biopsychosocial model presentation

The biopsychosocial model

Jul 31, 2014

2.55k likes | 8.33k Views

The biopsychosocial model. What is the biopsychosocial model?.

Share Presentation

• effect size
• different types
• mental health workers
• meaningful way
• common factors theory propose

Presentation Transcript

What is the biopsychosocial model? • The biopsychosocial model (Engel, 1977) is a general model or approach that states that biological, psychological (which entails thoughts, emotions, and behaviors), and social factors (abbreviated "BPS") all play a significant role in human functioning in the context of disease or illness. • This is in contrast to the traditional, reductionist biomedical model of medicine that suggests every everything which is psychological is first physical

The BPS model…

Model description and application… • The biopsychosocial model implies that treatment of abnormal behavior for example depression, requires that the health care team address biological, psychological and social influences upon a patient's functioning. • In a philosophical sense, the biopsychosocial model states that the workings of the body can affect the mind, and the workings of the mind can affect the body. • The biopsychosocial model presumes that it is important to consider the biological, psychological and the social when explaining and treating abormal behaviour and empirical literature suggests that these factors all play a significant role in abnormal behaviour

Model description and application… • Practitioners of this model address the patients needs on the three levels – Biological/ Psychological and Social • There are theories that the mind directly effects the immune system – (we see this in the research on the stress response system) • Psychosocial factors can cause a biological effect by predisposing the patient to risk factors: An example is that depression by itself may not cause liver problems, but a depressed person may be more likely to have alcohol problems (an environmental risk), and therefore liver damage.

Evaluation • A plausible explanation because it takes into account three factors • Does not offer a clear cut explanation of abnormal behavior • has not been fully successful – the biomedical model still dominates in the treatment of abnormal behavior

Questions to check your understanding of the biopsychosocial model • What three factors does the biopsychosoical (BPS) model propose play a significant role in human functioning? • Why is the traditional biomedical model seen as reductionist? • What does the BPS model say about the workings of the mind and body? • Give an example of a connection between psychological factors and biological effects • Give two well developed evaluative points which relate to BPS (expand on the ones given in this packet)

The diathesis–stress model

What is the diathesis-stress model? • The diathesis–stress model is a psychological theory that explains behavior as both a result of biological and genetic factors ("nature"), and life experiences ("nurture"). • This model thus assumes that a disposition towards a certain disorder may result from a combination of one's genetics and early learning. • The term "diathesis" is used to refer to a genetic predisposition toward an abnormal or diseased condition. • According to the model, this predisposition, in combination with certain kinds of environmental “stress”, results in abnormal behavior. • This theory is often used to explain how mental disorders like schizophrenia are produced by the interaction of a vulnerable hereditary predisposition, with precipitating events in the environment. • It was originally introduced as a means to explain some of the causes of schizophrenia (Zubin & Spring, 1977).

Model Description and application… • In the diathesis–stress model, a biological or genetic vulnerability or predisposition (diathesis) interacts with the environment and life events (stressors) to trigger behaviors or psychological disorders. • The greater the underlying vulnerability, the less stress is needed to trigger the behavior or disorder. • Conversely, where there is a smaller genetic contribution greater life stress is required to produce the particular result. • Even so, someone with a diathesis towards a disorder does not necessarily mean they will ever develop the disorder. Both the diathesis and the stress are required for this to happen.

Evaluation • This model has had profound benefits for people with severe and persistent mental illnesses. It has stimulated research on the common stressors that people with disorders such as schizophrenia experience. • More importantly, it has stimulated research and treatment on how to mitigate this stress, and therefore reduce the expression of the diathesis, by developing protective factors. • Protective factors include psychopharmacology, skill building (especially problem solving and basic communication skills) and the development of support systems for individuals with these illnesses. • Even more importantly, the stress–vulnerability–protective factors model has allowed mental health workers, family members, and clients to create a sophisticated personal profile of what happens when the person is doing poorly (the diathesis), what hurts (the stressors), and what helps (the protective factors). This has resulted in more humane, effective, efficient, and empowering treatment interventions.

Questions to check your understanding of the diathesis stress model of abnormal behavior • What two factors does this model use to explain abnormal behavior? • What does the term “diathesis” mean? • What was this model initially used to explain? • In the diathesis stress model what is needed for abnormal behavior to occur? • What has this research stimulated an interested into? • What has the recent focus on protective factors enable health professionals to do?

The Dodo Bird Verdict

The Dodo Bird Verdict • In Lewis Carroll's Alice's Adventures in Wonderland (1865), at a certain point a number of characters become wet. • In order to dry themselves, the Dodo decided to issue a competition. Everyone was to run around the lake until they were dry. Nobody cared to measure how far each person had run, nor how long. • When they asked the Dodo who had won, he thought long and hard and then said "Everybody has won and all must have prizes." "Everybody has won and all must have prizes."

The Dodo Bird Verdict • In psychological literature, Rosenzweig (1936) coined this phrase the "Dodo bird verdict", and it has been extensively referred to in subsequent literature as a consequence of the common factors theory. This is the theory that the specific techniques that are applied in different types of treatments for abnormality serve a very limited purpose (such as a shared myth to believe in), and that most of the positive effect that is gained from psychotherapy is due to factors that the schools have in common, namely the therapeutic effect of having a relationship with a therapist who is warm, respectful and friendly. Meta-analyses by Lester Luborsky (2002) show that the effect size that can be attributed to specific therapy techniques is only 0.2. Therefore, all therapies are considered equal and "all must have prizes". "Everybody has won and all must have prizes."

The Dodo Bird Verdict • On the other hand, scientists who believe in empirically supported therapies (EST) contend that it is not a fair picture of affairs. • Amongst many others Chambless (2002), for example, support the EST movement because there is much evidence that specific therapies are helpful to "specific people in specific situations with specific problems". • The significance of the figure of 0.2 is then an artifact of grouping problems and therapies in a non-meaningful way. "Everybody has won and all must have prizes."

The Dodo Bird Verdict • The "Dodo bird verdict" is especially important because policymakers have to decide on the usefulness of investing in the diversity of psychotherapies that exist. The debate has been very much heated since its re-inception in 1975 with a publication of Lester Luborsky. • Depending on what the outcome of the debate is held to be, many jobs and also the healthcare for many individuals are at stake. "Everybody has won and all must have prizes."

Questions to check your understanding of the dodo bird verdict in the treatment of abnormal behavior • Why is this called the dodo bird verdict? • Who was the person who came up with this concept? • What does the common factors theory propose? • What are ESTs? • What are the implications in terms of treating abnormal behavior if the dodo bird verdict is true?

• More by User

Biopsychosocial Development during Adolescence

2. OBJECTIVES. Review the evolution of the concept of adolescence, and explore existing definitions Identify the main biological events and timings of puberty and growth Identify the psychological and social events of adolescent development Manage the delivery of health care according to adolesce

1.11k views • 63 slides

The Biopsychosocial Context 0f Psychiatric Nursing Care

The Biopsychosocial Context 0f Psychiatric Nursing Care. NUR 305 Mrs. Roberts. Bio context-the brain. The Cerebrum- conscious perception, abstract reasoning, and thinking 4 lobes: Frontal-speech & motor function Temporal-auditory processing & language Parietal-sensory function

851 views • 35 slides

Vascular Dementia – biopsychosocial aspects!

Vascular Dementia – biopsychosocial aspects!. Dr Maryam Hussain Dr Cornelia van Ineveld March 11 th , 2008. Clinical Vignette. 82 year old female, widowed, referred because of rapid decline in cognition 2 year history of gradual decline in cognition and function

975 views • 56 slides

THE FUTURE OF PSYCHIATRY IS THE BIOPSYCHOSOCIAL MODEL

THE FUTURE OF PSYCHIATRY IS THE BIOPSYCHOSOCIAL MODEL. D B Double. My argument. Psychiatry has always had a biomedical emphasis. My argument. Psychiatry has always had a biomedical emphasis There has always been a biopsychosocial minority view. My argument.

895 views • 45 slides

Biopsychosocial Model

Bodily Stress Reactions. Biopsychosocial Model . 1. Voluntary Nervous System. Conscious enables you to scratch your ear, shake hands, turn your head. 2. Autonomic Nervous System. Mainly unconscious blushing, getting gooseflesh, having an orgasm reacts powerfully to stress

657 views • 8 slides

Biopsychosocial /cultural factors of the sex offender

Biopsychosocial /cultural factors of the sex offender. By Al Duke. Biological Factors. Most sex offenders are male ( Wodarski & Johnson, 1988). In fact my expert, a Probation Officer of sex offenders only encountered about 5 females out of 50-60 sex offenders in the course of 6 years.

191 views • 7 slides

Biopsychosocial Health of Military Couples

Session # H2a October 11, 2013 1:30pm-2:00pm. Biopsychosocial Health of Military Couples. Angela Lamson, PhD East Carolina University Melissa Lewis, PhD University of Minnesota-Duluth Meghan Lacks, MS East Carolina University Amelia Muse, MS Texas Tech University Lisa Buchner, MS

384 views • 24 slides

Gambling within the Biopsychosocial framework

Gambling within the Biopsychosocial framework. Biological Factors. Impulse Control Disorder. Currently in the DSM and ICD there is no category for an ‘addictive disorder’. Gambling comes under a type of impulse control disorder in the DSM-IV-TR.

179 views • 10 slides

Bipolar Disorder: A Biopsychosocial Overview

Bipolar Disorder: A Biopsychosocial Overview. mdl.psych.northwestern.edu. Source: Touched by Fire, Jamison, 1996. Bipolar Disorder: Epidemiology. Elevated suicide, divorce, work impairment, substance use 6 th leading cause of disability worldwide (Murray & Lopez, 1996).

393 views • 21 slides

Gambling within the Biopsychosocial framework. Addiction and Gambling. Addiction occurs when an: Individual ‘feels’ a constant desire to use a specific substance or engage in certain activities. Despite the potentially negative consequences. This can cause:

822 views • 52 slides

Understanding the Biopsychosocial Impact of Trauma

Understanding the Biopsychosocial Impact of Trauma. Module created by Saxe, 2002. Brian R. Sims, M.D., NASMHPD Consultant. Longitudinal Course of PTSD Symptoms in Children with Burns. 50. 45. 40. 35. 30. PTSD-RI Score. 25. 20. 15. 10. 5. 0.

613 views • 45 slides

Cholera in 1849 and the Biopsychosocial Model: Historical Analysis or Anachronism?

Cholera in 1849 and the Biopsychosocial Model: Historical Analysis or Anachronism?. The Snowflakes of MSU: Peter Vinten-Johansen Howard Brody Nigel Paneth Steve Rachman Michael Rip. The Argument. One can draw useful analogies between: Today’s biopsychosocial model of human health, and

488 views • 32 slides

Engaging Men with Sexual Difficulties in Rural General Practice A biopsychosocial model

Engaging Men with Sexual Difficulties in Rural General Practice A biopsychosocial model. Dr Raie Goodwach Malvern Psychotherapy Centre 1232 Malvern Rd Malvern Vic 3144 Ph 98244322 On behalf of Andrology Australia. The Facts. 1 in 5 men – erectile difficulties

620 views • 46 slides

BIOPSYCHOSOCIAL MODEL

BIOPSYCHOSOCIAL MODEL. I wake to sleep, and take my waking slow. I learn by going where I have to go . - The Waking , Theodore Roethke. February, 2001. March, 2001. April, 2001. April, 2001. INTERDISCIPLINARY. RESEARCH INTENSIVE.

723 views • 50 slides

BIOPSYCHOSOCIAL SYSTEMS AFFECTED BY AD

ALZHEIMER PATHOLOGY AND NEUROPLASTICITY AD ATTACKS NEUROPLASTIC MECHANISMS NEUROPLASTICITY AS THE FOCUS OF THE ALZHEMIER ATTACK ALZHEIMER ATTACK AS A MODEL TO UNDERSTAND NEUROPLASTICITY J. Wesson Ashford, M.D., Ph.D. Stanford / VA Aging Clinical Research Center.

205 views • 12 slides

Biopsychosocial model of disease

Biopsychosocial model of disease. Human Disease: Three Models. Medical Model. Biopsychosocial Model. Epidemiological Model. Human Disease. Medical Model. Emphasis on medical treatment You’re either healthy or you’re not. Missing important dimensions of health

915 views • 19 slides

Biopsychosocial Perspective

Biopsychosocial Perspective. Biological genetic physiological Cognitive processes knowledge Socioemotional interactions with others emotional reactions personality. Periods of Human Development (western culture ). Prenatal: conception - birth Infancy: birth - toddler

382 views • 12 slides

639 views • 56 slides

• Bipolar Disorder
• Therapy Center
• When To See a Therapist
• Types of Therapy
• Best Online Therapy
• Best Couples Therapy
• Best Family Therapy
• Managing Stress
• Sleep and Dreaming
• Understanding Emotions
• Self-Improvement
• Healthy Relationships
• Student Resources
• Personality Types
• Guided Meditations
• Verywell Mind Insights
• 2023 Verywell Mind 25
• Mental Health in the Classroom
• Editorial Process
• Meet Our Review Board
• Crisis Support

Understanding the Biopsychosocial Model of Health and Wellness

A holistic approach to well-being

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Maskot/Getty Images

• The Three Aspects of the Biopsychosocial Model

How the Biopsychosocial Model Impacts Mental Health

• Criticism of the Model

How Healthcare Professionals Use the Biopsychosocial Model

How clients and patients can use the biopsychosocial model.

The biopsychosocial model is an approach to understanding mental and physical health through a multi-systems lens, understanding the influence of biology, psychology, and social environment. Dr. George Engel and Dr. John Romano developed this model in the 1970s, but the concept of this has existed in medicine for centuries.

A biopsychosocial approach to healthcare understands that these systems overlap and interact to impact each individual’s well-being and risk for illness, and understanding these systems can lead to more effective treatment. It also recognizes the importance of patient self-awareness , relationships with providers in the healthcare system, and individual life context.

Dr. Akeem Marsh, MD , physician and author of Not Just Bad Kids , described the biopsychosocial model as “at its core, centering around social determinants of mental health in connection with the ‘standard’ biomedical and psychological models. One of the more common ways in which it is represented when using the model is through the four ‘Ps’ of case formulation: predisposing, precipitating, perpetuating, and protective factors.”

Learn more about how providers can use the biopsychosocial model to offer holistic care and how clients and patients can benefit from this approach.

What Are the Three Aspects of the Biopsychosocial Model?

When understanding an individual’s physical and mental health through the biopsychosocial model, we consider physiological factors such as genetics and illness pathology (biological); thoughts, emotions, and behavior (psychological); and socioeconomic components, social support, and culture (social). How do each of these components inform the model as a whole?

“Biology” refers to our genetics , physical health, and the functioning of our organ systems. Our physical well-being impacts our mental health for multiple reasons. First, our brain is an organ and can become unwell just like any other organ. Second, physical health conditions can wear on mental health. For example, chronic pain can lead to symptoms of depression.

Additionally, just like we can have genetic predisposition to a physical disability, mental health has genetic roots as well. According to Dr. Marsh, “Genetics are the most basic level by which mental health is influenced, and on some level has an impact for everyone.” In other words, “Whatever the phenotypical expression, genetics does play a role to some degree.” The expression is in turn influenced by the environment.

Psychological

Mental health is health, and one’s psychological well-being impacts both mental and physical health. Unhealthy and maladaptive moods, thoughts, and behaviors can all be symptoms of mental health conditions, and in turn can contribute to our overall health. Mental health and behavior can be cyclical; for example, an individual who self-isolates as a symptom of depression may experience increased depressive symptoms as a result of isolation.

Routine physical activity is known to promote positive mental wellness, while inadequate or excessive physical activity can contribute to different types of mental health struggles.

Addressing these symptoms is key in improving mental health.

Dr. Marsh shares the impact of external factors on health: “The expression [of genetics] is in turn influenced by environment.” Changes in one’s environment can impact mental health, both positively and negatively. In the previous example of depression and isolation , individuals who have appropriate social support experience fewer mental health issues compared to those without this support.

An individual who is struggling with their mental health might need social support and environmental changes just as much as they need therapy or medication intervention for their symptoms.

Traditionally, healthcare has focused primarily on the medical and biological side of the patient’s needs, and mental health care has focused on the psychological side. While it makes logical sense to address manifesting symptoms, a holistic approach to care that aims to address the social as well as the psychological and biological contributions to illness can be more health-promoting.

Sometimes, for instance, addressing an underlying social need or environmental stressor can improve mental health more effectively than other psychological or biological treatments. This may allow for less-invasive treatments and interventions, and it can improve the individual’s well-being in a way that non-holistic models overlook.

Criticism of the Biopsychosocial Model

Although many providers support a holistic approach to care and implement the biopsychosocial model in practice, like any model it has limitations. Dr. Marsh notes that there are concerns about its evidence backing: “Some people believe that [the biopsychosocial model] is not scientific, as in it has not quite met the ‘gold standard’ of being validated through multiple randomized trials, as it is a uniquely challenging study prospect.” How can researchers study controlled variables in a model that requires holistic care that takes individual needs into account?

