2. Psychological
impact of
chronic illness
Dr. Amal Yassien Haikal
Lecturer of psychiatry
Faculty of medicine-
Mansoura University 2

3. Chronic illness is considered as a stressful event.
Definition of stress:
The cognitive appraisal of external events in relation to
one’s coping resources & its physiological responses in
the individual. 3

4. • eustress optimal arousal for
Primary task performance
appraisal: • stressful higher arousal, distress
& deterioration of performance
“event”
Secondary
appraisal: • sufficient successful coping
• insufficient vulnerability
“coping
resources” 4

5. factors that
increase or
decrease the
effects of
stress.
mediators that
protect from
unhealthy
effects of
stress
5

6. Personality
”type A/B”
Emotional
Cognitive reaction to Social
appraisal chronic support
illness
Spiritual
support
“Belief in
afterlife” 6

7. Anxiety
Depression
guilt, anger
7

8. • Fear of death , surgery
, disfigurement, dependency, incontinence, severe pain
• more in young patients
Anxiety
• Fear of loss, separation from family
• Loss of physical activity
• Changes in physical appearance
• The effect of surgery
Depression • Debilitating effect of radiotherapy
(5-15%)
8

9. • Guilt from
dependency, excessive
demand
Guilt • Illness represented to the
& patient as a punishment
for previous wrong doings
anger • Anger displaced to
medical staff
9

10. Denial
• Adaptive (calms patient)
• maladaptive (refuse medical care)
Dependency
• adaptive (comply with ttt)
• maladaptive (burden on caregiver)
Displacement
anger towards medical staff
Acceptance
• role of staff through good
communication 10

11. Denial &
isolation
“Something is
wrong, shock” Anger
Acceptance “Why me?
displaced….
Stages of
emotional
reaction to
chronic illness
Depression Bargaining
“hopelessness, isolati (partial
on, sleep problems acceptance)
11

13. help patients adjust to their illness and take a more active approach
Multimodal interventions using a variety of techniques but with
same general goal
increasing family
pain management stress management coping skills 13
communication

14. Chronic illness involves more than physical
symptoms. There are the psychological and
emotional symptoms as well.
The psychological effects of chronic illness can be
profound.
Chronic illness can strongly disrupt social life and put
strains on social support networks.
Individuals with chronic illness are more likely to be
depressed, especially those who experience greater
levels of pain and disability.

15. Emotional disturbance “e.g., depression”
interferes with compliance to ttt and worsen
prognosis
Patients who become unmotivated to improve
their illness-related coping tend to have greater
numbers of hospital admissions and poorer
health.
There is substantial diversity in individuals’
adjustment to chronic disease
magority: positive adjustment
minority: significant distress or life disruption.