Subject

Disease Prevention and Control

Biopsychosocial Paradigm

Date: June 27, 2011

Lecturer: Dr. Javier

OUTLINE:
1.
2.

3.

To differentiate the biomedical model and the

biopsychosocial model;
To understand how biological, psychological, and social
factors influence health; and
To apply the biopsychosocial approach to the holistic care
of patient and his/her family and community.

HEALTH:

The highest possible level or state of complete physical,

mental, and social well-being and not merely the absence
of disease (WHO, 1948)
A.

BIOMEDICAL MODEL

This is the traditional medical model.

Understanding a more complex entity
Can be achieved by analyzing its component parts; and
thus, this can be studied and explained by the methods
and in the language of physics and chemistry.
Person

organ systems (CNS)

Organs

Tissues

Cells

Organelles

Molecules

Atoms

Sub-atomic particles

B. BIOPSYCHOSOCIAL MODEL

This model of Dr. George Engel emphasizes the unit of the

body, mind, and social context, showing that our concern
as physicians is not just the disease process, but also how
the patient feels and perceives his condition
Does not attempt to replace the traditional way of
approaching medicine, but tries to go further by taking a
whole person approach to managing patients.

Esling, G; Esternon, K; Fernandez, C

Biopsychosocial
Model

Biosphere

Society / nation

Culture / sub-culture

Community

Family
Two persons

Person

Biomedical Model

BIOLOGIC FACTORS
Demographic Profile:

Age
o Common Pediatric Diseases:

Measles (a common childhood viral

disease that is characterized by
maculopapular lesions on the trunk of
the body accompanied by runny nose,
fever and cough)

Pertussis (also known as whooping

cough caused by a bacteria known as
Bordetella pertussis)

Nutritional Deficiencies (marasmus,

kwashiorkor)
o Middle Age

Sexually Transmitted Diseases (HPV,

Syphillis, Gonorrhea, etc)
o Old Age:

Degenerative diseases (Alzheimers

Degenerative Osteoarthritis, Coronary
Artery Diseases)
o Biomodal Age Peaks:

15-35 years old and >50 years old

o Advanced Maternal Age:

Can cause problems in fetal

development leading to congenital
disorders such as Downs Syndrome

Sex
o Males:

Diseases common in males: Coronary

Artery Disease (CAD) and Lung Cancer
o Females:

Diabetes Mellitus, Graves Disease,

Chutta Cancer of the hard palate
o Homosexuals:

HIV, Hepa A, Hepa B

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Biopsychosocial Factors

Marital Status and Parity

o Married:

Cervical and uterine cancer (women)

o Nulliparous (never been pregnant)

Breast cancer, ovarian cancer (due to

increased levels of progesterone)
Race
o Acne vulgaris
o Angle Closure Glaucoma
o Sickle Cell Anemia
Occupation:
o Carpenters
o Contact dermatitis

Lifestyle
o Alcohol abuse

characterized by a constellation of
changes that are collectively grouped
as chronic alcoholism

pathologic findings include: hepatitis

and liver cirrhosis, pancreatitis,
gastritis, oral and esophageal
carcinoma, cardiomyopathy, peripheral
neuropathy, and Wernicke-Korsakoff
syndrome
o Smoking

Has been established to be a cause of

lung carcinoma.

A stick of cigarette contains thousands

of known carcinogens.
o Exercise

Regular aerobic exercise (e.g. brisk

walking, swimming, biking) is known to
improve cardiorespiratory function

Esling, G; Esternon, K; Fernandez, C

An improper or unbalanced diet

predisposes one to develop either
protein energy malnutrition or obesity

PSYCHOLOGICAL FACTORS
Affective, cognitive, behavioral dimensions, feelings,
beliefs, and expectations
Personality types
Defense mechanisms and coping styles

A. HEALTH BELIEFS

Genetics:
o Adult Polycystic Kidney Disease
o Minamata Disease (Japan): caused by the
release of methyl mercury in the industrial
wastewater (shellfish) leading to mercurial
poisoning)
o Important tool: Newborn Screening

Can detect inborn errors of

metabolism such as:
Inborn Error
Glucose-6 Phosphate
Lack of the G6PD enzyme
Dehydrogenase (G6PD)
causing hemolytic anemia when
exposed to oxidative substances
in certaind rugs, foods and
chemicals
Congenital hypothyroidism
Lack of thyroid hormone
Congenital Adrenal Hyperplasia
Endocrine disorder causing
severe salt loss
Galactosemia
Inability to process sugar in milk
(galactose)
Phenylketonuria
Inability of the body to process
the enzyme phenylalanine
leading to brain damage

Diet

June 27, 2011

Major influencer of health-seeking behaviors and

health in general (ex. Breast milk to cure
bacterial infections of the eye)
Major role of physicians: correcting existing
misperceptions regarding illnesses

B. PERSONALITY TYPES
Type A: Action-oriented individuals who
struggle to achieve poorly defined goals by
means of competitive hostility.
Characteristics: Aggressive,
impatient, upwardly mobile, and
extremely angry when frustrated.
Type B: Relaxed individuals, less angry
C. DEFENSE / COPING MECHANISMS
Isolation is characteristic
of the
orderly, controlled person, often labeled as
obsessive-compulsive personality.

