Psychosocial Adaptation: Chronic Illness and Disability

Concerned c abnormalities of body structure and appearance and with organ or system function

Impairment

Any loss of abnormality of psychological , physiological or anatomic structure or function

Impairment

Disturbance at organ level

Impairment

Paralysis of limbs due to SCI

Impairment

Reflects the consequence of impairment in terms of functional performance and activity

Disability

Disturbance at the level of the person

Disability

Inability to walk and perform ADLs

Disability

Disadvantage from which prevents from performing a role

Handicap

Reflect interaction with and adaptation to the individual’s surroundings

Handicap

Societal level

Handicap

Immobility, dependence

Handicap

Statistics on chronic illness and disability - WHO: Estimated __ ppl experience significant disability

• Increasing in number due to increase in __

1.3B

Noncommunicable disease and longer lifespan

Statistics on chronic illness and disability - WHO: Some persons with disability die up to __ years earlier than those without disabilities

20

Statistics on chronic illness and disability - WHO: Persons c disabilities have __ the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity, or poor oral health

Twice

Statistics on chronic illness and disability - WHO: Face many health __ (arise from unfair conditions faced by persons c disabilities, including stigma, discrimination, poverty, exclusion from education and employment and barriers faced in the health system)

inequities

Statistics on chronic illness and disability - WHO: Approx __ americans have physical, sensory, psychiatric or cognitive disabilities that interfere with daily living

54M (1 in 5)

Statistics on chronic illness and disability - WHO: __ Amreicans with disabilities are unable to work or attend school

>9M

Statistics on chronic illness and disability - WHO: Costs of annual income support and medical care provided by US government is about __

$60B

Statistics on chronic illness and disability - WHO: Disabilities are higher among __

• Older ppl

• Minorities

• Lower socioeconomic groups

Statistics on chronic illness and disability - WHO: __ most common causes of death in US are associated with chronic illness

8 out of 10

Factor that create a profound effect on the life of the indivs c chronic illness and disability

• Degree of functional limitations

• Interference with ability to perform daily activities and life roles

• Uncertain prognosis

• Prolonged course of medical tx and rehab

• Psychosocial stress associated c the incurred trauma or disease process itself

• Impact on fam & friends

• Sustained financial losses

Dynamics to the psychosocial adaptation to CID

• Stress

• Crisis

• Loss & grief

• Body image

• Self-concept

• Stigma

• Uncertainty

• Unpredictability

• Quality of life

Dynamics to the psychosocial adaptation to CID: Increased frequency and severity of stressful situations

Stress

Dynamics to the psychosocial adaptation to CID: Need to cope c daily threats

Stress

Dynamics to the psychosocial adaptation to CID: __: One’s life and well being

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: __: Body integrity

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: __: Independence and autonomy

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: __: Fulfillment of familial, social and vocational roles

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: __: Future goals and plans

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: __: Economic stability

Stress: Need to cope c daily threats

Dynamics to the psychosocial adaptation to CID: Sudden onset, life-threatening, loss of valued functions

Crisis

Dynamics to the psychosocial adaptation to CID: Although its time is limited, during its presence life is affected by disturbed psychological, behavioral and social equilibrium

Crisis

Dynamics to the psychosocial adaptation to CID:Its consequences are long lasting and may evolve into pathological disorders

Crisis

Dynamics to the psychosocial adaptation to CID: Triggers a mourning process for the lost body part or function

Loss and grief

Dynamics to the psychosocial adaptation to CID: Constant reminder of the permanency of the condition

Loss and grief

Dynamics to the psychosocial adaptation to CID: Daily triggering events act to remind of the permanent disparity bw past and present or future situations

Loss and grief

Different stages of mourning

• Non-acceptance of the facts

• Erupting emotions

• Parting with the former

• Finding a new self as well as new perspectives for one’s future

Dynamics to the psychosocial adaptation to CID: Unconscious mental representation or schema of one’s own body

Body image

Dynamics to the psychosocial adaptation to CID:Evolves gradually and reflects interactive forces exerted by sensory (visual, auditory, kinesthetic), interpersonal (attitudinal), environmental (physical conditions) and temporal factors