At the same time, the model has many strengths and can benefit patients in the healthcare and mental health systems: “It has been researched extensively and shown positive results when applied in different ways,” Dr. Marsh said.

Mental health professionals who utilize the biopsychosocial model in practice include extensive medical history, family history, genetics, and social factors in assessments in addition to psychological information.

Additionally, they use this information to ensure that all of the client’s needs are met , as many medical issues can manifest with mental health symptoms. Therapy services to treat, for example, depression caused by an under-functioning thyroid is unlikely to be effective.

When adopted appropriately, health professionals conceptualize patients that they work with in a broad context that attempts to understand and see patients as a whole person—complex human being with nuance, so much more than just a cluster of symptoms or diagnosis.

This model lets providers see the whole person beyond their presenting symptoms.

While the biopsychosocial model has its place in the healthcare and mental healthcare systems, individuals might also implement tenants of this model in their own lives. This means being aware of how environmental factors impact their mental and physical health, as well as how their genetics and medical history in turn influence behaviors, thoughts, and emotions.

It can help individuals better understand themselves as complex, whole beings as well. “I believe that [the biopsychosocial model] could enhance their self-awareness and understanding of themselves, along with broadening their personal sense of what issues or challenges may be going on with them," says Dr. Marsh.

Engel GL. The need for a new medical model: a challenge for biomedicine .  Science . 1977;196(4286):129-136. doi:10.1126/science.847460

Soltani S, Kopala-Sibley DC, Noel M. The co-occurrence of pediatric chronic pain and depression: a narrative review and conceptualization of mutual maintenance .  The Clinical Journal of Pain . 2019;35(7):633-643. doi:10.1097/AJP.0000000000000723

Alsubaie MM, Stain HJ, Webster LAD, Wadman R. The role of sources of social support on depression and quality of life for university students .  International Journal of Adolescence and Youth . 2019;24(4):484-496. doi:10.1080/02673843.2019.1568887

By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

IResearchNet

The Biopsychosocial Model Explained

The Biopsychosocial Model is a comprehensive framework in health psychology that acknowledges the intricate interplay of biological, psychological, and social factors in influencing an individual’s health and well-being. This article provides a thorough exploration of the model, starting with its definition, historical context, and significance in health psychology . The biological component delves into the role of genetics, epigenetics, neurobiology, and hormonal influences on health. The psychological component examines cognitive, emotional, and behavioral factors, emphasizing their impact on health behaviors and outcomes. The social component explores the influence of socioeconomic factors, education, and social support on health. The article then illustrates the integration of these components through examples of health issues explained by the Biopsychosocial Model. It discusses the criticisms and limitations of the model, offering insights into potential refinements. Additionally, the article explores future directions in health psychology, emphasizing emerging concepts, advances in research methodology, and the integration of technology. In conclusion, the article underscores the holistic nature of the Biopsychosocial Model, emphasizing its relevance for health professionals and the ongoing need for research and application in this dynamic field.

Introduction

Health psychology, as a field, strives to comprehend the multifaceted nature of human health by considering the intricate interplay between biological, psychological, and social factors. At the core of this integrative approach lies the Biopsychosocial Model, a theoretical framework that views health as a product of the dynamic interaction between these three domains. A. Definition of the Biopsychosocial Model: The Biopsychosocial Model posits that health and illness are outcomes of the interdependence between biological, psychological, and social influences. This section provides a concise yet comprehensive definition of the model, elucidating its fundamental principles. B. Historical Background: Tracing its roots to the late 20th century, the historical background section explores the development of the Biopsychosocial Model. From its conceptualization by George L. Engel in the 1970s to subsequent refinements, this section offers insight into the intellectual origins and evolutionary trajectory of the model. C. Significance in Health Psychology: Acknowledging its pivotal role in contemporary health psychology, this subsection delineates the significance of the Biopsychosocial Model. By embracing a holistic perspective, the model has reshaped the understanding of health, paving the way for a more comprehensive and nuanced approach to the study and practice of health psychology.

Academic Writing, Editing, Proofreading, And Problem Solving Services

Get 10% off with 24start discount code, biological component.

The Biological Component of the Biopsychosocial Model delves into the intricate physiological processes that contribute to an individual’s health. This section provides an encompassing overview of the biological aspect, emphasizing the dynamic interactions within the human body that influence overall well-being.

Genetics, as a fundamental aspect of human biology, plays a pivotal role in shaping health outcomes. 1. Genetic Predispositions: This subsection explores the influence of inherited traits on health, examining how genetic predispositions can impact susceptibility to certain illnesses. Understanding the genetic foundation of health provides valuable insights into preventive and personalized healthcare strategies. 2. Epigenetics and Health: Building upon the genetic framework, this section elucidates the role of epigenetics in health. The dynamic interplay between genes and environmental factors, as explored through epigenetics, underscores the malleability of genetic expression and its implications for health.

The intricate connections between the brain and the body contribute significantly to health outcomes. 1. Brain-Body Connections: This subsection explores the bidirectional communication between the brain and other bodily systems, elucidating how mental processes influence physical health. Understanding the neurobiological pathways highlights the importance of psychological well-being in maintaining overall health. 2. Hormones and Health: Delving into the endocrine system, this section examines the role of hormones in regulating various physiological functions. The impact of hormonal balance on mood, stress response, and overall health underscores the integrative nature of the Biopsychosocial Model, emphasizing the interconnectedness of biological and psychological factors in shaping health outcomes.

Psychological Component

The Psychological Component of the Biopsychosocial Model investigates the intricate connections between mental processes and health outcomes. This section offers a comprehensive overview of the psychological aspect, highlighting the influential role of cognitive, emotional, and behavioral factors in shaping an individual’s health.

Cognition, encompassing thoughts, beliefs, and perceptions, plays a crucial role in health-related behaviors and outcomes. 1. Beliefs and Health Behaviors: This subsection explores how individual beliefs, including health-related beliefs, impact behavior. Examining the cognitive processes that underlie decision-making in health contexts provides insights into adherence to medical advice, lifestyle choices, and health-promoting behaviors. 2. Stress and Coping: Stress, a ubiquitous aspect of human experience, can significantly impact health. This section delves into the cognitive dimensions of stress and coping mechanisms, elucidating how individuals’ cognitive appraisals of stressors influence their physical and mental well-being.

Emotions, integral to the human experience, have profound implications for health outcomes. 1. Emotional Well-being and Health: This subsection explores the bidirectional relationship between emotional well-being and physical health. Examining the impact of positive emotions on health and the role of emotional resilience in coping with challenges provides a holistic understanding of the psychological dimension. 2. Impact of Mood on Physical Health: Investigating how mood states, including anxiety and depression, influence physiological processes, this section emphasizes the crucial interplay between emotional states and overall health outcomes.

Health-related behaviors, encompassing lifestyle choices and preventive measures, are integral components of the psychological aspect. 1. Health-Related Behaviors: This subsection examines how psychological factors, such as motivation, self-efficacy, and perceived control, influence health-related behaviors. Understanding the psychological determinants of behaviors like exercise, diet, and substance use informs interventions aimed at promoting healthier lifestyles. 2. Health Promotion and Prevention: The psychological component is pivotal in designing effective health promotion and prevention strategies. This section explores the role of psychological factors in motivating individuals to adopt preventive health measures, contributing to the holistic approach of the Biopsychosocial Model.

Social Component

The Social Component of the Biopsychosocial Model scrutinizes the impact of social contexts and relationships on health outcomes. This section provides a comprehensive overview of the social aspect, highlighting the significance of societal factors in shaping an individual’s overall well-being.

Social determinants play a pivotal role in influencing health disparities and outcomes. 1. Socioeconomic Status: This subsection examines how socioeconomic status, encompassing factors like income, education, and occupation, acts as a crucial determinant of health. Disparities in access to healthcare, opportunities, and resources based on socioeconomic status contribute to variations in health outcomes. 2. Education and Health: Exploring the dynamic relationship between education and health, this section delves into how educational attainment influences health behaviors, preventive measures, and overall well-being.

The presence of supportive social networks and relationships has profound implications for health. 1. Family and Social Networks: This subsection investigates the role of family and broader social networks in shaping health outcomes. Examining the impact of social connections on emotional well-being, coping mechanisms, and health behaviors underscores the importance of social support structures. 2. Community Influence on Health: Communities provide a broader social context that influences health at a collective level. This section explores how community characteristics, such as social cohesion, neighborhood resources, and cultural factors, contribute to health outcomes. Understanding the social determinants and support systems is essential for a comprehensive application of the Biopsychosocial Model in addressing health issues at both individual and community levels.

Integration of Components

The Biopsychosocial Model operates on the premise that biological, psychological, and social factors are intricately interconnected, collectively influencing an individual’s health and well-being. This section underscores the holistic nature of the model, emphasizing how these components interact dynamically and contribute synergistically to health outcomes. The interconnectedness highlights the need for an integrative approach in understanding and addressing health issues.

Chronic illnesses, characterized by prolonged and often complex health challenges, exemplify the utility of the Biopsychosocial Model. This subsection explores how biological factors such as genetic predispositions, psychological factors such as stress and coping mechanisms, and social factors including socioeconomic status can collectively contribute to the onset, progression, and management of chronic conditions. Understanding these interwoven factors is essential for developing comprehensive and effective interventions for individuals living with chronic illnesses.

Mental health disorders provide another illustrative context for the application of the Biopsychosocial Model. Biological factors such as neurobiological imbalances, psychological factors like cognitive distortions and emotional dysregulation, and social factors such as stigma and social isolation all play integral roles in the development and manifestation of mental health disorders. Recognizing the interplay of these factors is crucial for the formulation of holistic treatment plans and support systems.

Health professionals, including physicians, psychologists, and social workers, play a central role in applying the Biopsychosocial Model in clinical practice. This subsection elucidates the responsibilities of health professionals in conducting comprehensive assessments that consider biological, psychological, and social factors. Additionally, it emphasizes the importance of collaborative and multidisciplinary approaches to treatment and intervention. Health professionals, armed with a holistic understanding of the interconnected components, are better equipped to address the complexity of health issues and provide patient-centered care that extends beyond mere symptom management.

Criticisms and Limitations

While the Biopsychosocial Model has garnered widespread recognition, it is not immune to criticisms and debates within the scientific community. This section delves into some of the prominent critiques leveled against the model. Critics argue that the model’s comprehensive nature may lead to ambiguity and lack of specificity in clinical application. Additionally, concerns have been raised about the potential for overlooking the primary causes of health issues by distributing explanations across multiple domains. Some critics question the model’s utility in guiding precise interventions, arguing that it may be more conceptual than practical in certain clinical contexts. By examining these critiques, this section aims to provide a balanced perspective on the model’s limitations.

Acknowledging the critiques and limitations is a critical step in refining and advancing the Biopsychosocial Model. This subsection explores efforts to address these limitations both in research and practical application. Researchers are actively working to develop more precise methodologies for investigating the interactions between biological, psychological, and social factors. Moreover, interdisciplinary collaborations are being promoted to enhance the integration of the model into various healthcare settings. The section also discusses ongoing initiatives to refine the model for specific populations or health conditions, ensuring that it remains a versatile and adaptable framework. By addressing these limitations, researchers and practitioners strive to strengthen the model’s validity and applicability, contributing to its continued evolution in the field of health psychology.

Future Directions

As health psychology continues to evolve, this section explores emerging concepts that hold promise for further enriching the Biopsychosocial Model. The evolving landscape includes a heightened emphasis on precision medicine, personalized healthcare plans tailored to individual characteristics, and a deeper understanding of the role of cultural factors in health. Additionally, the exploration of positive psychology and the promotion of resilience are gaining traction, offering new dimensions to the model. This subsection aims to shed light on these evolving concepts and their potential impact on the future development of the Biopsychosocial Model.

The Biopsychosocial Model’s strength lies in its ability to integrate diverse factors, but methodological challenges persist. This section explores advances in research methodology designed to enhance the precision and rigor of studies applying the model. Innovations in data analytics, longitudinal studies, and the integration of biomarkers with psychological and social measures are discussed. The section also addresses the importance of interdisciplinary collaboration in developing robust research designs that capture the complexity of the interplay between biological, psychological, and social factors.

The advent of emerging technologies offers unprecedented opportunities for the Biopsychosocial Model. This subsection examines the potential integration of technologies such as wearable devices, mobile applications, and telehealth platforms in advancing the model’s application. These technologies hold promise for real-time monitoring of biological markers, tracking psychological states, and fostering social connections. The section explores how these tools can enhance healthcare delivery, improve patient outcomes, and contribute to a more nuanced understanding of health dynamics. As technology continues to advance, its integration with the Biopsychosocial Model stands as a key avenue for future exploration in health psychology.

In summarizing the key points of this exploration into the Biopsychosocial Model, it is evident that this integrative framework offers a holistic understanding of health by incorporating biological, psychological, and social factors. The model’s conceptualization, historical background, and significance in health psychology were examined. We explored the intricate interplay of genetics, neurobiology, cognition, emotions, behaviors, social determinants, and support systems. Examples of its application to chronic illness and mental health disorders were provided, underscoring its relevance in diverse health contexts. The role of health professionals in applying the model was discussed, highlighting the need for comprehensive assessments and multidisciplinary approaches.

The overarching theme throughout this article is the holistic nature of the Biopsychosocial Model. By emphasizing the interconnectedness of biological, psychological, and social factors, the model offers a comprehensive lens through which to understand health and illness. It recognizes individuals as dynamic beings shaped by a myriad of influences, urging a departure from reductionist perspectives that isolate specific components. The holistic nature of the model encourages a nuanced appreciation for the complexity of human health, fostering a more integrative and patient-centered approach in both research and clinical practice.

As we conclude, it is essential to underscore the importance of continued research and application of the Biopsychosocial Model. While acknowledging critiques and limitations, the model remains a foundational framework in health psychology. Future research should delve into evolving concepts, advance research methodologies, and explore the integration of emerging technologies. Health professionals are encouraged to incorporate the model into their practice, recognizing its utility in understanding and addressing the multifaceted nature of health. By fostering a commitment to ongoing exploration and refinement, researchers and practitioners contribute to the enduring relevance and adaptability of the Biopsychosocial Model in the dynamic landscape of health psychology.

References:

• Adler, N. E., & Stewart, J. (2010). Health disparities across the lifespan: Meaning, methods, and mechanisms. Annals of the New York Academy of Sciences, 1186(1), 5-23.
• Antonovsky, A. (1979). Health, stress, and coping. Jossey-Bass.
• Berkman, L. F., & Syme, S. L. (1979). Social networks, host resistance, and mortality: A nine-year follow-up study of Alameda County residents. American Journal of Epidemiology, 109(2), 186-204.
• Boardman, J. D., Saint Onge, J. M., Rogers, R. G., & Denney, J. T. (2005). Race differentials in obesity: The impact of place. Journal of Health and Social Behavior, 46(3), 229-243.
• Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320-1334.
• Cutrona, C. E., & Russell, D. (1987). The provisions of social relationships and adaptation to stress. Advances in personal relationships, 1, 37-67.
• Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.
• House, J. S., Landis, K. R., & Umberson, D. (1988). Social relationships and health. Science, 241(4865), 540-545.
• Ironson, G., & Hayward, H. (2008). Do positive psychosocial factors predict disease progression in HIV-1? A review of the evidence. Psychosomatic Medicine, 70(5), 546-554.
• Kaplan, G. A., & Turrell, G. (2000). Socioeconomic factors in the etiology of cardiovascular disease: A selective review of the literature. Seminars in Vascular Medicine, 5(2), 99-107.
• Krieger, N. (2001). Theories for social epidemiology in the 21st century: An ecosocial perspective. International Journal of Epidemiology, 30(4), 668-677.
• Marmot, M. (2005). Social determinants of health inequalities. The Lancet, 365(9464), 1099-1104.
• Maunder, R., & Hunter, J. (2001). Attachment and psychosomatic medicine: Developmental contributions to stress and disease. Psychosomatic Medicine, 63(4), 556-567.
• McEwen, B. S. (1998). Protective and damaging effects of stress mediators. New England Journal of Medicine, 338(3), 171-179.
• McEwen, B. S., & Seeman, T. (1999). Protective and damaging effects of mediators of stress: Elaborating and testing the concepts of allostasis and allostatic load. Annals of the New York Academy of Sciences, 896(1), 30-47.
• Suls, J., & Rothman, A. (2004). Evolution of the biopsychosocial model: Prospects and challenges for health psychology. Health Psychology, 23(2), 119-125.
• Taylor, S. E. (2011). Health psychology (8th ed.). McGraw-Hill Education.
• Thoits, P. A. (2010). Stress and health: Major findings and policy implications. Journal of Health and Social Behavior, 51(Suppl), S41-S53.
• World Health Organization. (2004). Promoting mental health: Concepts, emerging evidence, practice (Summary Report). WHO.
• Zautra, A. J., Hall, J. S., & Murray, K. E. (2008). Resilience: A new paradigm for adaptation to chronic pain. Current Pain and Headache Reports, 12(6), 384-390.

