Psychological factors in patients with chronic rheumatoid arthritis.

Review Psychological factors in patients with chronic rheumatoid arthritis Although there are clear anatomical and physiological changes in patients with chronic rheumatoid arthritis (RA), evidence is accumulating for the importance of psychological factors as determinants of disease development and of patients' ability to adapt to their condition. There is also an increasing awareness that arthritis treatment and education programmes car. be improved by paying greater attention to the problems patients face in adapting to a chronic disease both physically and psychologically.5 There are inevitable problems in unravelling the cause and effect relationship between a chronic physical illness and psychological status. Premorbid personality may have a role in the development of arthritis-for example, unconscious or habitual coping preferences may identify individuals who tend to deny emotions and are more prone to experience somatic symptoms. The possibility that RA is associated with personality disorders has received considerable attention.68 Evidence takes the form of clinical reports and controlled investigations.9 10 Factors such as repressed hostility',ll poor marital, social, and vocational adjustment, 2 13 and obsessive compulsive character structures14 are among some of the reported manifestations of psychological maladjustment in arthritic patients. After many years of disease, however, it may be difficult to distinguish between cause and effect. The concept of repressed hostility was once thought to be particularly important. In 1958 Fisher and Cleveland found that patients with RA had considerable difficulty in expressing anger. l5 Barchi-lon reported in 1963 the case of a young woman with RA who avoided translating her angry feelings into action by adopting muscular hypotonicity in areas of her body which later became the sites of rheumatoid symptoms.16 Further work by Cobb found that male patients with RA admitted to angry feelings to a lesser extent than control groups of their male relatives and patients with duodenal ulcer.17 Standard psychological tests have been used to charac-terise the personality profiles of arthritic patients. One of these is the Minesota Multiphasic Personality Inventory (MMPI), which consists of 566 true/false statements which comprise three validity scales and 10 clinical scales. It was completed by 35 women and 10 men with RA.18 Repressed hostility did not emerge as a special problem in this group, but the authors reported that patient profiles resembled the classical neurotic pattern with raised hypochondriasis, depression, and hysteria scales. The MMPI has been used by several other authors to assess arthritic patients,1921 and reports all record an increase …