Psychiatric and psychosocial concomitants of abnormal illness behaviour in patients with cancer

Background: Previous studies of medically ill patients suggest that abnormal illness behaviour (i.e. high hypochondriasis, disease conviction, dysphoria and irritability) is associated with depressive symptoms. The present study was carried out in order to examine more in detail the role of psychiatric and psychosocial variables in moulding abnormal illness behaviour in patients with cancer. Methods: Two-hundred and one newly diagnosed cancer patients were submitted to a semistructured interview to assess past and current psychiatric disorders (DSM-III-R) and social support. Self-report questionnaires were also given in order to evaluate psychological stress symptoms (Symptom Check List-90-R - SCL-90-R), external locus of control (ELC) and illness behaviour (Illness Behaviour Questionnaire - IBQ). Results: A pattern of abnormal illness behaviour was shown in patients with a life-time history of psychiatric disorders (n = 33) and in those with a current DSM-III-R diagnosis (n = 101), IBQ dimensions were associated with SCL-90-R, ELC and low social support. The patients' tendency to deny life events other than cancer was related both to the progression of the illness and to their receiving chemotherapy, Conclusions: The study confirms the association between psychological disorders and abnormal illness behaviour and points out a role for personality variables (external locus of control) and low social support in favouring maladaptive responses to cancer.