Biopsychosocial Model in Action: 12 Tips & Resources

We are made up of more than skin and bones. We are more than just a “computer” mind that processes information. We have emotions, the freedom to think, experience physical sensations, and develop social connections.

Psychology is often thought of as the study of the human mind. But even that is an understatement, as branches of psychology have merged with nearly every aspect of the human experience.

The biopsychosocial model of psychology addresses several facets of the human experience in an attempt to gain a more holistic understanding of clients in the field of health.

This model of psychology and health includes the biological (physical), psychological (mental and emotional), and social (relational) components of an individual. Let’s pull that apart in more detail below.

Before you continue, we thought you might like to download our three Positive Psychology Exercises for free . These science-based exercises explore fundamental aspects of positive psychology, including strengths, values, and self-compassion, and will give you the tools to enhance the wellbeing of your clients, students, or employees.

This Article Contains

4 components of the biopsychosocial model, an example of a biopsychosocial assessment, why the biopsychosocial approach is important in psychology, 4 tips when applying the biopsychosocial model of mental health, critiques of the model, 3 best books and resources, related resources from positivepsychology.com, a take-home message.

The biopsychosocial approach was developed by George Engel (1977) and John Romano to counter traditional biomedical models, which focused on pathophysiology. The concept was an attempt to emphasize the importance of understanding human health in its fullest context rather than limiting it to a biological system alone.

The biopsychosocial model considers biological, psychological, and social factors and their network of interactions within the realm of health, illness, and health care delivery (Engel, 1977).

The biological component of this model refers to genetics , physical health, and the function of our body and internal organs (Papadimitriou, 2017). Physical health affects mental wellbeing in many ways. The brain is an organ and can be prone to illness and disease just like any other organ of the body.

Physical illness also plays an impact on mental and emotional wellbeing. Most of us have experienced pain, illness, and physical discomfort and understand how this affects our mental and social health.

Genetics are the most basic components of how mental health is impacted. The phenotypic expression of genetics plays a role in brain function and perception (Papadimitriou, 2017). This foundational piece of biology influences all aspects of human life.

Psychological

Psychological wellbeing influences mental, physical, and social health (Cozolino, 2017). Unhealthy moods, thinking patterns, and behaviors are often symptoms of mental health conditions and contribute to an individual’s general health.

Psychological health is cyclical. Individuals who have depression or low mood might isolate themselves and avoid physical activities, resulting in less social interaction and higher levels of depression.

Similarly, individuals who are anxious will avoid situations that might be beneficial to other areas of health, such as getting out in nature, going out with friends, taking part in forms of physical activity, or going to regular medical checkups.

Social factors include culture, family, socioeconomic, and relational components. External factors play a role in every aspect of health (Garcia-Gomez et al., 2013). Changes to the environment can play a negative or positive role in mental and physical health.

For example, individuals with low socioeconomic status may not have the means to live in a safe environment, which may also impact mental and emotional health. Family background impacts life choices, such as selection of hobbies, level of education, choice of career, and opportunity to access mental and physical health resources.

The biopsychosocial model uses a holistic viewpoint and acknowledges how health and illness are shaped by the interaction of biological, psychological, and social factors. Where the biomedical model sees disease as isolated, the biopsychosocial model sees them as a result of a dynamic connection between multiple dimensions.

Dynamic component of the model

An important underpinning of the biopsychosocial model is the interaction of how these components work. For example, physical health (biological) can impact type of employment, productivity at work , and therefore access to healthier foods and living environments, which impacts social and psychological aspects of health (Garcia-Gomez et al., 2013).

Mental health has also been shown to affect the decision-making process, leading to poorer choices in areas of physical and social health (Garcia-Gomez et al., 2013). For example, those with mental health issues may select unhealthy coping mechanisms (e.g., alcohol, drugs, or gambling) and unhealthy relationships rather than getting treatment for psychological issues or taking steps to improve wellbeing.

Further, physical activity is negatively correlated with depression, low mood, and anxiety and has both mental and physical benefits (Ohrnberger et al., 2017).

There is also a strong relationship between social interaction and mental health. Loneliness and social isolation have both been linked to higher rates of mortality and lower levels of physical health (Steptoe et al., 2012).

These dynamic interactions show the importance of considering the biopsychosocial model and assessing each of the components within it.

Assessment generally involves asking open-ended questions regarding biological, psychological, and social areas of an individual’s life.

Biological assessment

The biological assessment includes factors that influence genetics, physiology, neurology , and chemistry. Questions should inquire about medication, underlying health conditions, history of disease, and family health history.

Examples include:

• Are you experiencing any medical conditions that impact your life?
• Family history of mental health and substance abuse
• What are your current sleep habits?
• Amount and type of physical activity
• Current dietary habits

To aid in gathering information for a biological assessment, also consider using the client’s biofeedback  devices.

Psychological assessment

The goal of the psychological portion of the assessment is to understand an individual’s thoughts, feelings, reasons for behavior, and mental state.

Ideas for assessing psychological components include:

• What brings you to therapy today?
• Describe your history of mental health.
• How would you describe yourself? What are your strengths and weaknesses?
• Assess for suicidal and homicidal thoughts, tendencies, and ideations.
• What do you hope to get out of therapy?

Social assessment

The social assessment addresses any thoughts or behaviors that affect social situations. These are environmental factors, socioeconomic status, educational history, family relationships, and recreational activities and hobbies.

Questions should include:

• Quality of relationships and support of family, friends, and community (Do you feel supported by those around you?)
• Employment, educational, or military history
• Information on legal issues (Have you been arrested or committed crimes?)
• Describe the relationship you have with your immediate family members.
• What do you do in your free time?

Assessment in each of these areas may be done through intake forms and face-to-face interviews. In most cases, some of the information may not be relevant to the presenting problem. However, it is the clinician’s job to determine which factors interact and the impact they may have on the client’s wellbeing and to create a treatment plan to address the areas that will allow the client to reach their goals.

Also consider reading our article sharing reliable mental health assessment tools .

Download 3 Free Positive Psychology Exercises (PDF)

Enhance wellbeing with these free, science-based exercises that draw on the latest insights from positive psychology.

Download 3 Free Positive Psychology Tools Pack (PDF)

By filling out your name and email address below.

The biopsychosocial model provides a wonderful option to gather a more holistic view of an individual and provides more than one way to improve life and wellbeing.

Biological and psychological models cannot explain mental health disorders adequately alone (Tripathi et al., 2019). The bridge between biological and psychological factors warrants further investigation.

This video explains how the biopsychosocial model helps to explain mental disorders such as anxiety.

The model helps the field of psychology and mental health acknowledge that each of the three systems overlap and interact, playing a role in wellbeing, risk for illness, and effective treatment for clients. This foundation places importance on client self-awareness and the relationship they have with health care providers.

Every client is different. Individual beliefs, drives, values, environmental background, resources, and genetics play a role in both understanding and treatment. Psychological disorders are not the result of a linear cause and effect, which the medical model suggests. Instead, they should be viewed as a complex circular model of multiple causes and effects.

Relationship between mental and physical health

The biopsychosocial model is an important model for the field of psychology because there are both direct and indirect relationships between physical and mental health (Ohrnberger et al., 2017).

As mentioned previously, the dynamic interaction between each of the three components shows the need to consider biological and social areas through the lens of psychology.

5 Activities and exercises

There are many practical ways to implement activities and exercises using the biopsychosocial model.

1. Activity monitoring

Activity monitoring is an exercise used in Cognitive-Behavioral Therapy for behavioral activation . Clients record what they are doing throughout the day, generally going hour by hour, and the moods that follow these activities.

This creates awareness of how much time is spent doing specific tasks (e.g., watching TV, scrolling through social media) and how it makes the client feel. Clients may also start to see how positive behaviors such as physical activity and positive social interaction can improve mood, which is a motivating way to get them to engage in healthy coping mechanisms.

2. Goal worksheets

Setting specific goals in areas of physical (biological), social, and environment (such as work, school, and extracurricular areas) can improve mental and emotional health as well.

Goal worksheets can be a great way to address all areas of the biopsychosocial model. This SMART+ Goals worksheet outlines SMART goals that can be implemented in any area of a client’s life.

3. Scheduling pleasurable moments

Since the biopsychosocial model is based on the concept of holistic healing and wellness, scheduling positive, joyful, and peaceful moments into a client’s daily life and routine can be a helpful activity.

This Pleasant Activity Scheduler provides a guide for thinking about and planning pleasurable moments. These moments may encompass any or every area of the client (biological, psychological, or social). For example, scheduling time with friends (social) to go on a walk (physical/biological) can help with mood (psychological).

4. Mindfulness

Mindfulness is beneficial for physical, mental, emotional, and social health. It helps bring us into the present moment to fully experience life. The Right Here, Right Now worksheet provides guidance for practicing mindfulness in any area of life.

5. Nature walk

The benefits of walking in nature touch on physical health and mental and emotional wellbeing and can be done with friends or loved ones to incorporate a social element as well. Any time spent in nature is good for health.

This worksheet Nature Play provides additional guidelines to focus on in order to make the most of the experience.

Assessment is one foundational way this model sets itself apart from other models used in psychotherapy and counseling. The assessment process tends to be more in depth by including psychological, biological, and social components (see above for examples of each).

In addition to a comprehensive assessment, the following areas should be considered when using the biopsychosocial approach.

1. Collaboration

Collaborating with other medical professionals is an important part of integrating holistic and thorough treatment in the biopsychosocial model. Medical doctors, psychiatrists, nutritionists, social workers, and legal experts are some examples of professionals that can play a part in a client’s treatment plan.

Practitioners should recognize that the relationship with other professionals is central in providing care.

2. Individualized treatment plan

Along with collaboration, the treatment plan for clients should be individualized based on specific biological, psychological, and social factors that are uncovered during the assessment. The treatment plan will include collaboration with appropriate medical professionals and specialists.

3. Cultural competence

It is critical to have cultural competence when using the biopsychosocial model in therapy. Cultural factors play a role in each of the three components of the model and should be understood and addressed in assessment, treatment planning, and ongoing care.

It’s important to understand how a client’s beliefs, values, and background play a role in their past experience, current situation, and choice of effective treatment.

4. Ethical consideration of autonomy

A client’s autonomy is central to the biopsychosocial model. It allows clients to make informed decisions of which aspects of the treatment plan they are open to and willing to comply with.

For example, a client who is against taking psychiatric medication should not be forced or coerced into believing this is the only (or most important) way to treat a mental health problem. Providing multidimensional options to treatment is a critical part of patient care.

While the biopsychosocial model is comprehensive, holistic, and applicable to many areas of the medical field, it is not without its critics.

Lehman et al. (2017) suggest that the model is insensitive to a client’s subjective experience. These authors further claim that the model does not have safeguards in place to protect against allowing one of the three domains to be either over- or under-represented or emphasized.

In other words, there is still the probability that practitioners would focus too much attention on one of the three areas and neglect the rest.

An additional critique of the model is that it unintentionally creates a false distinction between biology and psychology (Wade & Halligan, 2017). This causes confusion in training programs and psychological assessments and has contributed to the stigmatization of mental health .

There are a multitude of books and resources on the biopsychosocial model. These books offer deeper insight into the model and practical ways to assess and apply it in a therapy practice.

1. The Biopsychosocial Formulation Manual: A Guide for Mental Health Professionals – William Campbell and Robert Rohrbaugh

This is a comprehensive guidebook that provides a framework for conducting biopsychosocial assessments and formulating interventions in the field of mental health.

The book emphasizes the significance of considering biological, psychological, and social factors when understanding and addressing an individual’s mental health concerns.

It offers practical tools and case examples to aid mental health professionals in effectively integrating these diverse components into their clinical practice. The manual is designed to enhance the assessment and treatment process, ultimately improving patient care and outcomes.

Find the book on Amazon .

2. The Rise and Fall of the Biopsychosocial Model: Reconciling Art & Science in Psychiatry – Nassir Ghaemi

This text delves into the historical trajectory of the biopsychosocial model in psychiatry and its impact on clinical practice.

The book critically examines the tensions between scientific objectivity and the subjective nature of mental health care, offering insights into reconciling these aspects.

It provides a thought-provoking exploration of how art and science converge in the field of psychiatry.

3. Biopsychosocial Assessment in Clinical Health Psychology – Frank Andrasik, Jeffrey Goodie, and Alan Peterson

This book provides tools for assessing health-related behaviors in each of the three areas of the biopsychosocial model. Through evaluating behavior and psychosocial components of mental illness, it provides evidence-based ideas for assessment and treatment.

The comprehensive text addresses behavioral, cognitive, and emotional issues and needs that clients may present with and how to guide them effectively on a path to holistic wellness.

Breathwork, specifically yogic breathing, has both physical and mental benefits, including decreasing stress and blood pressure, assisting with sleep , improving lung function, and improving cognitive performance (Sharma et al., 2013). This Yogic Breathing worksheet can be a guide for clients to get started with breathwork practice.

These Nurturing vs. Depleting Activities invite clients to review their daily activities and then assess whether these activities help or are detrimental to their mental, physical, and social health. Once they see how their time is spent, they can proactively seek activities that are more nurturing to their physical, social, and psychological health.

As mentioned earlier, being in nature can have many positive effects in all areas of health. This article What Is Nature and Ecotherapy & How Does It Work? expands on these benefits and offers wonderful ideas to help practitioners use nature to incorporate the three aspects of the biopsychosocial model.

This Exercise and Mental Health worksheet is designed for children and can be a great reminder of the benefits of exercise , physical activity, and movement on mental health and other areas of wellness. It explores ideas for becoming more active and encourages children and families to think about forms of exercise they might try.

If you’re looking for more science-based ways to help others enhance their wellbeing, check out this signature collection of 17 validated positive psychology tools for practitioners. Use them to help others flourish and thrive.

17 Top-Rated Positive Psychology Exercises for Practitioners

Expand your arsenal and impact with these 17 Positive Psychology Exercises [PDF] , scientifically designed to promote human flourishing, meaning, and wellbeing.

Created by Experts. 100% Science-based.

The path to health, healing, and wellness has many different roads. The biopsychosocial model provides a holistic approach to treating mental health.

The biological, psychological, and social aspects of an individual’s deficits and opportunities can be addressed to formulate an effective treatment plan. Through cultivating self-awareness and providing options for autonomy, clients can take charge of their health and improve various aspects of their lives.

The biopsychosocial model is both a philosophy of clinical care and a practical guide that clinicians can use for treatment. Moving beyond the one-size-fits all approach, multiple areas can be addressed to improve physical, psychological, and social wellbeing .

We hope you enjoyed reading this article. Don’t forget to download our three Positive Psychology Exercises for free .

• Cozolino, L. (2017). The neuroscience of psychotherapy: Healing the social brain . Norton and Company.
• Engel, D. (1977). The need for a new medical model: A challenge for biomedicine. Science , 196 , 129–136.
• Garcia-Gomez, P., Van Kippersluis, O., O’Donnell, E., & Van Doorslaer, H. (2013). Long term and spillover effects of health shocks on employment and income. Journal of Human Resources , 48 (4), 873–909.
• Lehman, B., David, D., & Gruber, J. (2017). Rethinking the biopsychosocial model of health: Understanding health as a dynamic system. Social and Personality Psychology Compass , 11 (8), 123–128.
• Ohrnberger, J., Fichera, E., & Sutton, M. (2017). The relationship between physical and mental health: A mediation analysis. Journal of Social Science in Medicine , 195 , 24–49.
• Papadimitriou, C. (2017). The biopsychosocial model: 40 years of application in psychiatry. Psychiatry , 28 , 107–120.
• Sharma, V., Trakoo, M., Subramaniam, V., Rajajeyakumar, M., Bhavanani, A., & Sahai, A. (2013). Effect of fast and slow pranayama on perceived stress and cardiovascular parameters in young health-care students. International Journal of Yoga , 6 (2), 104–110.
• Steptoe, A., Shanker, A., Demakakos, P., & Wardle, J. (2012). Social isolation, loneliness and all-cause mortality in older men and women. National Academy of Science , 111 (15), 5797–5811.
• Tripathi, A., Das, A., & Kar, S. (2019). Biopsychosocial model in contemporary psychiatry: Current validity and future prospects. Indian Journal of Psychological Medicine , 41 (6), 582–585.
• Wade, D., & Halligan, P. (2017). The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation , 31 (8), 995–1004.

Share this article:

Article feedback

Let us know your thoughts cancel reply.

Your email address will not be published.

Save my name, email, and website in this browser for the next time I comment.

Related articles

Positive Pain Management: How to Better Manage Chronic Pain

Chronic pain is a condition that causes widespread, constant pain and distress and fills both sufferers and the healthcare professionals who treat them with dread. [...]

Mental Health in Teens: 10 Risk & Protective Factors

31.9% of adolescents have anxiety-related disorders (ADAA, n.d.). According to Solmi et al. (2022), the age at which mental health disorders most commonly begin to [...]

18 Effective Thought-Stopping Techniques (& 10 PDFs)

From time to time, we all experience intrusive, unwanted thoughts in our stream of consciousness (Shackelford & Zeigler-Hill, 2020). While many are frivolous, such as [...]

