Chapter 9: Psychophysiological Disorders and Health
Psychophysiological disorders: are characterized by genuine physical symptoms that are caused
by or can be worsened by emotional factors; asthma, hypertension, headache and gastritis etc.
This used to be called psychosomatic disorders.
- These are diseases that involve damage to the body.
- DSM IV – needed diagnosis to indicate presence of psychological factors affecting
- DSM- psychiatric disorders are medical disorders
- Cardiovascular disease (CVD) – leading cause of death in Canada; prevention is possible
through a healthy lifestyle
- Health psychology and behavioural medicine work together for the treatment or
improvement of a person’s health.
Stress and Health
Defining the concept of Stress:
- ‘Stress’- word coined by Hans Seyle
- Selye known for identifying the General adaption syndrome (GAS).
- Stress affects the nervous system – autonomic nervous system
- Stress as a stimulus – called stressor; this kind of stimuli can be major, minor or chronic.
- Stressors can also be psychogenic (from psychological factors) or neurogenic (from a
- Allostatic load: a condition where there is intense and prolonged demands on
neurochemical systems that can lead to a variety of pathological outcomes.
- Coping: how people try to deal with a problem or handle the emotions it produces.
Effects of stress vary depending on how the person copes with the event. There are two
dimensions of coping:
- Problem focused coping: taking direct action to solve the problem of seeking info
that will be relevant to the solution.
- Emotion focused coping: efforts to reduce the negative emotional reactions to
- Lazarus believes that stress results from a transaction or interaction between situational
factors and factors inside the person.
- Goodness of fit hypothesis (Forsythe & Compass)- suggests that the adaptivity of a
particular coping response depends on the match between the coping response and what is
called for ideally by the problem situation.
- A key factor is whether the problem of situation is controllable or uncontrollable.
- In terms of cognitive appraisals and strategies, people often respond with denial and
avoidance when confronted with stressors of varying levels of severity, including
shocking events. This is the least effective method of coping especially for long term. Efforts to Measure Stress:
The two scales developed to measure life stress are:
The Social Readjustment Rating Scale and the Assessment of Daily Experience.
The Social Readjustment Rating Scale:
- Developed by Holmes and Rahe
- Ratings are totalled for all the events actually experienced to produce a Life Change Unit
(LCU) score, a weighted sum of events.
- The event of marriage was used as a reference point.
- From the findings it’s assured that physical illness was not always the result of stress but
vice versa; a certain amount of physical illness can cause huge amount of stress.
- Research on stress and health should be longitudinal and involve many assessment phases.
The Assessment of Daily Experience:
- Developed by Stone and Neale
- A day was used as the unit of analysis; report of per day is less severe however there is
now a direct evidence that these minor events relate to illness.
- Respiratory illness was selected as the criterion variable because it occurs with sufficient
frequency to allow it to be analyzed as a distinct outcome.
- Through this research we are close to believing that life events play a causal role in
increasing vulnerability to episodes of infectious illness.
- In another research it showed that measures of daily hassles are often better than measures
of major life events at predicting adjustment problems.
- However there were two problems that affected daily hassles: 1) the original Hassles Scale
was described as “contaminated” because some items were symptoms of distress and not
hassle; 2) the Hassles Scale was developed for use with middle-aged community sample
and was not relevant for other age group populations.
- The Brief College Hassles Scale taps 3 main themes: 1) academic hassles 2) interpersonal
hassles 3) financial hassles. It also assesses other common hassles.
- Illness specific hassles are also assessed; ex: cancer patients and their struggle
Stress in Specific Contexts:
- Job stress – linked consistently with depression and other negative outcomes
- Job spill over: the notion that stressed workers bring their work stress home with them and
it causes family stress.
- Job burnout – 1) a sense of emotional exhaustion; 2) depersonalization; 3) a sense of lack
of personal accomplishment; all this has been linked to a number of physical problems
including CVD. This burnout can also be a result of job addiction and workaholism.
