The BHI 2 began with a broad theory of the interaction between psychological and medical disorders. Bruns and Disorbio (2003) referred to this as the theory of "Psychomedical Disorders." This was an attempt to create a single construct which incorporated such diagnosis as somatoform disorders and somatization, reactive psychological disorders, factitious disorders, psychophysiological disorders and others.
It was hypothesized that all serious medical disorders tend to give rise to a significant psychological component. Conversely, all serious psychological disorders tend to present with a significant medical component as well. They defined a Psychomedical Disorder as any disorder in which related psychological and medical conditions could both be diagnosed. This would by definition include any DSM-IV diagnosis where an Axis III condition was diagnosed. These disorders were categorized into four different types:
Types of Psychomedical Disorders(Adapted from Bruns and Disorbio, 2003) |
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Reactive Disorders |
Psychological disorders where a psychological reaction occurs as a result of a medical condition. For example, a person who is diagnosed with terminal cancer could react psychologically with a panic attack, anger or severe depression. |
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Psychophysiological Disorders |
Disorders in which psychological problems give rise to real organic difficulties. For example, a person who is exposed to severe stress may develop problems with blood pressure, headaches, gastrointestinal distress or other sorts of medical disorders. |
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Somatoform Disorders |
Disorders in which psychological factors give rise to the experience of medical symptoms. For example, hypochondriasis is a condition where a person is convinced that he or she is suffering from a particular disease, despite objective medical information to the contrary. |
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Endogenous Disorders |
Disorders in which medical conditions directly produce a psychological disorder. For example, persons with hypothyroidism may experience depression as a result of the hormonal imbalance. |
In any of these disorders, comprehensive and effective treatment must address both the medical and the psychological components of the condition.
Given the importance of behavioral health interventions it seems likely that the field of health psychology will grow substantially in the years to come. For this to happen, both the psychological and the medical profession must learn new ways of practicing and coordinating care. A comprehensive assessment of psychomedical disorders generally involves both medical and psychological input.
More information about the BHI 2
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