Skip to Main Content

++

INTRODUCTION

++

Thirty years ago, psychiatrist George Engel coined the term “biopsychosocial model” to describe a developing paradigm for patient care (Engel, 1977). As shown in Figure 13-1, the model encourages treatments that consider the mind and body of a patient as two intertwining systems influenced by a third system—society. This was perhaps the first time a distinction was drawn between “disease” and “illness.” Namely, disease is the pathological process, and illness is the patient’s experience of that process. In keeping with this model, psychological factors have two distinct relationships with women’s reproductive health. At times, they are a consequence (infertility has been linked with psychological distress). At other times, they may be an insidious cause of a health problem (increased hysterectomy rates are noted in women with a low tolerance for the physical discomfort of menstruation).

++
FIGURE 13-1

Biopsychosocial model. (Data from Engel GL: The need for a new medical model: a challenge for biomedicine. Science 1977 Apr 8;196(4286):129–136.)

Graphic Jump Location
++

Years before Engel’s work, Erik Erikson (1963) created a model that describes psychological maturation in stages across the life span. Specifically, adolescents are confronted with identity development; reproductive-aged women with intimacy concerns; peri- and early menopausal women with productivity issues; and older women with life review. Combining Erikson’s developmental model with Engel’s psychosocial model provides a dimensional perspective to aid the evaluation, diagnosis, and treatment of any patient.

++

Not only do women use more health care services in general than men in the United States, but more women approach their physicians with psychiatric complaints, and more women have comorbid illness than men (Andrade, 2003; Kessler, 1994). Because primary care is the setting in which most patients with psychiatric illness are first seen, obstetricians and gynecologists often are the first to evaluate a woman in psychiatric distress. The clinical interview in Table 13-1 provides an example of an assessment that includes all three domains from the biopsychosocial model.

++
Table Graphic Jump Location
TABLE 13-1Psychiatric Assessment of Women
++

MOOD DISORDERS

++

Mood, anxiety, and alcohol or substance use disorders are three families of psychiatric disorders ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

Create a Free MyAccess Profile

* Required Fields

Note: If you have registered for a MyAccess profile on any of the Access sites, you can use the same MyAccess login credentials across all sites.

Passwords must be between 6 and 40 characters long (no whitespace), cannot contain characters #, &, and must contain:
  • at least one lowercase letter
  • at least one uppercase letter
  • at least one digit

Benefits of a MyAccess Profile:

  • Remote access to the site off-campus on any device
  • Notification of new content via custom alerts
  • Bookmark your favorite content such as chapters, figures, tables, videos, cases and more
  • Save and download images to PowerPoint
  • Self-Assessment quizzes saved for quick review
  • Custom Curriculum access for both instructors and learners

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.