Dysfunctional illness behaviour: Personal predicament and medical dilemma

P. Spencer

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    The effects of dysfunctional illness behaviour are considered both in terms of the individual and health service resources. Probable aetiological factors are considered and approaches to management and treatment discussed. The role of education is considered in the prevention and amelioration of dysfunctional illness behaviour.

    It is a phenomenon that has been described using many names. Hypochondria, somatisation disorder, factitious disorder, hysteria, Munchausen's syndrome and conversion disorder to name but a few. The latest name is Dysfunctional Illness Behaviour (DIB) and it perhaps best describes the phenomenon. They are often referred to as ‘heartsink’ patients because of the feelings they induce in health professionals. (O'Dowd, 1988).

    DIB refers to the over-emphasis of various symptoms such as muscular problems, feelings of nausea, aches and pains in various parts of the body, dizziness and fainting. Further, the person exhibiting DIB will insist that these symptoms signal some serious and often life-threatening physical illness. The nausea will signal stomach cancer, the earache an early warning sign of meningitis, and pins and needles will be interpreted as a certain symptom of motor neurone disease. Despite reassurance and exhaustive tests they will remain unconvinced and instead take their, by now burgeoning, file of medical notes to the next unsuspecting health professional in the hope of receiving what they will describe as a more ‘sympathetic and understanding ear’.

    This reaction of patients to disturbing and mysterious symptoms is very understandable. Western culture especially is distinguished by its emphasis on physical as opposed to psychological distress. Often psychological illness is relegated to being ‘imaginary’. Given this attitude it is not surprising that patients try to legitimise their suffering by attaching an organic label to it. It is still not completely accepted that all illnesses have a psychological as well as an organic component.

    The vapours, neurasthenia, hysteria, melancholia and hypochondria were once all considered to be purely physical illnesses but are now viewed as primarily psychological problems (Richmond, 1989).

    DIB can be an expensive problem—both for the health service and the individual. One patient with Munchausen's syndrome totalled hospital fees of a quarter of a million pounds, including eleven operations and almost three years in hospital. Railway Spine, an illness popular in Victorian times, led to huge claims for compensation and led people to live lives of chronic invalidism. Originally considered to be caused by the jolting of spinal nerves it was eventually recognised as an anxiety disorder.
    Original languageEnglish
    Pages (from-to)19-21
    Number of pages3
    JournalInternational Journal of Health Promotion and Education
    Issue number1
    Publication statusPublished - 2000


    • Behaviour
    • Causes
    • Cognitive
    • Dysfunctional
    • Illness
    • Treatment


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