title: Abnormal illness behaviour: physiological, psychological and social dimensions of coping with distress.
abstract: OBJECTIVE
  Pilowsky introduced the term 'abnormal illness behaviour' to characterize syndromes of excessive or inadequate response to symptoms, including hypochondriasis, somatization, and denial of illness. This review summarizes recent work from sociology, health psychology and psychiatry that contributes to an understanding of the processes that may underlie abnormal illness behaviour.
  
  
  RESULTS
  Disturbances in the regulation of physiological systems may account for many 'unexplained' symptoms and sickness behaviour. Increased attention to bodily sensations, sensitivity to pain and catastrophizing play important roles in illness behaviour in medical illness. Developmental adversities and parental modelling of illness behaviour in childhood may increase bodily preoccupation and health care utilization. Apparent cross-national differences in illness behaviour may reflect differences in health care systems, but cultural models of illness and social stigma remain important determinants of illness denial and avoidance of mental health services.
  
  
  CONCLUSIONS
  Research into illness behaviour is relevant to efforts to rethink the psychiatric nosology of somatoform disorders. The discrete somatoform disorders might well be replaced by a dimensional framework that identifies specific pathological processes in cognition, perception and social behaviour that contribute to bodily distress, impaired coping, inappropriate use of health services, chronicity and disability.
authors.affiliation: Division of Social & Transcultural Psychiatry, McGill University, and Department of Psychiatry, Sir Mortimer B. Davis--Jewish General Hospital, Montreal, Quebec, Canada. laurence.kirmayer@mcgill.ca
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Kirmayer
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Looper
mesh_terms: D000223:Adaptation, Psychological; D015928:Cognitive Behavioral Therapy / Q000379:methods; D003469:Culture; D003717:Denial, Psychological; D003865:Major Depressive Disorder / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D006801:Humans; D011584:Psychology; D012803:Sick Role