Body image

Dynamics to the psychosocial adaptation to CID: CID alters and distorts own body image and self-concept

Body image

Dynamics to the psychosocial adaptation to CID: Successful psychosocial adaptation to CID is said to reflect the integration of physical and sensory changes into a transformed body image and self-perception

Body image

Dynamics to the psychosocial adaptation to CID: Linked to body image and often seen as conscious, social derivatives of it

Self concept

Dynamics to the psychosocial adaptation to CID: Self-identity (sense of self) is privately owned and outwardly presented

Self concept

Dynamics to the psychosocial adaptation to CID: __: May be denied in social interactions with others who respond to the person as disabled first = lost sense of real self

Self concept: Self identity

Dynamics to the psychosocial adaptation to CID: __: Self-esteem gradually becomes eroded ad negative self-perceptions follow

Self concept: Self identity

Dynamics to the psychosocial adaptation to CID: Negative set of beliefs about people c specific characteristics

Stigma

Dynamics to the psychosocial adaptation to CID: Inc life stress, reduced self-esteem and withdrawal from social encounters, including tx and rehab

Stigma

Dynamics to the psychosocial adaptation to CID: 3 kinds of stigma

• Public stigma

• Structural stigma

• Self-stigma

Dynamics to the psychosocial adaptation to CID: Stigma

• Social avoidance

• Stereotyping

• Discrimination

• Condescension

• Blaming

• Internalization

• Hate crimes and violence

Dynamics to the psychosocial adaptation to CID: Stigma: __: Left out of social activities, circle may be more distant, people hesitant to make eye contact or start conversation

Social avoidance

Dynamics to the psychosocial adaptation to CID: Stigma: __: Presumed helpless, unable to care for self, unable to make decisions

Stereotyping

Dynamics to the psychosocial adaptation to CID: Stigma: __: Jobs, housing, opportunities

Discrimination

Dynamics to the psychosocial adaptation to CID: Stigma: __: Coddled or over-protected d/t perceptions of helplessness

Condescension

Dynamics to the psychosocial adaptation to CID: Stigma: __: Accused of using disability for unfair gains

Blaming

Dynamics to the psychosocial adaptation to CID: Stigma: __: Person himself feels ashamed or embarrassed

Internalization

How disability stigma affects your relationship c patients: Reluctant to use AD or disclose diagnosis

Concealment

How disability stigma affects your relationship c patients: Some expres pride and positive identity to counteract stigma

Disability pride

How disability stigma affects your relationship c patients: Join groups with same disability

Disability pride

How disability stigma affects your relationship c patients: May opt against medical tx because they have developed an identity around the disability

Disability pride

How disability stigma affects your relationship c patients: Choose to make a disability more evident to improve their options for social participation (using a wheelchair instead of walker to travel c family without fatigue)

Social integration

How disability stigma affects your relationship c patients: Build a collaborative partnership with patient built on trust and respect communicates your support for the patient as a whole person

Need for respect

Dynamics to the psychosocial adaptation to CID: Stable or predictable

• Ex. __

Uncertainty and unpredictability

• Amputation, CP

Dynamics to the psychosocial adaptation to CID: Unstable and unpredictable

• Ex. ___

Uncertainty and unpredictability

• Epilepsy, cancer, DM, MS

Dynamics to the psychosocial adaptation to CID: Uncertainty and unpredictability: Exacerbation and remissions

Unstable and unpredictable

Dynamics to the psychosocial adaptation to CID: Uncertainty and unpredictability: Unpredictable complications

Unstable and unpredictable

Dynamics to the psychosocial adaptation to CID: Uncertainty and unpredictability: Experiences of pain and loss of consciousness

Unstable and unpredictable

Dynamics to the psychosocial adaptation to CID: Uncertainty and unpredictability: Alternating pace of gradual deterioration

Unstable and unpredictable

Dynamics to the psychosocial adaptation to CID: Uncertainty and unpredictability: Uncertainty, or inability to structure personal meaninng, results if the individual is unable to form a cognitive schema of illness-associated events