Read other articles by their category

• Body & Brain (48)
• Coaching & Application (57)
• Compassion (26)
• Counseling (51)
• Emotional Intelligence (24)
• Gratitude (18)
• Grief & Bereavement (21)
• Happiness & SWB (40)
• Meaning & Values (26)
• Meditation (20)
• Mindfulness (45)
• Motivation & Goals (45)
• Optimism & Mindset (34)
• Positive CBT (28)
• Positive Communication (20)
• Positive Education (47)
• Positive Emotions (32)
• Positive Leadership (17)
• Positive Parenting (3)
• Positive Psychology (33)
• Positive Workplace (37)
• Productivity (16)
• Relationships (46)
• Resilience & Coping (36)
• Self Awareness (21)
• Self Esteem (37)
• Strengths & Virtues (31)
• Stress & Burnout Prevention (34)
• Theory & Books (46)
• Therapy Exercises (37)
• Types of Therapy (64)

3 Positive Psychology Tools (PDF)

Module 1 Introduction to Health Psychology

Biopsychosocial model.

The biopsychosocial model states that health and illness are determined by a dynamic interaction between biological, psychological, and social factors.

The biopsychosocial model of health and illness is a framework developed by George L. Engel that states that interactions between biological, psychological, and social factors determine the cause, manifestation, and outcome of wellness and disease. Historically, popular theories like the nature versus nurture debate posited that any one of these factors was sufficient to change the course of development. The biopsychosocial model argues that any one factor is not sufficient; it is the interplay between people’s genetic makeup (biology), mental health and behavior (psychology), and social and cultural context that determine the course of their health-related outcomes.

Biopsychosocial model of health and illness

This diagram shows how biological, psychological, and sociological factors overlap to determine overall health.

Biological Influences on Health

Biological influences on health include an individual’s genetic makeup and history of physical trauma or infection. Many disorders have an inherited genetic vulnerability. The greatest single risk factor for developing schizophrenia, for example is having a first-degree relative with the disease (risk is 6.5%); more than 40% of monozygotic twins of those with schizophrenia are also affected. If one parent is affected the risk is about 13%; if both are affected the risk is nearly 50%.

It is clear that genetics have an important role in the development of schizophrenia, but equally clear is that there must be other factors at play. Certain non-biological (i.e., environmental) factors influence the expression of the disorder in those with a pre-existing genetic risk.

Psychological Influences on Health

The psychological component of the biopsychosocial model seeks to find a psychological foundation for a particular symptom or array of symptoms (e.g., impulsivity, irritability, overwhelming sadness, etc.). Individuals with a genetic vulnerability may be more likely to display negative thinking that puts them at risk for depression; alternatively, psychological factors may exacerbate a biological predisposition by putting a genetically vulnerable person at risk for other risk behaviors. For example, depression on its own may not cause liver problems, but a person with depression may be more likely to abuse alcohol, and, therefore, develop liver damage. Increased risk-taking leads to an increased likelihood of disease.

Social Influences on Health

Social factors include socioeconomic status, culture, technology, and religion. For instance, losing one’s job or ending a romantic relationship may place one at risk of stress and illness. Such life events may predispose an individual to developing depression, which may, in turn, contribute to physical health problems. The impact of social factors is widely recognized in mental disorders like anorexia nervosa (a disorder characterized by excessive and purposeful weight loss despite evidence of low body weight). The fashion industry and the media promote an unhealthy standard of beauty that emphasizes thinness over health. This exerts social pressure to attain this “ideal” body image despite the obvious health risks.

Cultural Factors

Also included in the social domain are cultural factors. For instance, differences in the circumstances, expectations, and belief systems of different cultural groups contribute to different prevalence rates and symptom expression of disorders. For example, anorexia is less common in non-western cultures because they put less emphasis on thinness in women.

Culture can vary across a small geographic range, such as from lower-income to higher-income areas, and rates of disease and illness differ across these communities accordingly. Culture can even change biology, as research on epigenetics is beginning to show. Specifically, research on epigenetics suggests that the environment can actually alter an individual’s genetic makeup. For instance, research shows that individuals exposed to over-crowding and poverty are more at risk for developing depression with actual genetic mutations forming over only a single generation.

Application of the Biopsychosocial Model

The biopsychosocial model states that the workings of the body, mind, and environment all affect each other. According to this model, none of these factors in isolation is sufficient to lead definitively to health or illness—it is the deep interrelation of all three components that leads to a given outcome.

Health promotion must address all three factors, as a growing body of empirical literature suggests that it is the combination of health status, perceptions of health, and sociocultural barriers to accessing health care that influence the likelihood of a patient engaging in health-promoting behaviors, like taking medication, proper diet or nutrition, and engaging in physical activity.

• Biopsychosocial Model. Located at : https://courses.lumenlearning.com/ccbcmd-health/chapter/biopsychosocial-model/ . License : CC BY: Attribution

Privacy Policy

• Last edited on January 27, 2024

Biopsychosocial Model and Case Formulation

Table of contents, diagnosis versus formulation, the formulation table, "jane doe", biological and social factors, psychological factors, completed table, method 1 (sequential), method 2 (narrative), method 3 (advanced), method 4 (chronological), common phrases to use, do's and dont's, another example, "templates".

The Biopsychosocial Model and Case Formulation (also known as the Biopsychosocial Formulation ) in psychiatry is a way of understanding a patient as more than a diagnostic label. Hypotheses are generated about the origins and causes of a patient's symptoms. The most common and clinically practical way to formulate is through the biopsychosocial approach, first described in 1980 by George Engel. [1] [2] Biopsychosocial formulation combines biological, psychological, and social factors to understand a patient, and uses this to guide both treatment and prognosis. Your formulation of a patient evolves and changes as you collect more information. Formulation is like cooking, and there is no 'right' or 'wrong' way to do it, but most get better over time with increasing clinical experience.

Buy on Amazon

<small> PsychDB is an Amazon Associate and earns from qualifying purchases. Thank you for supporting our site!</small> </HTML>

Diagnosis is not the same as formulation! In mental health, when there is a group of consistent symptoms seen in a population, these symptoms can be categorized into a distinct entity, called a diagnosis (this is what the DSM-5 does). For example, we diagnose someone with a major depressive episode if they meet 5 of the 9 symptomatic criteria. However, formulation tells us how the person became depressed as a result of their genetics , personality , psychological factors , biological factors, social circumstances ( childhood adverse events and social determinants of health ), and their environment.

You are probably already formulating, but just don't know it. Like most things in medicine, there are multifactorial causes of diseases, illnesses, and disorders. For example, type II diabetes does not develop because of a single pathophysiological cause. The patient may have a strong family history of the disease, a sedentary job, environmental exposures, and/or a nutritionally-poor diet. These factors all combine to cause the person to develop diabetes. Understanding how each factor contributes to a disease can better guide treatment decisions. In psychiatry, formulation appears more complicated because human behaviour and the brain itself is extraordinarily complex. However, like with anything, the more you practice, the better you will become at formulating.

What Are You Formulating?

Why is a biopsychosocial approach important, formulation in a nutshell.

The biopsychosocial model considers the “4 Ps” for each of the biological, psychological, and social factors:

• Predisposing factors are areas of vulnerability that increase the risk for the presenting problem. Examples include genetic (i.e. -family history) predisposition for mental illness or prenatal exposure to alcohol.
• Precipitating factors are typically thought of as stressors or other events (they could be positive or negative) that may be precipitants of the symptoms. Examples include conflicts about identity, relationship conflicts, or transitions.
• Perpetuating factors are any conditions in the patient, family, community, or larger systems that exacerbate rather than solve the problem. Examples include unaddressed relationship conflicts, lack of education, financial stresses, and occupation stress (or lack of employment)
• Protective factors include the patient’s own areas of competency, skill, talents, interest and supportive elements. Protective factors counteract the predisposing, precipitating, and perpetuating factors.

The “4 Ps” can be laid out in a 3 x 4 table to systematically do formulation and identity factors. Note that this table is extremely comprehensive and long, and not everything will (or should!) apply to your case. It is important to remember that not everything will fit neatly into each box. For example, many precipitating and perpetuating factors may overlap and fit in other boxes. Use this table as a general guide, but don't memorize it for the sake of memorizing it!

Biopsychosocial Model

Filling out the table.

• As you can see in the table above, it's a lot of questions to ask and a lot of things to think about!
• Let's do a simplified formulation for the patient (Jane Doe) below. The image ( figure 1 ) provides a guide on how to put information into the formulation table.
• These psychological symptoms/factors are then observed by the clinician to give a psychiatric diagnosis.
• This is why the psychological section of the table is filled last, so we can understand what biological and social factors led to the development of these symptoms.

• Jane Doe is a 30-year-old female who presents to the emergency room with acute suicidal ideation and self-harm
• Jane has been working at a start up company for the past 2 years. She was suddenly fired from her job today due to conflicts at work with co-workers and being late at work several times from sleeping in. After being told she was fired from her job, she went home and self-harmed to cope with the distress of this loss. She also drank 10 beers prior to arriving in the hospital. She subsequently planned to overdose on her medications. A concerned best friend called and talked to her this evening, and brought her to the hospital. Her mood was stable prior to this job loss, and she had no self-harm or suicidal thoughts in the past 1 year.
• Increasing alcohol use for the past 3 months, drinking up to 5 beers per day.
• Sertraline (Zoloft) 75mg PO daily
• She has a past history of borderline personality disorder , depression , and alcohol use disorder (moderate). She used to be a soccer player and has a history of multiple concussions. She does have a psychiatrist that she sees every month. She previously completed a course of dialectical behavioural therapy , which was helpful.
• Depression and bipolar disorder on maternal side of her family. There is a history of alcohol use disorder on paternal side.
• Born in Canada. University-educated. There was a parental divorce at age 5. She describes an invalidating childhood, where parents did not acknowledge or praise her. She experienced sexual abuse and trauma at age 12. She is in a 2-year relationship with a male partner, and there have been recent arguments about the direction of their relationship. She describes a long-standing fear of being abandoned in relationships, and reports having very intense relationships with friends/family. Financially, she is struggling to pay rent and living from paycheque-to-paycheque. Developmentally, there may have been some speech delay . Collateral information from the patient's older brother describe her childhood temperament as being avoidant and fearful of her parents.

Steps 1 and 2

Sample formulation for jane doe.

Now that you've filled in the easy parts from the history, the hardest part is conceptualizing the predisposing social factors (Step 3), and all of the psychological factors (Steps 4, 5, 6, 7). This is where you'll need to be creative and also think more in-depth about your patient. Ideally, each step should flow logically and intuitively into the next based on your framework, as you'll see in our case of Jane Doe. Having a framework for understanding of different psychological treatments and psychological theories can be helpful in making your psychological formulation flow intuitively (e.g. - attachment theory , cognitive behavioural therapy , dialectical behavioural therapy , interpersonal therapy , psychodynamic therapy ). However, this can be done intuitively even without an in-depth understanding of these frameworks (we don't need to be Freud to do this). The more cases you go through (and more of the sample formulations below) the more comfortable you will be with formulating!

Steps 3, 4, 5, 6, and 7

Jane doe's formulation, completed biopsychosocial formulation table, completed formulation of jane doe, presenting your formulation.

You've got your table all filled out now. Now what? How do you present all this information and data? Remember there is no “right” or “wrong” way to present your formulation. But the most important thing about formulation is that it should be intuitive and flow logically. Some different presentation styles are suggested here.

The “4 Ps” formulation table can be a very rigid and systematized way of presenting a formulation. At its most basic, you could present each box sequentially and describe each factor. Most learners will use this method as it is the most “simple.” It is usually presented as Predisposing → Precipitating → Perpetuating → Protective factors. As you get better and more expert at formulating, you may not need to use this rigid structured format, and instead, will be able to present a more intuitive and organic formulation of the patient instead (see other methods below).

• Brief summarizing statement that includes demographic information, chief complaint, and presenting problems from patient's perspective and signs and symptoms (onset, severity, pattern)
• Predisposing factors
• Precipitating factors
• Perpetuating factors
• Strengths and protective factors
• Integrative statement: how these factors interact to lead to the current situation and level of functioning, prognosis, and potential openings for intervention

Example: 4 Ps Table Formulation of Jane Doe

• Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. She presents to hospital today with acute suicidal ideation and self-harm after being fired from her job.
• Predisposing factors : Her predisposing biological factors include a family history of mental disorders and substance use, concussion history, and a fearful/anxious temperament at birth. Her predisposing social factors include a history of sexual trauma at a young age, and early parental divorce. These led to her predisposing psychological factors, including a history of invalidation by her parents, and fears of abandonment during childhood.
• Precipitating factors : Her precipitating biological factors include a 3-month history of increasing alcohol use. Her precipitating social factors is her being fired from her current job. These led to her precipitating psychological factors, which resulted in her underlying feelings of abandonment and invalidation re-activated after being fired from work.
• Perpetuating factors : Her perpetuating biological factors include being on a subtherapeutic dose of her medication, and her ongoing alcohol use. Her perpetuating social factors includes her ongoing relationship conflicts and financial stressors. Her perpetuating psychological factors include her lack of adaptive coping strategies and ongoing self-harm.
• Strengths and protective factors : She is medically healthy, and has previously responded well to therapy. She also is supported by a good friend, and sees a psychiatrist regularly.
• Integrative Statement : The acute stressor of losing her job has re-activated the psychological processes described above. The patient is psychologically minded and thus would benefit from treatment with dialectical behavioural therapy. Her medications could also be further optimized as well. Overall, her prognosis is good due to her protective factors as mentioned above.

The narrative formulation of the patient is a less rigid presentation structure where you may not choose to present everything in the 4 Ps table, and instead focus on the key factors that you think are relevant:

• [Patient] presents with a [diagnosis]. They are biologically predisposed because of [reasons]. They struggle with the following [psychological difficulties]. Their underlying temperament is [temperament], which further exacerbates the symptoms.
• Childhood/adult trauma (if any)
• Attachment style
• About themselves
• About others
• About the world
• (i) death of their spouse
• (ii) stopping medications
• (iii) loss of job
• (iv) re-experiencing of trauma
• They have the following: [protective factors]

Example: Narrative Formulation of Jane Doe

• Jane Doe presents with a diagnosis of borderline personality disorder and history of depression. She is biologically predisposed, with a family history of depression and alcohol use disorder in her immediate family members. She struggles with the following psychological difficulties, including fears of abandonment. Her underlying temperament is anxious, which further exacerbates her symptoms.
• Her underlying history of experiencing trauma and sexual abuse at a young age
• A history of invalidating experiences in childhood
• That she is not deserving of love or close relationships, a core belief of her being “unlovable”, and that self-harm is the main way of coping with stressors
• That others may leave or abandon her any time, increased rejection sensitivity, and a future fear of being rejected
• That the world can be a fearful and scary place
• After being fired from her job, she experienced strong feelings of rejection, and was unable to cope with this major stressor. This may have reactivated/exacerbated her emotional dysregulation, and resulted in negative coping styles such as her self-harming and suicidal ideation. She also appears to use alcohol as a way of managing distressing emotions, but does not have any psychological coping strategies. This has further exacerbated her alcohol use disorder.
• She has the following protective factors, including a supportive psychiatrist and friend. She has also previously responded well to psychotherapy and appears to be psychologically-minded.

A much more advanced and nuanced presentation might be using a more comprehensive formulation that integrates the 4Ps formulation through multiple lenses (e.g. - Eriksonian developmental stages , psychodynamic defenses , and dialectical behavioural ):

• Current stressors, plus salient developmental history
• “The patient presents at this time with [problem and symptoms], in the context of [situation and stressors]”
• Genetics, temperament, medical history, substances, medications
• “The patient has the following [genetic vulnerabilities, medical history]”
• “The patient grew up in a family characterized by [factors], with a caregiver who was [distant/available/invalidating]”
• “ Attachment was likely [secure/insecure/disorganized] given [developmental history]”
• “The patient may have had difficulty in [stage of development], and this is reflected in [examples from adult relationships]
• “It appears that the patient may have struggled with conflicts in early life. It also appears they may have had difficulty with [drives], stemming from [psychoanalytic concept]
• Control/regulation of drives
• “These experiences impacted the patient's view of themselves as being [view of self], and this has continued into adulthood based on [experiences].”
• “The patient appears to have adopted [defense mechanisms] as coping strategies by early adulthood, and these have continued on…”
• “The patient's interpersonal relationships appear to be [give examples of patterns of relationships]”
• These underlying factors may have precipitated the patient's [current presentation]. These symptoms have been maintained by [psychological factors/personality factors], and [social/environmental factors]
• “We would anticipate when engaging in treatment, the patient may have [resistance/transference/countertransference]. However, patient has the following [protective factors], which may be a good prognostic factor. Based on these factors, the following [treatment and management] would be the most helpful for this patient.

