Psych · Consultation-liaison psychiatry
Abnormal illness behaviour and the sick role
Also known as Abnormal illness behavior · Illness behaviour · Sick role · Illness Behavior Questionnaire · Pilowsky AIB · Somatization behaviour · Health-related help-seeking
Exam-exhaustive fellowship C-L topic on Parsons' sick role, Mechanic's illness behaviour, Pilowsky abnormal illness behaviour (definition, affirming/denying axes, IBQ measurement), mapping to DSM-5-TR SSD/IAD/FND/factitious/malingering, cultural formulation, and non-dualistic stepped care. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Diagnosing abnormal illness behaviour solely because tests are negative — miss evolving organic disease
- Using 'AIB' or 'somatiser' as a pejorative discharge slogan that ends medical curiosity
- Endless unfocused investigation that iatrogenically maintains disease conviction
- Dismissive 'all in your head' language that destroys alliance and increases doctor-shopping
- Care-avoidant illness denial delaying presentation of life-threatening disease
- Collusion with unnecessary invasive procedures or false certificates when intentional deception is probable
- Missing suicide risk, severe depression, or capacity issues while arguing about legitimacy of symptoms
Meet the patient
A 52-year-old man is on the gastroenterology ward for the fourth admission this year. Eleven investigations, two endoscopies, one laparoscopy — all unremarkable. He remains convinced of an undiagnosed cancer, has stopped work, and asks each new doctor to repeat the CT.[5][13]
Down the corridor is a 61-year-old woman with a fungating breast lesion she has hidden from her family for two years. She declines biopsy and says she is "fine". Nobody has referred her to you, because she is not the difficult one.[2][7]
Both are abnormal illness behaviour. Only one of them gets a psychiatry referral, and the one who does not is in far greater danger. That asymmetry is the whole topic.[2][3][7]
References18ShowHide
- [1]Pilowsky I Abnormal illness behaviour Br J Med Psychol, 1969.PMID 5378602
- [2]Pilowsky I A general classification of abnormal illness behaviours Br J Med Psychol, 1978.PMID 646959
- [3]Pilowsky I Abnormal illness behaviour: a 25th anniversary review Aust N Z J Psychiatry, 1994.PMID 7794200
- [4]Mechanic D Sociological dimensions of illness behavior Soc Sci Med, 1995.PMID 8545675
- [5]Waddell G, Pilowsky I, Bond MR Clinical assessment and interpretation of abnormal illness behaviour in low back pain Pain, 1989.PMID 2530486
- [6]Waddell G 1987 Volvo award in clinical sciences. A new clinical model for the treatment of low-back pain Spine (Phila Pa 1976), 1987.PMID 2961080
- [7]Kirmayer LJ, Looper KJ Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress Curr Opin Psychiatry, 2006.PMID 16612180
- [8]Kirmayer LJ, Young A Culture and somatization: clinical, epidemiological, and ethnographic perspectives Psychosom Med, 1998.PMID 9710287
- [9]Sirri L, Fava GA, Sonino N The unifying concept of illness behavior Psychother Psychosom, 2013.PMID 23295460
- [10]Prior KN, Bond MJ Somatic symptom disorders and illness behaviour: current perspectives Int Rev Psychiatry, 2013.PMID 23383663
- [11]Prior KN, Bond MJ The measurement of abnormal illness behavior: toward a new research agenda for the Illness Behavior Questionnaire J Psychosom Res, 2008.PMID 18291238
- [12]Barsky AJ, Wyshak G Hypochondriasis and somatosensory amplification Br J Psychiatry, 1990.PMID 2245272
- [13]Henningsen P, Zipfel S, Herzog W Management of functional somatic syndromes Lancet, 2007.PMID 17368156
- [14]Barsky AJ, Ahern DK Cognitive behavior therapy for hypochondriasis: a randomized controlled trial JAMA, 2004.PMID 15039413
- [15]Tyrer P, Cooper S, Salkovskis P, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial Lancet, 2014.PMID 24139977
- [16]Bass C, Halligan P Factitious disorders and malingering: challenges for clinical assessment and management Lancet, 2014.PMID 24612861
- [17]Dimsdale JE, Creed F, Escobar J, et al. Somatic symptom disorder: an important change in DSM J Psychosom Res, 2013.PMID 23972410
- [18]Lipowski ZJ Somatization: the concept and its clinical application Am J Psychiatry, 1988.PMID 3056044