Perceived uncertainty in illness

Dynamics to the psychosocial adaptation to CID: Quality of Life: Domains

• Intrapersonal

• Interpersonal

• Extrapersonal

• Successful restructuring of previously disrupted psychosocial homeostasis and attainment of an adaptive person-environment (reality) congruence

• QOL is linked to a more positive self-concept and body image, increased sense of control over CID

• QOL is negatively associated c perceived stress and feelings of loss and grief

Dynamics to the psychosocial adaptation to CID: Quality of Life: Domains: Health, perceptions of life satisfaction, feelings of well being

Intrapersonal

Dynamics to the psychosocial adaptation to CID: Quality of Life: Domains: Family life, social activities

Interpersonal

Dynamics to the psychosocial adaptation to CID: Quality of Life: Domains: Work activities, housing, schooling, or learning and recreational

Extrapersonal

CID triggered responses:

• Shock

• Anxiety

• Denial

• Depression

• Anger/hostility

• Adjustment (reintegration, acceptance)

CID triggered responses: Early:

• Shock

• Anxiety

• Denial

CID triggered responses: Intermediate:

• Depression

• Anger/ hostility

CID triggered responses: Late:

• Adjustment (reintegration, acceptance)

CID triggered responses: Short-lived reaction

Shock

CID triggered responses: Marks the initial experience following the onset of a traumatic or sudden injury or diagnosis of a life threatening or chornic and debilitating disease

Shock

CID triggered responses:”Psychic numbness”, cognitive disorganization and dramatically decreased or disrupted mobility and speech

Shock

CID triggered responses: Characterized by panic-like feature on initial sensing of the nature and magnitude of the traumatic event

Anxiety

CID triggered responses: Confused thinking, cognitive flooding, multitude of physiological symptoms including rapid heart rates, hyperventilation, excess perspiration and irritable stomach

Anxiety

CID triggered responses: Defense mechanism mobilized to ward of anxiety and other threatening emotions

Denial

CID triggered responses: Involves minimization and even complete negation of the chronicity, extent and future implications associated with the condition

Denial

CID triggered responses: Involves selective attention to one’s physical and psychological environments

Denial

CID triggered responses: Wishful thinking, unrealistic expectations of recovery, or blatant neglect of medical advice and recommendations

Denial

CID triggered responses: Reflect the realization of the permanency, magnitude and future implications associated with loss of body integrity, chronicity of condition, or impending death

Depression

CID triggered responses: Feelings of despair, helplessness, hopelessness, isolation and distress

Depression

CID triggered responses: Aggressive acts, abusive accusations, antagonism, passive-aggressive modes of obstructing treatment

Anger/hostility

CID triggered responses: Anger/hostility: Types

• Internalized anger (self)

• Externalized hostility

CID triggered responses: Self attributions of responsibility for the condition onset of failure to achieve successful outcomes

Anger/hostility: Internalized anger (self)

CID triggered responses: Blame others for CID onset or unsuccessful treatment efforts or aspects of the external environment

Anger/hostility: Externalized hostility

CID triggered responses: Reorganization, reintegration, or reorientation

Adjustment

CID triggered responses: __: Components: Earlier cognitive reconciliation of the condition, its impact, and its chronic or permanent nature

Adjustment

CID triggered responses: __: Components: An affective acceptance, or internalization of oneself as a person with CID, including a new or restored sense of self concept, renewed life values and a continued search for new meanings

Adjustment

CID triggered responses: __: Components: An active pursuit or personal, social, and or vocational goals

Adjustment

CID Associated Coping Strategies: Psychological strategy mobilized to decrease, modify or diffuse the impact of stress-generating life events

Coping

CID Associated Coping Strategies: Coping types:

• Disengagement coping strategies

• Engagement coping strategies

CID Associated Coping Strategies: Seek to deal with stressful events through passive, indirect, even avoidance-oriented activities

Disengagement coping strategies

CID Associated Coping Strategies: Denial, wish-fulfilling fantasy, self and other blame, resorting to substance abuse

Disengagement coping strategies