Example: Advanced Formulation of Jane Doe

• Jane Doe is a 30-year-old female who presents with acute suicidal ideation in the context of a job loss. She notably has a past history of childhood trauma and abuse.
• The patient has genetic vulnerabilities for mental illness in her family history, a history of anxious temperament, ongoing substance use, and subtherapeutic medication levels.
• She has several early developmental and pathogenic psychological factors, including growing up in a family characterized by invalidation, with parents who were distant and unavailable. This likely led to an attachment style that was likely insecure and disorganized. Due to her history of abuse at age 12, she may have struggled with identity versus role confusion during that Eriksonian stage of psychosocial development. As she was unable to develop a sense of self and personal identity, these psychological factors are reflected in her adulthood with unstable relationships, and fears of abandonment. This has led to her adulthood self-perception of being unworthy of being loved, a constant fear of rejection, and increased rejection sensitivity. The patient appears to have adopted self-harming as a primitive coping strategy by early adulthood, and these have continued on in adulthood.
• Precipitating and perpetuating factors: the stressor of losing her job has reactivated these more primitive defense mechanisms and coping strategies. These symptoms have been further perpetuated by the personality factors and traits described above, and her ongoing financial stressors. Her ongoing alcohol use is another example of a maladaptive coping strategy.
• We would anticipate when engaging in treatment, the patient may have difficulties with using primitive defense mechanisms. However, the patient has protective factors including psychological mindedness and previous response to therapy, which is a good prognostic factor. Based on these factors, dialectical behavioural therapy would be the most helpful for this patient.

Yet another way to present a formulation is in chronological order, starting from birth until present time:

• Genetics (family history)
• Birth (issues at birth, developmental history, developmental stages)
• Childhood (attachment style, neurodevelopment, milestones, trauma)
• Adolescence (relationships, trauma, school performance, substances)
• Adulthood (occupation, relationships, children, environment, stressors)
• Integrative statement (of how genetics, birth, childhood, adolescence, and adulthood factors contribute to current presentation, and how this directs your treatment/management)

Having certain common phrases to use can be helpful to structure your presentation. Here are some examples:

• “From a biological perspective, the patient is vulnerable because…”
• “The patient's early childhood and developmental history suggest…”
• “Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [social factor].”
• “Used substances as a coping style in [the past], and now this is occurring again (or there is a relapse) due to [psychological vulnerability].”
• “I wonder if… [psychological factor] is contributing to [current symptoms/struggles]”
• Use your own words and personal style
• Tell a story and narrative that is unique to your patient
• Be specific and demonstrate your understanding of the patient as a person and not a diagnosis
• Use words like precipitating, protective, and perpetuating factors to anchor your listener
• Focus on the most salient features and be concise
• Try and use a psychological theory (but only if you understand it)
• Be confident in your presentation!
• Include too much extra detail
• Try to be perfect only to overwhelm yourself
• Be generic (your formulation needs to be unique to your patient)
• Tell the patient's whole story all over again
• Mention life events or trauma without an understanding of its meaning or impact
• Try to formulate a “grand unified theory” of the patient and over-reach with your theory (if it doesn’t fit, it doesn’t fit! And that's okay!)
• Cover every box in the 4 Ps just for the sake of doing it (not all boxes will always apply!)

Beyond Basic Formulation

A good formulation should be integrative, and let you understand how all of the patient's factors interact to lead to the current situation. This gives you a sense of their current level of functioning, prognosis, and guides your direction for treatment and management decisions.

A good biopsychosocial formulation allows you to come up with a comprehensive and holistic treatment plan for your patient. Here is an example of a set of treatment recommendations for Jane Doe:

• What level of care is required (outpatient or inpatient)?
• Jane is able to articulate a safe plan to stay with a friend, and is suitable for outpatient care
• Jane might benefit from an increase of her sertraline from 75mg to 100mg and beyond (maximum dose of 200mg), for her mood dysregulation and depressive symptoms
• Jane might benefit from the use of anti-craving medications such as gabapentin or acamprosate to reduce her cravings for alcohol use
• Dialectical behavioural therapy (DBT) would be the most appropriate for Jane
• Jane would also benefit from motivational interviewing for her alcohol use
• Long-term, Jane might also benefit from a more in-depth understanding of how her past trauma affects her present self and symptoms. This could be achieved with more specific and in depth trauma therapy, but given the acuity of her symptoms, this is something that would follow after DBT.
• Jane could benefit from accessing support from her company's HR department to understand what options she has after her job termination
• Substance use groups such as Alcoholic's Anonymous
• Increasing connections to her friends and social supports

For good measure, here is another sample formulation for someone with a diagnosis of schizophrenia . Note that in this example, since the precipitating cause for acute psychosis (also applies to manic episodes ) is more “biological,” it may be harder to identify underlying psychological factors (but that's OK too – even the most “biological” psychiatric disorders can often be precipitated by psychosocial stressors). Again let's fill out the easiest parts of the table first:

Sample Formulation for Schizophrenia (Initial)

Now here is one potential example of a predisposing social and psychological formulation of psychosis (again, there are no right or wrong ways to formulate, it depends on the patient you have in front of you!)

Example of A Possible Psychological Formulation of Psychosis/Schizophrenia

Here's what the completed table would look like with the psychological factors incorporated.

Completed Formulation for Schizophrenia (Initial)

As you do more formulation, you will notice that patients tend to present in “templates,” that is, certain diagnoses tend to follow a certain common theme of predisposing, precipitating, and perpetuating factors. The more you formulate, it can be helpful to have a rough template of different formulations for different diagnoses (e.g. - depression, self-harm, mania/psychosis, anxiety, etc.) It will make your job of formulating much easier.

The following readings below are excellent resources to further develop your formulation skills:

• Selzer, R., & Ellen, S. (2014). Formulation for beginners. Australasian Psychiatry, 22(4), 397-401.
• Winters, N. C., Hanson, G., & Stoyanova, V. (2007). The case formulation in child and adolescent psychiatry. Child and Adolescent Psychiatric Clinics, 16(1), 111-132.
• Weerasekera, P. (1993). Formulation: A multiperspective model. The Canadian Journal of Psychiatry, 38(5), 351-358.

Beyond the Biopsychosocial Model

• Kendler, K. S. (2012). The dappled nature of causes of psychiatric illness: Replacing the organic–functional/hardware–software dichotomy with empirically based pluralism. Molecular psychiatry, 17(4), 377-388.

Academia.edu no longer supports Internet Explorer.

To browse Academia.edu and the wider internet faster and more securely, please take a few seconds to  upgrade your browser .

Enter the email address you signed up with and we'll email you a reset link.

• We're Hiring!
• Help Center

Biopsychosocial Model - G. Engel

Related Papers

Philosophy, Psychiatry, & Psychology

Bradley Lewis

Psychotherapy and Psychosomatics

chiara ruini

Clinical rehabilitation

Peter W Halligan

The biopsychosocial model outlined in Engel&#39;s classic Science paper four decades ago emerged from dissatisfaction with the biomedical model of illness, which remains the dominant healthcare model. Engel&#39;s call to arms for a biopsychosocial model has been taken up in several healthcare fields, but it has not been accepted in the more economically dominant and politically powerful acute medical and surgical domains. It is widely used in research into complex healthcare interventions, it is the basis of the World Health Organisation&#39;s International Classification of Functioning (WHO ICF), it is used clinically, and it is used to structure clinical guidelines. Critically, it is now generally accepted that illness and health are the result of an interaction between biological, psychological, and social factors. Despite the evidence supporting its validity and utility, the biopsychosocial model has had little influence on the larger scale organization and funding of healthcare...

European journal of analytic philosophy

Kathryn Tabb

The biopsychosocial model, which was deeply influential on psychiatry following its introduction by George L. Engel in 1977, has recently made a comeback. Derek Bolton and Grant Gillett have argued that Engel’s original formulation offered a promising general framework for thinking about health and disease, but that this promise requires new empirical and philosophical tools in order to be realized. In particular, Bolton and Gillett offer an original analysis of the ontological relations between Engel’s biological, social, and psychological levels of analysis. I argue that Bolton and Gillett’s updated model, while providing an intriguing new metaphysical framework for medicine, cannot resolve some of the most vexing problems facing psychiatry, which have to do with how to prioritize different sorts of research. These problems are fundamentally ethical, rather than ontological. Without the right prudential motivation, in other words, the unification of psychiatry under a single conce...

The Lancet Psychiatry

hadi priyanto

Aaron Mishara

Inheriting the nineteenth century division between the naturaland human-historical sciences, Karl Jaspers emphasizes the psychological understanding of mental disorders as narrative-based, holistic and contextual. However, he also affirms the value of explanatory physiological and neurobiological approaches. Nassir Ghaemi nonetheless interprets Jaspers person-centered, methodologically based pluralism as contradicting George Engel&#39;s biopsychosocial project. In our view, Jaspers advances this project. Emphatically, Engel proposed a project and not a product. We have tried to develop a narrative somewhat different than Ghaemi&#39;s, with a synergistic consequence, a biopsychosocial model for medicine and psychiatry indebted to both Jaspers and Engel. It is our conclusion that Jaspers&#39; person-centered, methodological pluralism does not contradict biopsychosocial medicine and psychiatry but in fact complements and advances the broader medical model that Engel sought but never ac...

Damir Lucanin

Paolo Gritti

Since 1997, the Bio-Psycho-Social Model, proposed by George Engel, attracted the interest of clinical researchers as well epistemologists and was recognized as a turning point in the culture and praxis of medical diagnosis and treatments. According to Engel, biological, psychological as well as social events are mutually interconnected and reciprocally influenced; a paradigmatic shift in the approach to the mind-body problem. Lately, this model has received persuasive criticism that has caused a fading of its scientific reliability. This concise review focuses the core feature of Engel " s position as well as the scientific controversy that followed during these forty years.

Perspectives in Biology and Medicine

Abraham Fuks

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.

RELATED PAPERS

omer Mughieda

Journal for ImmunoTherapy of Cancer

Bent Jakobsen

European Journal of Cancer

Annisa Febrina

Rahayu Lubis

Clinical Psychopharmacology and Neuroscience

Adriane Rosa

2014 IEEE 14th International Conference on Advanced Learning Technologies

Sokratis Karkalas

EDUSAINTEK : JURNAL PENDIDIKAN, SAINS DAN TEKNOLOGI

Dyan Yuliana

Journal of Nepalgunj Medical College

Merina shrestha

Biology of the Cell

Ermanno Gherardi

Luisa Vitor

Psychiatry Research

Gantt Galloway

Neurobiology of Learning and Memory

Megan Shipman

AKRA KÜLTÜR SANAT VE EDEBİYAT DERGİSİ

ESMA ÇETİNKAYA KARADAĞ

Physical Review A

Ruggero Caravita

Nuclear Physics A

Igor Dremin

Geoffroy Feugier

Timisoara Physical Education and Rehabilitation Journal

Alexandru Oprean

Nature Protocols

Amanda Brooks

Journal of Virology

Genyan Yang

FEMS Microbiology Letters

Levente Emődy

Journal of modern science

Bronisław Sitek

Journal of Research of the National Institute of Standards and Technology

Richard E Ricker

International journal of management economics and business

Mehmet Pekkaya

Regional Science Policy & Practice

Robert Stimson

RELATED TOPICS

•   We're Hiring!
•   Help Center
• Find new research papers in:
• Health Sciences
• Earth Sciences
• Cognitive Science
• Mathematics
• Computer Science
• Academia ©2024

• My presentations

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

BIOPSYCHOSOCIAL MODEL

Published by Roger Persson Modified over 4 years ago

Similar presentations

Presentation on theme: "BIOPSYCHOSOCIAL MODEL"— Presentation transcript:

Abnormal Psychology Discuss to what extent biological, cognitive, and sociocultural factors influence abnormal behaviour Evaluate psychological research.

 The exact cause of bulimia nervosa is unknown.  Research suggests that inherited biological and genetic factors contribute.  Research has also focused.

CASIE Workshop Psychology Session 4: Teaching the Options.

Food Science. What is wellness?  Wellness: state of being in good health  Quality of life: refers to a persons satisfaction with his or her looks, lifestyle,

Chapter 1 Mental Health and Mental Illness Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Introduction to Mental Health and Human Rights. Did you know? There is a high prevalence of mental health (MH) problems: One in four people will develop.

Chapter 14 Psychological Disorders. Historical Perspectives of Psychological Disorders. Demon Possession Poor treatment of the mentally ill. Stigma Pyscho-dynamic.

Psychosomatic medicine History and Current Trends.

MENTAL HEALTH DR NORHASMAH SULAIMAN

Aetiology of Psychiatric Disorders Dr. Fatima Alhaidar Professor & Consultant Child & Adolescent Psychiatrist College of Medicine, KSU.

HEALTH. Defining Health 4 Developmental health psychology is the study of the interaction of age, behavior and health 4 World Health Organization (WHO)

Dr. YASER ALHUTHAIL Associate Professor & Consultant Consultation Liaison Psychiatry.

200 pt 300 pt 400 pt 500 pt 100 pt 200 pt 300 pt 400 pt 500 pt 100 pt 200 pt 300 pt 400 pt 500 pt 100 pt 200 pt 300 pt 400 pt 500 pt 100 pt 200 pt 300.

Introduction: Medical Psychology and Border Areas

Mental Disorders Mental Disorder- Is an illness that affects the mind and reduces person’s ability to function, adjust to change, or get along with others.

Optical Illusions Mental Disorders.

Focus On EATING DISORDERS. Eating Disorders CCHS reports that 3.8% of Canadian girls and women (aged 15 to 24) were at risk of eating disorder. Thirty.

Copyright © Allyn & Bacon 2007 Chapter 1 Introduction and History of Psychology.

Women and Mental Health: Part II. Depression Women are 2-4 times as likely as men to suffer from depression. Why?

Psychology’s Big Question… Nature versus Nurture 1.

About project

© 2024 SlidePlayer.com Inc. All rights reserved.

Biopsychosocial Model: Examples, Overview, Criticisms

George Engel first articulated the b iopsychosocial model in 1977, proposing that understanding a person’s medical condition requires assessing not only their biology but also psychological and social influences.

The biopsychosocial model encompasses three primary elements: physiological, psychological, and sociocultural aspects.

For example, biological factors can include a person’s age, genetic makeup, health history, and gender. Psychological influences can include the individual’s emotions, thoughts, and behavior. 

Finally, social aspects like economic status, family relationships, and access to healthcare services can drastically alter one’s choices.

This method emphasizes that people possess unique well-being needs, recognizing the interrelationship of these three components for optimal care.

By taking a comprehensive approach to patient healthcare, medical practitioners can understand the root causes of illness, thus enabling them to craft individualized care plans.

Overview of the Biopsychosocial Model

A biopsychosocial model is a holistic approach to understanding health and illness considering multiple influences. It recognizes the interplay between biological, psychological, and social factors on health throughout a person’s lifespan (Bolton & Gillett, 2019).

Through this model, practitioners can gain insight into how physical, psychological, and social stressors can interact to affect an individual’s overall health. 

According to Erb and Schmidt (2021), a biopsychosocial model:

“…is a general model of care, positing that biological, psychological (i.e., thoughts, emotions, and behaviors), and social factors all play a significant role in human functioning in the context of disease or illness (p. 29).

While traditional medical models focus purely upon problems’ pathological origins, this alternative considers multiple aspects beyond mere biological cause.

This method focuses on comprehending how combined biological, psychological, and social aspects can affect our well-being.

Kusnanto and colleagues (2018) state that:

“…the biopsychosocial model is an ideal representation of science and humanism in medical practice, although many argue that the model is hard to implement” (p. 497). 

Integrating mental, physical, and social factors into patient care can be arduous. Its primary goal is to give a complete view of patient care by concentrating on nurturing the individual as an entirety rather than solely focusing on their medical symptoms.

For example, a person suffering from persistent pain could find relief through integrated physical and psychological therapies, along with the assistance of their psychologist. The treatment plan must always be carefully tailored to an individual’s needs accordingly.

Simply, the biopsychosocial model allows practitioners to understand the root causes of ailments or discomfort, enabling them to create more tailored treatment strategies.

Three Components of the Biopsychosocial Model

The biopsychosocial healthcare model comprises three interrelated components: biological, psychological, and social (Landow, 2006).

Let’s look at each of these components:

1. Biological Component

This component refers to the physiological and genetic characteristics of the individual that affect his health. It includes predisposition to certain diseases, immune system, age, gender, and other biological factors.

For instance, hereditary factors may make a patient with a family history of type 2 diabetes more prone to developing the disorder.

2. Psychological Component

The psychological aspect covers the patient’s emotional and psychological state, including stress, anxiety, mood, and consciousness.

Psychological factors can influence health through behavioral and cognitive processes.

As in the first case, in a patient with a chronic condition such as arthritis, increased stress levels can increase pain and cause depression.

3. Social Component

This component affects the social environment and cultural factors that affect human health.

For example, it may include health care availability and quality, family support, economic status, and educational attainment.

A patient with low socioeconomic status may have limited access to quality health care or a healthy diet, leading to chronic diseases.

