Kirmayer Laurence J, Looper Karl J
Division of Social & Transcultural Psychiatry, McGill University, and Department of Psychiatry, Sir Mortimer B. Davis--Jewish General Hospital, Montreal, Quebec, Canada.
Curr Opin Psychiatry. 2006 Jan;19(1):54-60. doi: 10.1097/01.yco.0000194810.76096.f2.
Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour.
Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services.
Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.
皮洛斯基引入了“异常疾病行为”这一术语，用于描述对症状过度或不充分反应的综合征，包括疑病症、躯体化障碍和疾病否认。本综述总结了社会学、健康心理学和精神病学领域的近期研究成果，这些研究有助于理解异常疾病行为背后可能的过程。
生理系统调节紊乱可能是许多“无法解释”的症状和疾病行为的原因。对身体感觉的关注度增加、对疼痛的敏感性以及灾难化思维在医学疾病的疾病行为中起重要作用。童年时期的发育逆境和父母的疾病行为模式可能会增加对身体的过度关注和医疗保健的利用率。疾病行为明显的跨国差异可能反映了医疗保健系统的差异，但疾病的文化模式和社会耻辱感仍然是疾病否认和避免使用心理健康服务的重要决定因素。
对疾病行为的研究与重新思考躯体形式障碍的精神病学分类学的努力相关。离散的躯体形式障碍很可能会被一个维度框架所取代，该框架识别出认知、感知和社会行为中的特定病理过程，这些过程导致身体不适、应对能力受损、医疗服务使用不当、慢性病和残疾。
