The stresses of physical illness

Any physical illness and/or its treatment can give rise to multiple losses and threats, such as the following:

• unpleasant physical symptoms such as pain, breathlessness, or nausea

• body-image problems, as in weight loss or gain, or surgical removal of a body part

• biological influences on cognition and mood due to brain disease, metabolic disturbance, or drugs such as steroids

• enforced restrictions on lifestyle, causing boredom or loss of self-esteem as well as practical and financial problems

• interpersonal problems, involving changed family dynamics and sexual relationships

• concern and uncertainty about future prognosis; some patients are also troubled by existential and spiritual issues in relation to, for example, the reasons for their illness or the prospect of death and dying

• a sense of stigma, attached most strongly nowadays to HIV/AIDS but also to many other physical disorders, such as epilepsy and skin disease.

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