Biopsychosocial Model Examples

• Eating Disorders : The biopsychosocial model offers invaluable insights into the development of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating, by exploring their biological, psychological, and social nuances. Evidence affirms that these conditions cannot be attributed to any cause but rather a combination of factors from several domains. So, treatment plans must look at all aspects of an individual’s condition rather than solely focusing on physical symptoms.
• Anxiety Disorders : Anxiety can be attributed to biological, psychological, and social factors. Thus, by blending biological elements such as neurotransmitter imbalances with psychological approaches like cognitive behavioral therapy (CBT) and social paradigms , including supportive networks – it is achievable to mitigate the symptoms of anxiety conditions, for example, panic disorder or OCD.
• Depression : This psychological condition can be caused by various components, such as genetics, hormone imbalances, detrimental thought patterns and environmental pressures. An effective treatment should take into consideration each of these contributing aspects to successfully tackle depression symptoms.
• Addiction : Addictive behaviors may have a biological base due to chemical imbalances in the brain or genetic predispositions. Still, they can also be triggered by personal struggles or difficult situations in a person’s life. So, before developing a treatment strategy, it’s important to consider all the contributing factors to an individual’s addiction.
• Chronic Pain : If you experience persistent pain, there is likely to be a physiological cause. Additionally, psychological and environmental elements can contribute to distress. To successfully handle chronic soreness requires physical treatments that address the root of your condition and cognitive-behavioral strategies designed to lessen its emotional impact while receiving support from family members or friends.
• Heart Disease : Biological risk factors like smoking or high cholesterol levels and psychological elements like stress and lack of physical activity can contribute to this chronic condition. Understanding these different components helps healthcare professionals create comprehensive prevention plans for individuals at risk of developing heart disease.
• Autism Spectrum Disorders : Like many other conditions, ASD can be the result of biological factors such as neural development or genetic makeup. Psychological issues, including anxiety, or social problems, such as communication or social interaction difficulties, can also influence it. Integrating all of these components into treatment plans can help to improve the lives of those struggling.
• ADHD/ADD : Biological causes, like an increase in certain neurotransmitters levels alongside environment elements e.g. absence/or not enough parental monitoring and inadequate nutrition are known causes culminating to Attention Deficit /Hyperactive disorder (ADHA/ADD). So, treatment plans should take all of these factors into consideration to help those affected by this condition.
• Schizophrenia : This mental disorder is associated with multiple biological changes in the brain and possible genetic influences. However, social factors, including trauma or relationship issues, may trigger its onset or exacerbate existing symptoms. Thus, creating an effective treatment plan should include assessing these contributing components. 
• Insomnia : Studies suggest that there are both physical and emotional drivers behind insomnia. Thus, if you have insomnia, a comprehensive treatment plan should include not just lifestyle interventions such as reducing caffeine and alcohol intake. In addition, consider taking some form of mental health guidance such as CBT (cognitive behavioral therapy) aimed at detecting and addressing underlying emotions capable of disrupting adequate slumber.

Origins of the Biopsychosocial Model

In the 1970s, George L. Engel – an American psychiatrist – proposed a biopsychosocial model as an alternative to the biomedical model that was then prevailing (Smith, 2002).

The biomedical model focused exclusively on the physical and biological aspects of the disease. It marked the beginning of a revolutionary new era in psychiatry and medicine.

Still, this model took a reductionist approach and only looked at the disease from an anatomical, physiologic, and chemical perspective of the body. Thus, psychological and social influences were disregarded.

According to Smith (2002), based on various studies and clinical experience, Engel proposed the biopsychosocial model to combine diseases’ biological, psychological, and social aspects. 

This model emphasizes the significance of taking into account all three elements in combination in order to gain a comprehensive insight into diseases and their causes.

Over time, the biopsychosocial model has earned immense global recognition from researchers.

It found considerable traction in many current approaches to diagnosing, curing, and averting ailments ranging from psychological conditions to chronic illnesses.

Criticisms of the Biopsychosocial Model

While the biopsychosocial model may look a promising unified approach to patient treatment, its ambiguity in terms of outcomes, lack of unity amongst practitioners, and its complexity have been heavily criticized.

Here are some key criticisms of this model:

• Lack of c larity and s tructure : One major criticism of the biopsychosocial model is its relative uncertainty and absence of structure. The lack of clear boundaries and criteria for each component (biological, psychological, and social) can make developing and evaluating standard treatment techniques challenging (Carey et al., 2014).
• Lack of unity : The biopsychosocial model is often seen as an alternative to the biomedical model but is not always integrated with it. This separation can lead to interaction problems between specialists in different fields and a lack of a unified treatment strategy.
• Complex ity : Measuring and evaluating psychological and social factors can be complex and subjective. Determining the relationship between these components and diseases can take time, creating difficulties in developing and evaluating treatment effectiveness (Carey et al., 2014).
• Resource limitations : The biopsychosocial model requires a broader and deeper approach to treatment, which can require significant resources and time. Implementing such an approach can be challenging, especially with limited budgets and overburdened healthcare facilities.

To gain insight into every aspect of one’s well-being requires a comprehensive perspective such as what’s provided by the biopsychosocial model.

This evidence-based approach helps us gain greater insight into how physical and mental issues come about – giving us an invaluable tool for improving our overall health.

Developed by George Engel in the late 1970s, healthcare practitioners have widely adopted this model due to its comprehensive and integrative approach.

Despite its advantages, the biopsychosocial model has been criticized for its lack of certainty, structure, unity, complex process, and resource limitations. 

Still, it serves as a significant means of comprehending and dissecting physical and mental healthcare challenges, whilst devising potent treatments for multiple conditions.

Bolton, D., & Gillett, P. G. (2019). The biopsychosocial model 40 years on. In  www.ncbi.nlm.nih.gov . Palgrave Pivot. https://www.ncbi.nlm.nih.gov/books/NBK552030/

Carey, T. A., Mansell, W., & Tai, S. J. (2014). A biopsychosocial model based on negative feedback and control.  Frontiers in Human Neuroscience ,  8 . https://doi.org/10.3389/fnhum.2014.00094

Erb, M., & Schmid, A. A. (2021).  Integrative rehabilitation practice: The foundations of whole-person care for health professionals . Jessica Kingsley Publishers.

Kusnanto, H., Agustian, D., & Hilmanto, D. (2018). Biopsychosocial model of illnesses in primary care: A hermeneutic literature review.  Journal of Family Medicine and Primary Care ,  7 (3), 497–500. https://doi.org/10.4103/jfmpc.jfmpc_145_17

Landow, M. V. (2006).  Stress and mental health of college students . New York: Nova Science Publishers.

Smith, R. C. (2002). The biopsychosocial revolution.  Journal of General Internal Medicine ,  17 (4), 309–310. https://doi.org/10.1046/j.1525-1497.2002.20210.x

Viktoriya Sus (MA)

Viktoriya Sus is an academic writer specializing mainly in economics and business from Ukraine. She holds a Master’s degree in International Business from Lviv National University and has more than 6 years of experience writing for different clients. Viktoriya is passionate about researching the latest trends in economics and business. However, she also loves to explore different topics such as psychology, philosophy, and more.

• Viktoriya Sus (MA) #molongui-disabled-link 15 Free Enterprise Examples
• Viktoriya Sus (MA) #molongui-disabled-link 21 Sunk Costs Examples (The Fallacy Explained)
• Viktoriya Sus (MA) #molongui-disabled-link Price Floor: 15 Examples & Definition
• Viktoriya Sus (MA) #molongui-disabled-link Linguistic Relativity: 10 Examples and Definition

Chris Drew (PhD)

This article was peer-reviewed and edited by Chris Drew (PhD). The review process on Helpful Professor involves having a PhD level expert fact check, edit, and contribute to articles. Reviewers ensure all content reflects expert academic consensus and is backed up with reference to academic studies. Dr. Drew has published over 20 academic articles in scholarly journals. He is the former editor of the Journal of Learning Development in Higher Education and holds a PhD in Education from ACU.

• Chris Drew (PhD) #molongui-disabled-link 25 Positive Punishment Examples
• Chris Drew (PhD) #molongui-disabled-link 25 Dissociation Examples (Psychology)
• Chris Drew (PhD) #molongui-disabled-link 15 Zone of Proximal Development Examples
• Chris Drew (PhD) #molongui-disabled-link Perception Checking: 15 Examples and Definition

Leave a Comment Cancel Reply

Your email address will not be published. Required fields are marked *

Adolescent Risk Behavior and Self-Regulation pp 49–53 Cite as

The Biopsychosocial Model and Behavioral Presentation

• Franz Resch 3 &
• Peter Parzer 3  
• First Online: 13 April 2021

381 Accesses

The developmental model that underlies a functional analysis of symptoms in developmental psychopathology is the interactionist development theory [178]. Influences of nature and culture, civilization norms, and expectations of caregivers as well as natural environmental conditions are development incentives and represent developmental tasks that must be mastered by the individual. The peculiarity of the interactionist theory is that it gives the individual an active role in shaping his environment and does not degrade it to the passive place of action of different development influences.

This is a preview of subscription content, log in via an institution .

Buying options

• Available as PDF
• Read on any device
• Instant download
• Own it forever
• Available as EPUB and PDF
• Compact, lightweight edition
• Dispatched in 3 to 5 business days
• Free shipping worldwide - see info
• Durable hardcover edition

Tax calculation will be finalised at checkout

Purchases are for personal use only

Oerter R, Montada L, editors. Entwicklungspsychologie: ein Lehrbuch. 3rd ed. Weinheim: Beltz; 1995.

Google Scholar  

Bischof N. Struktur und Bedeutung: eine Einführung in die Systemtheorie. Bern: Huber; 2013.

Powers WT. Behavior: the control of perception. Chicago: Aldine; 1973a.

Schleiffer R. Verhaltensstörungen: Sinn und Funktion. Heidelberg: Carl Auer Verlag; 2013.

Resch F. Beitrag der klinischen Entwicklungspsychologie zu einem neuen Verständnis von Normalität und Pathologie. In: Oerter R, von Hagen C, Röper G, Noam G, editors. Klinische Entwicklungspsychologie: Ein Lehrbuch. Weinheim: Beltz; 1999b. p. 606–22.

Freud S. Wege der psychoanalytischen Therapie. In: Gesammelte Werke XII. Frankfurt: Fischer; 1919. p. 183–94.

Skinner BF. Contingencies of reinforcement: a theoretical analysis. New York: Appleton-Century-Crofts; 1969.

Resch F, Parzer P. Entwicklungspsychopathologie und Psychotherapie: Kybernetische Modelle zur funktionellen Diagnostik bei Jugendlichen. Wiesbaden: Springer; 2015.

Book   Google Scholar  

Herpertz-Dahlmann B, Resch F, Schulte-Markwort M, Warnke A. Entwicklungspsychiatrie. In: Herpertz-Dahlmann B, Resch F, Schulte-Markwort M, Warnke A, editors. Entwicklungspsychiatrie: Biopsychologische Grundlagen und die Entwicklung psychischer Störungen. 2nd ed. Stuttgart: Schattauer; 2008. p. 303–51.

Caspi A, McClay J, Moffitt TE, et al. Role of genotype in the cycle of violence in maltreated children. Science. 2002;297:851–4. https://doi.org/10.1126/science.1072290 .

Article   CAS   PubMed   Google Scholar  

Caspi A, Moffitt TE. Gene-environment interactions in psychiatry: joining forces with neuroscience. Nat Rev Neurosci. 2006;7:583–90. https://doi.org/10.1038/nrn1925 .

Feder A, Nestler EJ, Charney DS. Psychobiology and molecular genetics of resilience. Nat Rev Neurosci. 2009;10:446–57. https://doi.org/10.1038/nrn2649 .

Article   CAS   PubMed   PubMed Central   Google Scholar  

Kinnally EL, Huang Y, Haverly R, et al. Parental care moderates the influence of MAOA-uVNTR genotype and childhood stressors on trait impulsivity and aggression in adult women. Psychiatr Genet. 2009;19:126–33. https://doi.org/10.1097/YPG.0b013e32832a50a7 .

Article   PubMed   PubMed Central   Google Scholar  

Reichl C, Kaess M, Resch F, Brunner R. Die Rolle des Genotyps bei der generationsübergreifenden Übertragung belastender Kindheitserlebnisse. Z Kinder Jugendpsychiatr Psychother. 2014;42:349–59. https://doi.org/10.1024/1422-4917/a000310 .

Article   PubMed   Google Scholar  

Kieling C, Hutz MH, Genro JP, et al. Gene-environment interaction in externalizing problems among adolescents: evidence from the Pelotas 1993 Birth Cohort Study. J Child Psychol Psychiatry. 2013;54:298–304. https://doi.org/10.1111/jcpp.12022 .

Resch F, Westhoff K. Das biopsychosoziale Modell in der Praxis: Eine kritische Reflexion. Resonanzen. 2013;1:32–46.

Sturma D. Philosophie und Neurowissenschaften. Frankfurt: Suhrkamp; 2006.

Fuchs T. Das Gehirn - ein Beziehungsorgan: Eine phänomenologisch-ökologische Konzeption. Stuttgart: Kohlhammer; 2017.

Wittgenstein L. Philosophische Untersuchungen. Frankfurt: Suhrkamp; 1978.

Resch F, Westhoff K. Wie weit trägt das biopsychosoziale Modell des Menschen in der Psychotherapie? Psychotherapie Forum. 2006;14:186–92. https://doi.org/10.1007/s00729-006-0167-9 .

Article   Google Scholar  

Resch F, Parzer P. Gibt es psychopathologische Modelle zur Erklärung der Wirkungen von Psychotherapie und Psychopharmakotherapie? In: Küchenhoff J, editor. Psychopharmakologie und Psychoanalyse. Grundlagen, Klinik, Forschung. Stuttgart: Kohlhammer; 2016. p. 72–90.

Herpertz S, Caspar F, Mundt C, editors. Störungsorientierte Psychotherapie. München: Urban & Fischer; 2008.

Bastine R. Komorbidität: Ein Anachronismus und eine Herausforderung für die Psychotherapie. In: Fiedler P, editor. Die Zukunft der Psychotherapie. Heidelberg: Springer; 2012. p. 13–26.

Chapter   Google Scholar  

Resch F. Die Perspektive der Kindheit und Jugend. In: Fiedler P, editor. Die Zukunft der Psychotherapie. Heidelberg: Springer; 2012. p. 93–116.

Download references

Author information

Authors and affiliations.

Clinic for Child and Adolescent Psychiatry, University Hospital Heidelberg, Heidelberg, Germany

Franz Resch & Peter Parzer

You can also search for this author in PubMed   Google Scholar

Corresponding author

Correspondence to Franz Resch .

Rights and permissions

Reprints and permissions

Copyright information

© 2021 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Cite this chapter.

Resch, F., Parzer, P. (2021). The Biopsychosocial Model and Behavioral Presentation. In: Adolescent Risk Behavior and Self-Regulation. Springer, Cham. https://doi.org/10.1007/978-3-030-69955-0_5

Download citation

DOI : https://doi.org/10.1007/978-3-030-69955-0_5

Published : 13 April 2021

Publisher Name : Springer, Cham

Print ISBN : 978-3-030-69954-3

Online ISBN : 978-3-030-69955-0

eBook Packages : Behavioral Science and Psychology Behavioral Science and Psychology (R0)

Share this chapter

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

• Publish with us

Policies and ethics

• Find a journal
• Track your research

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• Springer Nature - PMC COVID-19 Collection
• PMC10107555

The biopsychosocial model: Its use and abuse

Alex roberts.

Department of Political Science, University of South Dakota, Vermillion, SD USA

Associated Data

The biopsychosocial model (BPSM) is increasingly influential in medical research and practice. Several philosophers and scholars of health have criticized the BPSM for lacking meaningful scientific content. This article extends those critiques by showing how the BPSM’s epistemic weaknesses have led to certain problems in medical discourse. Despite its lack of content, many researchers have mistaken the BPSM for a scientific model with explanatory power. This misapprehension has placed researchers in an implicit bind. There is an expectation that applications of the BPSM will deliver insights about disease; yet the model offers no tools for producing valid (or probabilistically true) knowledge claims. I argue that many researchers have, unwittingly, responded to this predicament by developing certain patterns of specious argumentation I call “wayward BPSM discourse.” The arguments of wayward discourse share a common form: They appear to deliver insights about disease gleaned through applications of the BPSM; on closer inspection, however, we find that the putative conclusions presented are actually assertions resting on question-begging arguments, appeals to authority, and conceptual errors. Through several case studies of BPSM articles and literatures, this article describes wayward discourse and its effects. Wayward discourse has introduced into medicine forms of conceptual instability that threaten to undermine various lines of research. It has also created a potentially potent vector of medicalization. Fixing these problems will likely require reimposing conceptual rigor on BPSM discourse.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11019-023-10150-2.

Since its articulation by George Engel ( 1977 ), the biopsychosocial model (BPSM) has enjoyed growing acceptance and use in medicine. A recent major work on the BPSM described the model as having “become the orthodox overarching model for health, disease and healthcare” (Bolton and Gillett 2019 , 5). Such an assessment of the BPSM’s place in contemporary medicine is arguably overstated (Wade and Halligan 2017 ). But perhaps not by much. The BPSM literature has grown exponentially in recently decades, and prominent researchers in medical subfields such as psychiatry, chronic illness, spine care, and disability studies have used terms like “status quo,” “overarching conceptual framework,” and “dominant” to characterize the BPSM’s status (Bolton and Gillett 2019 ; Edwards et al. 2016 ; Ghaemi 2011 ; McLaren 2021 ; Weiner 2008 ). The BPSM is also increasingly taught in medical schools and healthcare trainings (Barron et al. 2021 ; Bolton and Gillett 2019 ).