Suicide:
Age: risk increases starting at age
40-50 years old but may also
affect adolescents and early
adults
Sex: men commit suicide more
(due to more violent methods), but
women attempt suicide more
Personality disorders: borderline
PD, anti-social PD, cylcothymic PD
Recent stressors: loss of spouse,
recent unemployment, early
parental loss
Conjugal status: separated,
divorced, widowed, single

What is the importance of family in health education?

Primary social agent in the promotion of
health and well-being
First teachers
May influence a childs way of thinking
which he/she can carry to adulthood

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Biopsychosocial Factors

SOCIAL FACTORS
B. SOCIAL SYSTEM
Family Characteristics:
1. Structure
2. Orders of magnitude of
change and family life
cycle
3. Family assessment tool
Impact of illness / illness trajectory

ORDERS OF MAGNITUDE OF CHANGE AND FAMILY LIFE

CYCLE

FAMILY CHARACTERISTICS

STRUCTURE
Structure
Nuclear Family: Parents +
Dependent children only (no
grandparents, uncles, aunts,
etc)
Extended Family: 3
generations under 1 roof
(may be unilateral or
bilateral)
Single Parent: children 17
years old and below who live
with single parents, a relative
or a non-relative

Clinical Correlation

Higher death rates due to

cardiovascular diseases,
malignancies, infectious
diseases, accidents,
homicides and suicides
Widowed: 4x higher agespecific death rates
compared to married
individuals
Divorced: increased rates of
depression-suicides,
domestic violence

Blended Family: Mixed - Two

individuals, who may have
previous marriage (step
sisters / step brothers)
Corporate / Communal (A
group of individuals formed
for specific ideological or
societal purposes. It is
considered as an alternative
lifestyle for people who feel
alienated)

Esling, G; Esternon, K; Fernandez, C

Step children: pervasive

developmental delay
(Aspergers syndrome,
autism, ADHD), depression,
adjustment disorders

June 27, 2011

First Order Change:

Change in ability
A need to do something new
Involves increments of mastery and adaptation
Does not involve changes in the main structures of
the family or in an individuals identity and selfimage
Involves tasks that must be accomplished by the
family and family members working within a stage of
the family life cycle.
Second Order Change:
Role reversal
A need to be something new
Involves transformation of an individuals status and
meaning
Change in the very basic attributes of the family
systems
Typically occurs between stages of the family life
cycle --- intergenerational connectedness

FAMILY LIFE CYCLE:

Represents the composite of individual
developmental changes of family members
Shows the evolution of the marital relationship and
presents cyclic development of the evolving family
unit --- ability of the family to transcend the
emotional process of transition (EPT)
STAGE
EPT (EXPECTED)
PROBLEM
Unattached Accepting parentSTDs, Preyoung
offspring separation
employment
adults
Newly
Commitment to the
Reproductive health,
married
new system
adjustment problems
Family with Accepting new
Perinatal problems,
young
members into the
adjustment disorders
children
system
Family with Increasing flexibility of Sexuality and
adolescents boundaries to include
dermatologic
children
problems
independence
Launching
Accepting a multitude Depression
of adult
of entries and
(Emptiness
children
exits into the family syndrome), midlife
system
crisis
Family in
later years

Accepting the shifting

of generational goals

Degenerative
diseases, age related
disorders

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Biopsychosocial Factors

June 27, 2011

FAMILY ASSESSMENT TOOLS:

Family Genogram:
o A graphic representation of both the genetic pedigree
of the family and key psychosocial and interactional
data using standardized symbols
o It represents three components of the family:
Family tree (including its description)
Functional chart
Family illness / history
o Advantage: Excellent tool that can be used to learn
about family structure
o Disadvantage: Limited role in assessing family
function

Family Map
o Developed by: Dr. Salvador Minuchin
o Gives a better picture of the various relationships
existing among the family members
o This is a snapshot of a moment in the life of the
family. Thus, a family map, unlike a genogram,
changes from time to time.
o Establishes family boundaries (rules that govern the
interactions among subsystems in the family)
o GOAL: TO MAINTAIN HOMEOSTASIS (when a problem
arises, it should be fixed in order to prevent its
consequences)

