ABSTRACT
It is a truism to say that psychological and behavioural factors and physical disease are intimately associated, although it is less easy to agree on what the direction of this association is-do psychological factors cause physical disease or vice versa? Earlier this century the concept of ‘psychosomatic disease’ was developed, suggesting that some physical diseases had a primary psychological aetiology, resulting from a particular personality type, or perhaps developing in response to outside psychological stressors. More recently, this conceptual model has been widened, so that the idea of a limited group of ‘psychosomatic’ disorders has been modified to suggest that states of mind, attitudes and behaviour can play a part in the development of physical diseases, their subsequent progress and their nature of the response to treatment. All physical disorders should therefore be regarded as having a psychosocial component which in some disorders may be more important than others (Engel, 1977).