- Vital exhaustion: extreme form of burnout; a physical depletion that is also linked to CVD Assessing Coping
- Most common way of measurement is questionnaires
- Avoidant coping methods such as denial and behavioural disengagement were related to
higher levels of distress (research on women diagnosed with breast cancer)
- Endler, Parker and others highlights the role of emotional preoccupation as a maladaptive
coping response to illness; emotional preoccupation is similar to rumination (rumination
focuses on bad feelings and experiences from the past).
- Perseverative cognition: tendency to ruminate
- Perseverative cognition hypothesis: the notion that rumination prolongs the stress
response and thus contributes to health problems
- According to research – those who ruminated the most had prolonged stress responses;
rumination contributes to stress and hypertension by prolonging CV activation following a
stressful experience; ruminators show less adaptation and prolonged physiological
responses to stress.
- People characterized to be highly hostile are most prone to health problems as a result of
brooding about negative social interactions
Moderators of the Stress-Illness Link
- There are many types of social support that can lessen effects of stress:
Structural social support: a person’s basic network of social relationships (marital
status, friends etc)
The kind of assistance in social support are:
- Emotional: provides the recipient with a sense of being cared for by warm and
- Instrumental: provides with more tangible forms of assistance.
Functional social support: concerned more with the quality of a person’s relationships
(e.g. believing if he/she has friends in time of need)
- Structural support is a good predictor of mortality; low social support = higher mortality
rate and vice versa.
- Higher functional support = lower atherosclerosis and chronic rheumatoid in women
- Higher levels of social support = positive health behaviours.
- Social support is said to have causal effect on physiological process
- During social interaction, a hormone called oxytocin is released and decreases the activity
of sympathetic nervous system and may thereby lessen the physiological effects of a
Theories of the Stress-Illness Link
- Connection between psychophysiological disorders to specific organ weakness etc.
- According to this theory, the connection between stress and a particular
psychophysiological disorder is a weakness in a specific body organ. Specific – Reaction Theory:
- According to this theory, individuals respond to stress in their own idiosyncratic ways,
and the body system that is the most responsive becomes a likely candidate for the locus
of a psychophysiological disorder
- E.g. a person who already has high blood pressure may result in hypertension due to
Prolonged Exposure to stress hormones:
- Biological changes that stress produces are adaptive in the short run
- Major biological responses to stress involve activation of the sympathetic nervous system
and the hypothalamic-pituitary – adrenal axis.
- The key to McEwen’s theory is that the body pays a price if it must constantly adapt to
- High levels of stress hormones = altered immune system functioning = susceptible to
- High levels of cortisol = direct negative effects on the brain
- 10% of people show no adaptation to stress and even increase cortisol secretion
- The nature of the stressor is important – prolonged high activation resulted from more
traumatic stressors, stressors that threaten survival, and ones involving profound threat to
the social self.
- Uncontrollable stressors are linked with persistent HPA axis activation
Stress and the Immune System:
- Stress affects many body systems: the autonomic nervous system, hormone levels and
- Immune system is a current area of interest; it has been accepted that stress triggers
autoimmune diseases such as rheumatoid arthritis
- There is evidence now that stress weakens the immune system and responses to bacterial
and viral vaccines can be delayed
- High stress can kill – secretion of cytokine
- Short term stress is good while long term stress weakens immune system
- Secretory Immunity contains substance called secretory immunoglobulin A or sIgnA
that contains antibodies which serve as body’s first line of defense against viruses and
- Stone and his colleagues found out that a number of sIgA antibodies are linked to changes
- Another study shows links between stress and respiratory infection; some reasons for
stressors were interpersonal problems, work difficulties, less social support and emotional
- Bandura’s studies show that deficits in self efficacy are linked to diminished immune
- Self -efficacy: personal sense of perceived capability Psychological Theories
Cognitive and behavioural factors:
- People who continually appraise life experiences as exceeding their resources may be
chronically stressed and at risk for the development of a ps