Overt rules (open, taught)

Covert rules (does not need to be said,

automatically understood)

Rigid vs. Diffuse boundaries

Rigid: not open to negotiation in spite of
the fact that circumstances render the old
boundaries no longer appropriate
(Disengagement: boundaries that are too
rigid)
Diffuse: lack of clarity and by intrusions by
one subsystem into another (Enmeshment
or over-involvement: occurs when
boundaries are not set)

Esling, G; Esternon, K; Fernandez, C

Family Map

Family Lifeline:
o Important family events may play a significant role in
the holistic management of patients (i.e. emergence
of certain symptoms, compliance with medications,
decision-making in certain health issues, etc.).
o Life events and clinical events may facilitate analysis
of connection and establish correlation between the
two.
o Example:

Family APGAR
o A rapid screening instrument used to measure family
dysfunction
o Determines the family members level of satisfaction
about their relationships
o TWO PARTS:
Part I: defines the degree of patients
satisfaction / dissatisfaction with family function
Part II: delineates relationship with other
members (identifies support system of the
patient)

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Biopsychosocial Factors

FAMILY APGAR:
Adaptation

Partnership

Growth

Affection

Resolve

INTERPRETATION

June 27, 2011

IMPACT OF ILLNESS / ILLNESS TRAJECTORY

Capability of the family to utilize and
share inherent resources, which are
either intra-familial or extra-familial
Sharing of decision-making and measures
the satisfaction attained in solving
problems by communicating
Physical and emotional growth and
measures the satisfaction of the available
freedom to change.
How emotions (i.e. Love, anger, hatred)
are shared among members and
measures the family members
satisfaction with the intimacy and
emotional interaction that exist in the
family
How time, space, and money are shared
and measures the members satisfaction
with the commitment made by other
members of the family
8-10 points: HIGHLY FUNCTIONAL
4-7 points: MODERATELY
DYSFUNCTIONAL
0-3 points: SEVERELY DYSFUNCTIONAL

Foreign and local medical literature state that there is a

statistical correlation between some health outcomes
and family function (e.g. TB-DOTS).

Family S.C.R.E.E.M.
This is used to assess the familys capacity to participate
in provision of health care or to cope with various crises
This is an acronym that stands for Social, Cultural,
Religious, Economic, Educational, and Medical factors
affecting health.
o
These factors may be considered as resource or as
pathology.
Examples: Jehovahs witness (refusal to accept donated
blood)
Other Family Tools used:
Family Circle
FACES (Family Adaptability and Cohesion Evaluation
Scale)
FES (Family Environmental Scale)
DRAFT (Draw a Family Test)
Clinical Biography and Life Events

Esling, G; Esternon, K; Fernandez, C

This refers to the normal course of the psychosocial

aspects of disease for the patient and the family --impact of illness on the patient and family
Knowledge of the trajectory allows the primary care
physician to predict, anticipate, and deal with the
familys response to the disease / illness and eventually
enables the primary care physician to formulate
individualized therapeutic plans.

STAGES IN THE FAMILY ILLNESS TRAJECTORY:

STAGE:
DURATION:
Onset of
Prior to contact
Signs and symptoms
illness to
with physician
of the patient
diagnosis
definitive
Diagnostic work-up
diagnosis
Establishment of the
diagnosis.
Impact
Final diagnosis of Appropriate
the disease
treatment is given to
the patient and
explained according
to the patients level
of understanding
Alleviation of anxiety
by explaining his/her
condition thoroughly
Support and
encouragement
Major
Treatment phase Inquire about the
Therapeutic
(psychological
assumption of
Efforts
preparedness of
responsibility for
the patient and
care; give realistic
family is taken
role/s to everyone.
into
Consider economy
consideration to
of therapeutic plan
determine
treatment
option
Recovery
Period of healing
Return to health
(important
or adjustment
Partial recovery
phase)
Permanent disability
Adjustment
Crucial time for
Development of
to
the family
coping mechanisms
permanency
of outcome
ILLNESS TRAJECTORY:
Certain issues have to be addressed esp. for patients with
chronic debilitating illnesses
Nursing homes
Caregiver fatigue

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Biopsychosocial Factors

June 27, 2011

QUALITY OF LIFE OF INDIVIDUALS

SUPPORTIVE, PALLIATIVE AND HOSPICE CARE:
To provide support and care for terminally ill patients
and their families in order for them to live as fully and as
comfortable as possible
Philosophy of Supportive, Palliative and Hospice Care:
o Hospice affirms life (recognizes dying, whether or
not resulting from a disease as a normal process)
o Palliative care: not withholding treatment, but
creating a pro-active treatment plan appropriate to
the end stages of life

Esling, G; Esternon, K; Fernandez, C

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