7 Old age psychiatry7.4 Psychiatric aspects of physical disease
7.4.3 Emotional responses to chronic illness
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Written by Resident Doctor Committee · Published
New in the 2027 syllabus
The College added this topic for exams from January 2027.
Understanding the response
Living with a physical illness can bring uncertainty, pain and loss of independence. People may feel their identity has changed, and many worry about becoming a burden to others.
Sadness, fear and anger are often understandable responses. Having them does not by itself mean the person has a psychiatric disorder.
When you assess, explore:
how the person understands their illness
how they have coped with difficulties before
their relationships
the practical things they have lost
what matters most to them now
Telling the presentations apart
Presentation | What helps distinguish it |
|---|---|
Adjustment response | Distress linked to a stressor, with difficulty adapting or functioning |
Depressive episode | A persistent depressive syndrome, including loss of pleasure (anhedonia), guilt or suicidal thinking |
Anxiety | Worry focused on threat, avoidance or panic. Check for physical and drug causes |
Demoralisation | Helplessness, loss of meaning or feeling unable to cope. It can coexist with depression |
Delirium | An acute change with impaired attention or alertness. It needs medical assessment |
Avoiding misattribution
Misattribution means putting a symptom down to the wrong cause.
Sleep, appetite and energy can change because of the illness or because of depression. Do not dismiss these symptoms. Look at the whole syndrome and at change from the person's usual baseline.
Pain and breathlessness can make fear worse. Avoidance may then reduce activity and confidence. The person may need both physical treatment and psychological support.
Suicidal thinking must be asked about directly. Explore intent and access to means. Consider whether a wish to die comes from untreated symptoms or from hopelessness.
Helping adaptation
Clear information reduces uncertainty. Match it to the person's questions and how ready they are to hear it, and be honest about what is not yet known.
Collaborative goals, agreed with the person, focus on achievable activities, relationships and control over daily choices.
Psychological treatment can work on avoidance, unhelpful interpretations, grief and coping. Adapt it for sensory or cognitive difficulties.
Practical support includes rehabilitation, benefits advice, transport and help for carers.
Review mood, function, symptoms and safety. If distress persists or worsens, reassess the person rather than offering automatic reassurance.