It is therefore surprising that the BPSM has received relatively little critical scrutiny from medical scholars and philosophers. To be sure, the BSPM is sometimes discussed in the health philosophy literature (see, e.g.: Berghmans et al. 2009 ; Kelly et al. 2014 ; Boisaubin and McCullough 2004 ; Brendel 2003 ; Solli and Da Silva 2012 ; Lindau et al. 2003 ). There have also been a few more extended philosophical and theoretical discussions of the BPSM’s strengths and weaknesses (Bolton and Gillett 2019 ; Gask 2018 ; Gatchel and Turk 2008 ; Ghaemi 2009 , 2010 , 2011 ; McLaren 1998 , 2021 ; Van Oudenhove and Cuypers 2014 ; Saraga et al. 2014 ; Weiner 2008 ). Nonetheless, as Weiner ( 2008 , 211) notes, the model has received “remarkably little” close attention in light of its widespread influence.

The lack of attention is especially surprising given the serious questions raised by some existing criticisms of the BPSM. McLaren, Ghaemi, and others have argued that the BPSM is vague and/or devoid of meaningful scientific content (Bolton and Gillett 2019 ; Ghaemi 2009 ; McLaren 1998 ; Van Oudenhove and Cuypers 2014 ; Weiner 2008 ). Indeed, McLaren goes so far as to say that, as a scientific model, the BPSM “doesn’t exist” (McLaren 2021 , 644). These criticisms—which, we will see, are compelling—raise fundamental questions about the BPSM’s place in medicine. How can the BPSM be playing the role it is now said to have in healthcare? What does it mean to have an arguably non-existent model guiding whole areas of medical research and practice? Ghaemi is one of the few scholars to have given a sustained answer to these questions (Ghaemi 2010 ). He argues that, in practice, “the biopsychosocial approach” often devolves into unprincipled eclecticism. The BPSM’s all-inclusive nature has left its adherents free to select and mix and match different perspectives—including incompatible dogmatisms—in a haphazard way.

This article offers a different critical argument about the BPSM’s impact. The main thesis I advance can be summarized as follows: As some scholars have attempted to use the BPSM as a guiding framework for medical research, they have inadvertently introduced a general explanatory gap into their work. There is an expectation that, by “applying the biopsychosocial model,” they will be learning and demonstrating new things about disease; yet the BPSM does not actually offer tools for constructing (probabilistically) true knowledge claims. I contend that this gap is often bridged in practice with certain forms of specious argumentation. These arguments have a common form. They purport to offer scientific conclusions about disease. It might be claimed, for example, that BPSM-based research has established that temporomandibular disorder is a disease caused by various specific biological and psychosocial factors. When we examine such claims closely, however, we find that they lack compelling scientific bases and rest heavily on question-begging arguments, appeals to the BPSM’s authority, and other fallacious rhetorical maneuvers. These maneuvers are, we might say, doing the work of the missing BPSM and producing the hoped-for knowledge claims. Using these specious arguments—which I call “wayward” BPSM discourse—researchers have, likely unwittingly, introduced into the health literature many unsubstantiated claims. These include that various ill-defined states of suffering are diseases with known etiologies, and that various phenomena correlated with patients’ symptoms are the causes of those symptoms.

This article will show what wayward BPSM discourse is and why it is a problem. I begin by providing some needed background on the BPSM. Section one offers a brief overview of the model. In section two, I argue, consistent with others (Bolton and Gillett 2019 ; Ghaemi 2010 , 2011 ; McLaren 1998 ; Quintner and Cohen 2019 ; Weiner 2008 ), that the BPSM is not a scientific or explanatory model. The BPSM cannot be used to distinguish disease from non-disease, define diseases, or identify genuine cause-effect relationships. (This is not to say the BPSM has no value. As I argue, it is still a useful tool for organizing and communicating information about the psychosocial determinants of health). In sections three through five, I develop my main argument. Drawing on Engel’s seminal 1977 article and several BPSM illness literatures, I describe the patterns of specious argumentation that constitute wayward discourse. I then highlight the deleterious effects of wayward discourse. Among other things, wayward discourse has sown disruptive conceptual instability in certain lines of medical research and also created a potentially dangerous new vector of medicalization in society. I conclude by arguing that correcting these problems will require imposing conceptual rigor on BPSM discourse.

Overview of the BPSM

Although it has roots in the work of others (Ghaemi 2011 ), the BPSM was first formally introduced by George Engel in his 1977 article, “The Need for a New Medical Model: A Challenge for Biomedicine.” Engel’s goal in proposing the BPSM was to remedy certain perceived deficiencies of the biomedical model. Disease, Engel argued, involves important psychological and social factors in addition to biological ones. He noted, for example, that people who experience a mismatch between their social role and cultural resources are more apt to become ill (Engel 1977 , 132). The problem with biomedicine is that it typically ignores such psychosocial health determinants because it is “basically mechanistic and reductionistic” in orientation (Engel 1977 , 134). The result is an impoverished understanding of health and disease. The BPSM, Engel argued, would overcome the biomedical model’s limitations by conceiving of disease as the outcome of interactions among biological, psychological, and social factors.

Figure  1 provides a visual representation of the BPSM that is broadly consistent the verbal and graphical depictions of the model offered in the literature (Bolton and Gillett 2019 ; Edwards et al. 2016 ; Engel 1977 ; Gatchel et al. 2014 ; Spurgeon 2002 ; Turk et al. 2011 ; Vogele 2015 ; Waddell 1993 ; Wade and Halligan 2017 ).

The biopsychosocial model

According to the model, illness is a product of dynamic interactions among the sorts of factors listed in Fig.  1 , and must be understood as such. Thus a BPSM-based account of chronic pain, for example, might posit that the pain is not a product of bodily damage alone, but of perceptions of that damage modulated by the patient’s attitudes or other psychological factors (which might, in turn, be shaped by other psychosocial or biological factors) (Clauw et al. 2019 ; Ohrbach and Dworkin 2016 ; Spurgeon 2002 ). BPSM researchers have also explored how social status and stressors can affect health outcomes (Bolton and Gillett 2019 ; Engel 1977 ).

Note that a number of more specific versions of the BPSM have been proposed over the years (Bolton and Gillett 2019 ; Lindau et al. 2003 ; Wade and Halligan 2017 ). I will not be dealing with these models in this article. My focus will be on references to, and applications of, the general version of the BPSM described above.

What the BPSM can and cannot do

As McLaren has argued (1998), for the BPSM to be a genuinely scientific model, it would have to go beyond merely positing that illness involves biological, psychological, and social factors. It would have to provide an integrating theory that explained exactly how these factors interact to cause illness in practice. The model could do this by, for example, defining its three domains clearly and explaining how social factors of type X cause biological events of type Y, which in turn produce symptoms of type Z, and so on. Engel hoped that general systems theory could be used to build this kind of scientific version of the BPSM (Engel 1977 ). Yet he never built such a model, and nor has anyone else—although work on this project remains ongoing (Bolton and Gillett 2019 ; Edwards et al. 2016 ; Kelly et al. 2014 ; McLaren 1998 , 2021 ). What the BPSM is, then, is essentially the general proposition that illness involves biological, psychological, and social factors.

It is easy to see that the BPSM, as it stands (Fig.  1 ), offers an exhaustive description of all possible causal relationships surrounding illness. The model’s three domains include more or less everything that impacts human life. The BPSM simply posits that when people fall ill, it is because some subset of all possible causal factors somehow interacted to make them ill. The model is thus vague, all-inclusive, and lacks meaningful scientific content (Bolton and Gillett 2019 ; Brendel 2003 ; Ghaemi 2010 , 2011 ; McLaren 1998 ; Weiner 2008 ). Essentially the BPSM states a truism about illness.

The BPSM’s lack of content means it is limited in two important ways. These limitations are perhaps obvious; but they nonetheless need emphasis for reasons that will become clear.

First, the BPSM does not provide criteria by which to distinguish disease from non-disease, or by which to define specific diseases. “Disease,” according to most common medical and philosophical definitions, is a bodily disruption or abnormality that has negative consequences for the organism as a whole (see, e.g.: Boorse 1975 ; Kingma 2014 ; Murphy 2020 ; Roberts, forthcoming ). 1 Engel himself called this our “dominant” concept of disease (1977, 130). (I will use this standard concept of disease in this article, as it has broad scientific, political, and social relevance, and also for normative reasons laid out elsewhere (Roberts, forthcoming )). To see why the BPSM cannot be used to distinguish disease from non-disease, consider the following states of suffering: Late-stage HIV infection, stress, people injuring themselves while playing football, anger concerning particular zoning rules, being repulsed by certain foods, sights, or smells. Each of these unpleasant phenomena will undoubtedly be preceded by complex chains of biological, psychological, and social factors (genetic predispositions, life experiences, cultural customs, legal decisions, etc.). Thus, for each, we could at least partially fill in the fields of the BPSM shown in Fig.  1 . Yet completing this exercise would tell us nothing about whether the given state of suffering is a disease (or a potential disease, or best treated as a disease)—in the sense of being a state of suffering caused primarily by a known defect or dysfunction of the body. Because all suffering “fits” the BPSM, fitting per se does not establish diseasehood. 2

It is important to note that what is at stake here is not just our usage of the term “disease” per se. Calling something “a disease” often has powerful effects. It implies that the cause of the problem is more or less known and that it is organic in nature. This, in turn, implies that the problem is not a case of malingering, primarily psychological in nature, or under the patient’s direct control, and that, therefore, the patient is entitled to the sick role and its benefits. Calling a problem “a disease” also generally brings it under the jurisdiction of physicians, whose primary expertise is in the body and its defects, thereby encouraging pursuit of characteristically medical modes of treatment and management. These ways of handling human problems can have negative consequences, especially if the problem at hand is actually medically unexplained or a non-disease. For these and other reasons, it is important to avoid applying the appellation “disease” to phenomena that do not fit the definition of that term (Roberts, forthcoming ). This means that there is also a strong normative case to be made that the BPSM should not be used to define disease(s), barring developments that would justify doing so.

Second, the BPSM itself does not provide intellectual tools for establishing causality. Unlike, say, the Henle-Koch postulates or Evans’ criteria for causality (Evans 1976 ), the BPSM does not articulate epistemic principles that would allow researchers to distinguish true cause-effect relationships from spurious correlations. Furthermore, because the BPSM is really an atheoretical model (Brendel 2003 ; Ghaemi 2011 ; Skarmeta et al. 2019 ), it obviously cannot establish which explanations make theoretical sense. Thus, although the BPSM tells us we can list a huge array of factors as disease causes (see Fig.  1 ), the model itself does not tell us how to determine which factors play a causal role in any given case.

To sum up, the BPSM can appropriately be called a “conceptual framework,” but it is not a scientific model or an explanatory model of disease (Bolton and Gillett 2019 ; Ghaemi 2011 ; McLaren 1998 ; Quintner and Cohen 2019 ). There is nothing in the model itself that would allow us to distinguish disease from non-disease, define specific diseases, or separate genuine cause-effect relationships from spurious correlations.

This is not to say the BPSM has no value, however. As a conceptual framework, it can still serve as a useful tool for organizing and communicating information on the determinants of health and illness. There is now a large body of research indicating that psychosocial factors often play important roles in shaping health outcomes (Bolton and Gillett 2019 ; Edwards et al. 2016 ; Gatchel et al. 2014 ; Vogele 2015 ). Although the BPSM itself is not a necessary or sufficient tool for uncovering these relationships, it can certainly focus attention on them in several useful ways. Consider the example of lower back pain (LBP). LBP has long been a vexing problem for medicine. In many cases, patients experience pain and disability that cannot be adequately accounted for in terms of anatomical or physiological abnormalities (Weiner 2008 ). This makes LBP often difficult to manage from a biomedical perspective. In recent decades, however, significant advances in understanding and treating LBP have been made. Working from a BPSM perspective, researchers have found, for example, that fear avoidance, bodily fixation, stress, and other psychosocial factors affect LBP severity; working from such insights, they have developed new treatment modalities (e.g., exercise, therapy, addressing social/workplace factors) that appear to be more effective than biomedical approaches in reducing LBP pain and disability (Gatchel and Turk 2008 ; Gatchel et al. 2014 ; Waddell 1993 ; Weiner 2008 ). Even Weiner ( 2008 ), a spine specialist critical of the BPSM’s weaknesses as a scientific model, has acknowledged that it has been helpful in focusing attention on factors relevant to understanding and treating LBP, and now plays a prominent role in spinal care as a result.

These points can be extended beyond LBP. Important psychosocial determinants of health have been identified in many other areas as well, and the BPSM offers a schema for organizing this information and communicating it to medical and nursing students (Bolton and Gillett 2019 ), as Engel ( 1977 ) hoped the BPSM would. 3 In addition, the BPSM can help inform clinical epistemology in more general ways as well. For example, McWhinney ’s Textbook of Family Medicine (McWhinney and Freeman 2009 ), which draws on the BPSM and similar frameworks, has helped practitioners develop a more holistic approach to medical care. McWhinney and Freeman recognize the value of biomedical approaches to disease. However, they also encourage physicians and other practitioners to move beyond considerations of organic pathology by understanding each patient as a person whose being is fundamentally social and psychological, in addition to biological. Attending to these aspects of the patient can promote trust, bring to light additional information relevant to patient well-being, and expand opportunities for treatment (McWhinney and Freeman 2009 ). It is worth noting that, despite general awareness of their importance, psychosocial factors are sometimes deemphasized in everyday medical practice (Weiner 2008 ; Edwards et al. 2016 ). As a popular model, the BPSM may be able to help correct this imbalance.

In sum, the BPSM, as a conceptual framework, has expanded the parameters of medical research and practice in some helpful ways. So long as medical actors do not attempt to use BPSM itself for the purposes of defining disease(s) or establishing causal relationships, it can play a useful role in medicine.

Wayward BPSM discourse

Do researchers appreciate the BPSM’s limitations? To some extent, the answer is “yes.” Spurgeon, for example, writes, “implicitly or explicitly, when we adopt a biopsychosocial position we are concerned primarily with the understanding of illness rather than the explanation of disease ” (2002, 601). 4 This view, which has been echoed by other prominent BPSM researchers (Edwards et al. 2016 ; Gatchel et al. 2014 ; Gatchel and Turk 2008 ; Herman 2005 ; Schwartz 2007 ; Turk et al. 2011 ; Wade and Halligan 2017 ), reflects an accurate assessment of the BPSM’s capabilities and limitations. It is not a model that can produce scientific explanations of phenomena. Rather, it is a general perspective one can take to research and treatment. Notably, BPSM-based studies often describe their objects of study specifically as illness, illness behaviors, the experience of disease, disability, and so on. This also suggests some awareness that the BPSM cannot properly be used for defining and explaining disease .

Unfortunately, many researchers—including some of those cited above—appear to have become confused about the BPSM’s capabilities. For example, Gatchel and Turk ( 2008 , 2832) write: “The data supporting the predictive power of psychosocial variables [in back pain] support and thus validate the biopsychosocial model” and also render concerns about its unfalsifiability “moot.” This argument is mistaken. The empirical data “fit” the BPSM because it is all-inclusive and unfalsifiable; they do not demonstrate that the BPSM is a valid scientific model. 5 Nonetheless, the authors take this position and conclude that the BPSM offers, vis-à-vis the biomedical model, a more comprehensive “theor[y] of disease and causation” (Gatchel and Turk 2008 , 2833). This mistaken idea that the BPSM has been validated and thus has the capacity to define diseases and establish their causes has been echoed by other prominent researchers (Edwards et al. 2016 ; Engel 1977 ; Gask 2018 ; Gatchel et al. 2014 ; Maltzman 1994 ; Wade and Halligan 2017 ).

Adopting this strong position on the BPSM’s capabilities tends to place the researcher in an implicit bind. It creates an expectation that one can and will learn new things about disease by putting the BPSM to work; yet the BPSM itself offers no tools for generating new knowledge. I argue that, in practice, researchers have often bridged this gap between capacities and expectations with specious arguments that seem to deliver new insights about disease. I refer to these specious arguments, which follow certain common patterns, as “wayward” BPSM discourse.

Wayward BPSM discourse works something like this: A claim will be made that some poorly-understood state of suffering is a disease caused by various factors. This claim will be presented as a scientific conclusion that has been reached by the researchers “using” or “applying” the BPSM, or “taking a biopsychosocial perspective” on the ailment in question. On closer inspection, however, we find that what has actually happened is this: researchers have referenced or alluded to the BPSM in a general, verbal way, and used this discussion as an opportunity to assert the existence of a new disease and/or causal relationship by means of fallacious rhetorical maneuvers . The key rhetorical maneuvers of wayward BPSM discourse include the following:

• Concept shifting. While arguing for the BPSM’s aptness or superiority as a medical model, researchers will sometimes inappropriately blur the conceptual distinction between disease and illness (or syndrome). The practical effect of this maneuver is often to lower the bar for calling problems “diseases,” in ways that are unjustified.
• Question begging. Wayward BPSM discourse is characterized by various forms of the begging-the-question fallacy (using premises that contain, or presuppose the truth of, one’s conclusion). A common example is declaring that some malady is a “biopsychosocial disease” based on arguments that assume this is the case.
• Appeals to authority. Wayward discourse includes many arguments that boil down to the following: D is a disease caused by factors X, Y, and Z because the BPSM says so.

