Academic journal article Journal of Counseling and Development : JCD

Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors

Academic journal article Journal of Counseling and Development : JCD

Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors

Article excerpt

Chronic illnesses and disabling conditions are common occurrences in the lives of many individuals. It has been estimated that approximately 54 million Americans (about 1 in 5) have physical, sensory, psychiatric, or cognitive disabilities that interfere with daily living (Bowe, 2000). Furthermore (a) more than 9 million Americans with disabilities are unable to work or attend school; (b) costs of annual income support (e.g., supplemental security income, social security disability insurance) and medical care provided by the U.S. government to assist people with disabilities is about $60 billion; (c) disabilities are higher among older people, minorities, and lower socioeconomic groups; and (d) 8 of the 10 most common causes of death in the U.S. are associated with chronic illness (Eisenberg, Glueckauf, & Zaretsky, 1999; Stachnik, Stoffelmayr, & Hoppe, 1983).

Many disability- and nondisability-related factors interact to create a profound effect on the lives of individuals with chronic illness and disabilities (CID). Among these, the most commonly recognized factors include the degree of functional limitations, interference with the ability to perform daily activities and life roles, uncertain prognosis, the prolonged course of medical treatment and rehabilitation interventions, the psychosocial stress associated with the incurred trauma or disease process itself, the impact on family and friends, and the sustained financial losses (e.g., reduced income, increased medical bills).

The intent of this article is to provide the reader with an overview of(a) the dynamics (i.e., process) of psychosocial adaptation to CID, Co) methods commonly used to assess psychosocial adaptation to CID, and (c) intervention strategies applied to people with CID.

The Dynamics of Psychosocial Adaptation to CID

The onset of CID is typically associated with a disease process (e.g., multiple sclerosis [MS], cancer) or a traumatic injury (spinal cord injury, traumatic brain injury). CID is also dichotomized into congenital, or evident at birth (e.g., spina bifida, cerebral palsy), and adventitious, or acquired later in life (Parkinson's disease, amputation). In this article, we focus on psychosocial adaptation to acquired disabling conditions.

This overview of the literature on psychosocial adaptation to CID is grouped under three headings: basic concepts, CID-triggered reactions, and CID-related coping strategies.

Basic Concepts

Included here are the concepts of stress, crisis, loss and grief, body image, self-concept, stigma, uncertainty and unpredictability, and quality of life.

Stress. Individuals with CID normally face an increase in both the frequency and severity of stressful situations (Falvo, 1999; Horowitz, 1986). Increased stress is experienced because of the need to cope with daily threats that include, among others, threats to (a) one's life and well-being; (b) body integrity; (c) independence and autonomy; (d) fulfillment of familial, social, and vocational roles; (e) future goals and plans; and (f) economic stability (Falvo, 1999).

Crisis. The sudden onset of many medical impairments and disabilities (e.g., myocardial infarction, spinal cord injury, traumatic brain injury, amputation) and that of life-threatening diagnoses or loss of valued functions (e.g., cancer, vision impairment) is highly traumatic. As such, these conditions constitute a psychosocial crisis in the life of the affected person (Livneh & Antonak, 1997; Moos & Schaefer, 1984). Although crisis, by definition, is time-limited (e.g., Janosik, 1984), during its presence life is affected by disturbed psychological, behavioral, and social equilibrium. The psychological consequences of crisis are, in contrast, long lasting and may even evolve into pathological conditions such as posttraumatic stress disorder (PTSD).

Loss and grief The crisis experienced following the onset of a traumatic or progressive CID triggers a mourning process for the lost body part or function. …

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