be helpful in addressing some of the following aspects of pelvic floor disorders:

  • Dealing with emotional aspects related to pelvic floor disorders
  • Management of pelvic floor condition.
  • Addressing  traumatic  or other emotional  events related to pelvic floor dysfunction
  • Hypnotherapy  for pelvic floor pain management
  • Expectations in relation to surgery
  • Somatic psychotherapy  to build body-mind  awareness and connection
  • Teaching stress-management techniques
  • Addressing relationship issues
  • Dealing with sexual dysfunctions
  • Improvement of medical compliance.

Links & Resources

Donald Gordon Pelvic Floor Unit

 

Diabetes

Diabetes is a chronic illness in which the body is unable to produce or unable to properly use and store glucose (a form of sugar). Glucose backs up in the bloodstream — causing one’s blood glucose or "sugar" to rise too high. In South Africa we currently have approx 6,5 million diabetics, only 8 000 of whom are registered with Diabetes South Africa (DSA) - shocking statistics!

There are two main types of diabetes:

Type I diabetes or insulin-dependent diabetes (formerly called juvenile-onset diabetes, because it tends to affect persons before the age of 20) affects about 10 percent of people with diabetes. With this type of diabetes, the pancreas makes almost no insulin.

Type II diabetes or non-insulin-dependent diabetes. This was previously called "adult-onset diabetes" because in the past it was usually discovered after age 40. However, with increasing levels of obesity and sedentary lifestyle, this disease is now being found more and more in adolescents - and sometimes even in children under 10 - and the term "adult onset" is no longer used. Type II diabetes comprises about 90 percent of all cases of diabetes. With this type of diabetes, either the pancreas produces a reduced amount of insulin, the cells do not respond to the insulin, or both.

Symtoms and Teratment of Diabetes

Diabetes can occur in anyone. However, people who have close relatives with the disease are somewhat more likely to develop it.

Other risk factors include obesity, high cholesterol, high blood pressure, and physical inactivity and stress. The risk of developing diabetes also increases as people grow older.

Risk factors: sedentary life style, obesity, advanced age, unhealthy life style, family history of diabetes, stress,  certain type of medication (cortisone and high blood pressure medication). The warning signs:

Type I: Frequent urination, increased thirst, extreme hunger, unexplained weight loss, extreme fatigue, blurred vision, irritability, nausea and vomiting.

Type II: Any Type I symptom, plus: unexplained weight gain, pain, cramping, tingling or numbness in your feet, unusual drowsiness, frequent vaginal or skin infections, dry, itchy skin and slow healing sores.

Diagnosis of Diabetes. Besides a complete history and physical examination, the doctors will perform a battery of laboratory tests. There are numerous tests available to diagnose diabetes, such as a urine test, blood test, glucose-tolerance test, fasting blood sugar and the glycohemoglobin (HbA1c) test.

Treatment. There are certain things that everyone who has diabetes, whether type 1 or type 2, needs to do to be healthy. They need to have a meal (eating) plan. They need to pay attention to how much physical activity they engage in, because physical activity can help the body use insulin better so it can convert glucose into energy for cells.

Everyone with type 1 diabetes, and some people with type 2 diabetes, also need to take insulin injections. Some people with type 2 diabetes take pills called "oral agents" which help their bodies produce more insulin and/or use the insulin it is producing better. Some people with type 2 diabetes can manage their disease without medication by appropriate meal planning and adequate physical activity. 

Everyone who has diabetes should be seen at least once every six months by a diabetes specialist (an endocrinologist) as well as other members of a diabetes treatment team, including a diabetes nurse educator, and a dietitian and, a psychologist for help with the stresses and challenges of living with a chronic disease.

Diabetes complications. Please be aware of the following problems that exist with insulin intake:

  • Hypoglycemia (low blood sugar) is sometimes called an insulin reaction or insulin shock. It can occur suddenly in people using insulin if too little food is eaten, if a meal is delayed or in the case of extreme exercise. Symptoms include feeling cold, clammy, nervous, shaky, weak or hungry, and some people become pale, have headaches or act strangely.

  • Hyperglycemia (high blood sugar) occurs when too much food is eaten or not enough insulin is taken. The warning signs are large amounts of sugar in the urine and blood, frequent urination, great thirst and nausea.

  • Ketoacidosis (in its most severe form - diabetic coma) develops when insulin and blood sugar are so out of balance that ketones accumulate in the blood. Symptoms include high blood sugar or ketones in the urine, dry mouth, great thirst, loss of appetite, excessive urination, dry and flushed skin, labored breathing, fruity-smelling breath and possible vomiting, abdominal pain and unconsciousness.

Stress in Diabetes & Psychotherapy

In people with diabetes, stress can alter blood glucose levels. It does this in two ways. First, people under stress may not take good care of themselves. They may drink more alcohol or exercise less. They may forget, or not have time, to check their glucose levels or plan good meals. Second, stress hormones may also alter blood glucose levels directly. Physical stress, such as illness or injury, causes higher blood glucose levels in people with either type of diabetes.

Many newly diagnosed diabetics go through the typical stages of mourning. These are denial, anger, depression and acceptance.

  • Denial: This can be one of the more dangerous stages of the grief process. It may not occur only once. Many individuals cycle back to this phase several times. The honeymoon phase, associated with early Type I diabetes, may reinforce denial. Denial is a common stance for adolescent diabetics.

  • Anger: It really does seem unfair. The type II diabetic, trying to lose weight, may envy heavier people who seem to enjoy good health. One might erupt at someone who innocently offers a desert. Unfortunately, anger can drastically affect glucose levels.

  • Depression: Mild depressive feelings are a normal part of grieving and adaptation. Even though depression is not generally listed as a complication of diabetes, studies have shown that the rate of depression in diabetics is much higher than in the general population.

  • Acceptance: Individuals achieve different degrees of acceptance and inner peace. Some will need to experience the denial, anger and depression several times as they move through different phases of life and different stages of diabetes. Some people move through a chronic disease to a state of much greater self-knowledge and deeper understanding of themselves and their relations to others.

However, coping problems are very common among people with diabetes largely because the demands of diabetes management are so substantial. The sense of being overwhelmed is one factor leading to the low levels of diabetes self care. Self care is a critical issue in diabetes and focus of therapeutic intervention is on the development of coping skills and techniques designed to help diabetics establish self care goals, and develop and commit to a plan for achieving that goal.

Links and Resources

Diabetic Clinic - Dr Lynnsay Dickson

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