By employing such maneuvers, researchers have been able to, so to speak, fill the intellectual vacuum created by miscasting the BPSM as an explanatory model, and to construct seemingly-illuminating (but actually spurious) arguments about disease. 6

The resort to fallacious arguments in wayward discourse is almost certainly unintentional—a result of misunderstanding or carelessness, mixed with excitement about the BPSM’s perceived potential. Yet the effects of wayward discourse have been pernicious, nonetheless. I will develop these arguments over the remainder of this article.

Examples of wayward BPSM discourse

In this section I use three case studies to illustrate what wayward BPSM discourse is and how it works. These studies focus on Engel’s 1977 article and the BPSM literatures on temporomandibular disorder and irritable bowel syndrome. I use each of these cases to highlight one of the three rhetorical maneuvers discussed above. In this article’s Online Appendix, I demonstrate that these rhetorical maneuvers appear in other BPSM literatures as well. I discuss the negative effects of wayward discourse in the next section of this article.

Engel’s 1977 article

In his seminal 1977 article, Engel claims to present a new biopsychosocial model that offers better criteria for defining disease and a “blueprint” for medical research and practice (Engel 1977 , 131–32, 135). Yet Engel never presents a workable model (McLaren 1998 ). How, then, does he arrive at the aforementioned claims?

Here I argue that Engel’s claims are best seen as expressions of an underlying concept-shifting maneuver. In his article, Engel repeatedly substitutes the terms “disease” and “illness” for one another at critical junctures in his text. He uses this maneuver to expand the boundaries of the concept disease. Engel then uses this expanded concept of disease as a premise for his key claims. He uses it to imply—without ever stating clearly—new “biopsychosocial” criteria for defining disease, and names two new diseases in the process. Engel also argues that a new “biopsychosocial” medical model is needed to handle his expanded concept of disease. This is essentially the extent to which Engel articulates the BPSM: As put forth in his article, “the biopsychosocial model” is not a worked-out model, but rather Engel’s name for the thing that would, in principle, be suitable for the study of disease as he defines it. In this subsection, I show how Engel’s key claims rest on concept-shifting arguments, and explain why those arguments are faulty.

Let us begin by considering Engel’s discussion of schizophrenia, which occupies a prominent place in his article. Engel wants to argue that schizophrenia is a medical disease—that is, a problem falling under medicine’s purview—and that, if we carefully consider this disease’s properties (along with those of several other ailments) we will see that medicine ought to embrace his BPSM.

The claim that schizophrenia is a medical disease faces a hurdle, which Engel acknowledges. Whereas diseases are generally defined in terms of characteristic bodily dysfunctions (“specific pathogenesis and pathology”), schizophrenia is defined by “psychological… abnormalities” (Engel 1977 , 131), and thus would not currently qualify as a disease by normal biomedical standards. 7 Why, then, is schizophrenia to be regarded as a medical disease? The way Engel arrives at his answer to this question is revealing, for it exemplifies the core concept-shifting maneuver at work in his article.

Engel does not formally present a new definition of disease and show that it is satisfied by schizophrenia. Instead, Engel’s arguments work by forging an equivalence between schizophrenia and an ailment we already take for granted as a medical disease: diabetes mellitus. Engel notes that diabetes is well described in reductionist/biochemical terms; thus, there is little doubt it qualifies as a medical disease. Indeed, Engel introduces diabetes as a “paradigm of somatic disease” (Engel 1977 , 131). However, Engel then changes his terminology in a subtle yet consequential way. He equates diabetes itself with “illness” and also calls it “a human experience” (Engel 1977 , 131–32). Engel then argues that, as an illness and human experience , diabetes is shaped by psychosocial as well as biological factors. For example, psychosocial factors may affect how patients interpret their diabetes symptoms, thus altering their illness experience (Engel 1977 , 132). Schizophrenia, Engel argues, is no different. It is also an illness and human experience that is shaped by psychological and social factors. As for the missing/unknown biological component in schizophrenia, Engel simply “mak[es] the assumption that a specific biochemical abnormality[…] exists in schizophrenia,” while also suggesting that we do not necessarily need to emphasize biological factors when discussing illness (Engel 1977 , 131–32).

After describing “the reality of diabetes and schizophrenia as human experiences” – by listing various known and conjectured biological, psychological, and social factors involved in diabetes and schizophrenia qua illnesses – Engel concludes:

This list surely is not complete but it should suffice to document that diabetes mellitus and schizophrenia…. are entirely analogous and… appropriately conceptualized within the framework of a medical model of disease. (Engel 1977 , 131)

So, having shifted to a language of illness and human experience to frame schizophrenia and diabetes as equivalent, Engel then travels back in the other direction. He implicitly argues that, since diabetes and schizophrenia are “entirely analogous,” then schizophrenia must be a medical disease , since that is what diabetes is. Insofar as Engel makes a case for why schizophrenia is a disease falling under medicine’s purview, it depends on this underlying disease-to-illness-to-disease concept shift. 8

Engel later makes a very similar argument with respect to grief. Grief, he argues, though it involves no serious bodily defect, can qualify as a disease partly because “as with classic diseases, ordinary grief constitutes a discrete syndrome with a relatively predictable symptomatology which includes, incidentally, both bodily and psychological disturbances” (Engel 1977 , 133). Here we have another concept-shifting argument: Engel starts with “classic diseases” and then redescribes them as “syndromes” in order to expand the boundaries of “disease” to include grief. (Engel actually offers a version of this “syndrome” concept-shifting maneuver in connection with schizophrenia as well 9 ).

With little in the way of additional clarification, Engel then refers to “the proposed biopsychosocial concept of disease” (Engel 1977 , 134), as though one had been presented. Thus, Engel does not explicitly articulate and defend a new biopsychosocial definition of disease. At best he implies one. Using concept-shifting arguments, he expands the boundaries of the concept “disease” and takes this as an opportunity to apply the appellation “disease” to new ailments. Insofar as Engel implies a new definition of disease, it is something like the following: A disease is a “symptom cluster” precipitated by the “complex interaction” of known or conjectured biological, psychological, and social factors (Engel 1977 , 131, 133). 10

The ultimate purpose of Engel’s discussions of schizophrenia, diabetes, and grief is to make a case for his BPSM. After arguing that schizophrenia is a disease that belongs in a medical frame, he adds: “But the existing biomedical model does not suffice. To provide a basis for understanding the determinants of disease [and devising adequate treatments]… requires a biopsychosocial model” (Engel 1977 , 131–32). That is, since disease, according to Engel, is caused/constituted by psychosocial factors in addition to biological ones, it can only be adequately understood with “a biopsychosocial model” (Engel 1977 , 132–34). Unfortunately, Engel never explains what the BPSM is or how it could account for the psychosocial aspects of schizophrenia or grief. He only says that it “would” (Engel 1977 , 133). Thus, although Engel later writes of “the proposed biopsychosocial model” (Engel 1977 , 134–35), he does not, in fact, propose a model. “The biopsychosocial model” is mostly a placeholder. It is Engel’s name for the thing that would, hypothetically, explain the version of “disease” he constructs by conflating disease with illness.

In sum, Engel’s key claims in his article stem, in one way or another, from an underlying disease-illness concept-shifting maneuver. As Engel notes, several of his key conclusions hinge on “obliging ourselves” to think of diabetes and schizophrenia “in exactly the same terms” (Engel 1977 , 131), and this is accomplished by running disease into illness . Indeed, the thesis statement he offers at the opening and close of his main argument bears witness to this strategy: “The dominant model of disease today is biomedical, and it leaves no room within its framework for the social, psychological, and behavioral dimensions of illness ” (Engel 1977 , 130, 135). Engel’s arguments for the superiority of the BPSM over the biomedical model work by substituting illness for disease .

The concept-shifting arguments that Engel employs while advancing his key claims are fundamentally flawed because, as Engel himself acknowledges (Engel 1977 , 130), “disease” for our society generally means something like objectively-verifiable disruption of the body, whereas “illness” refers to subjective malaise and impairment of the person. Disease and illness (and human experience, syndrome, 11 etc.) are not the same thing. This means that Engel’s core argument is a non sequitur . The standard biomedical model is a model of disease . The fact that it cannot explain all aspects of illness proves nothing in particular.

Moreover, Engel fails to recognize that redefining disease as illness imposes an enormous burden on him, which he fails to meet. Disease so-defined—essentially, all human suffering involving known or presumptive biological, psychological, and social factors—is clearly a vast phenomenon. It would arguably fall within the purview of all the physical and social sciences, including biology, chemistry, psychology, sociology, economics, and so on. Engel tacitly acknowledges this when he writes that the “psychobiological unity of man requires that the physician accept the responsibility to evaluate whatever problems the patient presents” and that “the physician's basic professional knowledge and skills must span the social, psychological, and biological” (Engel 1977 , 133). But from these points it follows that, if Engel wanted rightfully to claim the phenomenon of illness for medicine (relabeled as “medical disease”), he would have to show that he had truly produced a new, expansive medical science capable of handling it—i.e., one built on the sort of integrative theory discussed previously. Yet he does not do that. Instead, Engel appears to proceed by folding “illness” back under “disease” and taking it for granted that “diseases” belong to medicine, and by this means brings ailments like schizophrenia and grief into medicine’s ambit—while saying, essentially, that he hopes to build a medicine capable of handling them in the future.

In the end, then, Engel’s arguments about the nature of disease and putative benefits of the BPSM seem uncompelling. They rest on unjustified conceptual maneuvers. They also, if accepted, would assign a potentially vast portion of human suffering to medicine, but without improving medicine’s ability to treat that suffering.

In addition to yielding a problematically expansive definition of disease, Engel’s concept-shifting maneuvers also open the door to serious problems in causal inference-making. For example, Engel argues at one point that, in schizophrenia, “conditions of life and living… [and] psychophysiologic responses to life change may 12 interact with existing somatic factors” to shape the onset and severity of “the manifest disease” (Engel 1977 , 132). This argument has significant flaws. The presumptive somatic and physiologic factors in schizophrenia are unknown according to Engel, and “life” is an all-encompassing category. A sound causal explanation cannot invoke unknown/conjectured factors and all-inclusive categories. However, since Engel makes these claims while still in the epistemically-uncharted territory of “illness” and “human experience,” there is nothing internal to the discussion itself that clearly rules them out. Engel’s concept-shifting maneuvers thus create a discursive space in which there appear to be few checks on the causal claims one can make about disease and illness.

Despite their flaws, Engel’s concept-shifting arguments have become a part of the wider BPSM discourse. For example, as discussed in this article’s online Appendix, Maltzman argues that, due in part to “developments in biopsychosocial medicine,” a disease can be defined as a syndrome or cluster of biological and psychosocial problems; on this basis, “alcoholism is a disease” (Maltzman 1994 , 13–15). The Appendix’s discussions of alcoholism, chronic pain, and chronic fatigue syndrome provide further examples of BPSM researchers using concept-shifting arguments to frame these maladies as diseases or disease equivalents. Echoing Engel, they also advance questionable causal claims in the process.

Temporomandibular disorder(s)

This subsection focuses on temporomandibular disorder (TMD). I argue that TMD has become the subject of unjustified claims and that these claims are at least partly products of the question-begging strand of wayward BPSM discourse. To keep the detail presented to a minimum, I have provided a full version of the TMD case study in the online Appendix, and offered an abridged version here.

TMD is an illness construct that was first formally defined in 1992 (Dworkin and LeResche 1992 ). TMD, by definition, refers to a pool of diverse jaw-related signs and symptoms. These include muscular pain and tenderness, clicking in the jaw joint, reduced jaw mobility, and osteoarthritis. An individual manifesting one or more of these problems ipso facto qualifies for a diagnosis of TMD. The way TMD has been depicted in the literature is somewhat confusing. TMD is often described as a “disease” and a “disorder,” and treated as though it were one: “TMD” is said, for example, to “cause,” and “manifest” in, patients’ jaw symptoms, which are also sometimes called “phenotypes” of TMD (Li and Leung 2021 , 459; Ohrbach and Dworkin 2016 , 1093–94, Slade et al. 2016 , 1091). However, TMD, properly described, is an unvalidated research construct. We know that TMD has not been validated in part because there are proposals on the table to radically redefine the TMD construct (Ohrbach 2021 ; Ohrbach and Dworkin 2016 ; Schiffman et al. 2014 ), which would not be the case if researchers were satisfied it was valid. Thus the “disease” depictions of “TMD” found in the literature appear to be problematic. As an unvalidated construct defined by mandible symptoms, TMD cannot cause or explain those symptoms. How, then, can researchers claim that TMD is a disease that causes/explains patients’ suffering?

I argue that the claims surrounding TMD appear to be, at least in part, products of a loop of question-begging argumentation that has become common in the literature. The loop generally looks something like this: During the first step, researchers will invoke the BPSM to define or construct TMD as a “complex disease”—that is, one caused/constituted by a “complex interaction” of various biological and psychosocial factors. (The precise nature of the “complex interaction” is generally not specified). During the second step, the previous step is forgotten. The idea that TMD is a “complex disease” is now treated as though it were a fact of nature being revealed by ongoing applications of the BPSM. Sometimes, researchers will further claim that the “complex” nature of TMD validates a BPSM-based approach; they will then invoke the BPSM to affirm claims made about TMD previously, as well as to advance new claims (at which point one is back at the start of the loop). These sorts of arguments beg the question because the conclusions they present are, in one way or another, assumptions in disguise. Partly by deploying such arguments, researchers have reified TMD as an objectively-existing disease with its own causes and effects, in the absence of evidence to support such claims.

We can see a small but nonetheless significant example of the question-begging loop in a recent article by Ohrbach, a prominent TMD researcher. In that article, Ohrbach introduces TMD as a “complex index disease” and writes that “the biopsychosocial model–based [TMD diagnostic system]… was perhaps the first diagnostic system to formally recognize TMDs as a complex disease not limited to the masticatory system” (Ohrbach 2021 , 89). This account is problematic. As I explain in more detail in the Appendix and below, researchers have, if anything, invoked the BPSM to define TMD as a “complex disease” caused/constituted by diverse elements. In the above-quoted passage, however, Ohrbach implies that researchers instead independently discovered this “complex disease” and then merely acknowledged its existence with the TMD diagnostic system. Although it does not offer an explicit argument, the above-quoted statement subtly begs the question with respect to the status of TMD. What is presented as a conclusion or inference of sorts—namely, that TMD is a complex biopsychosocial disorder – is really the foundational assumption of TMD research (Dworkin and LeResche 1992 ; Ohrbach and Dworkin 2016 , 1095), mischaracterized as a discovery or inference. In other words, Ohrbach’s statement appears to present an assumption as a fact. Note its effect: The statement implies that “TMD” is a preexisting disease rather than a construct.

During the mid-2000’s the U.S. National Institutes of Health (NIH) funded a major TMD study known as “OPPERA.” The OPPERA study has been highly significant in the field of TMD research. It is referenced frequently in the literature, and has provided the data underlying many claims made about TMD and its causes. In several descriptions of the OPPERA project offered by field leaders, we find additional question-begging transformations of TMD.

Consider a highly-cited article on OPPERA written by several of the project’s key researchers (Slade et al. 2016 ).

In their article, Slade et al. explain how researchers went about the OPPERA study and describe some of its key findings. Since this information will help us understand the claims made about OPPERA, I will briefly summarize it in this paragraph and the next. According to Slade et al., the NIH “funding opportunity was effectively a rallying call to apply the full expanse of the biopsychosocial model (Engel 1977 ) to an epidemiologic study of painful TMD” (Slade et al. 2016 , 1085). As described by the authors, this meant researchers started from the “premise” that “TMD is a complex disorder resulting from an interplay of causes from multiple genetic and environmental domains” (Slade et al. 2016 , 1091). Consistent with this conception of the problem, the researchers involved in the OPPERA project opted to “mov[e] beyond prevailing biomechanical explanations of TMD” and proceeded by analyzing various types of patient and environmental data for “putative [TMD] risk factors” and “vulnerability alleles” (Slade et al. 2016 , 1085).

Importantly, as Slade et al. note, the OPPERA study used a new definition of TMD. Researchers defined “TMD” as jaw-related pain occurring more than four days per month (Bair et al. 2013 ). After evaluating hundreds of potential correlates and antecedents of such jaw pain, researchers identified a number of statistically significant associations. They found, for example, that jaw pain onset was associated with various other nonspecific symptoms (especially those listed on the somatization subscale of the widely-used SCL-90R), several indicators of general physical and psychosocial well-being, and also several genetic markers (Bair et al. 2013 ; Slade et al. 2016 ). These associations varied in strength. Another finding was that stress was associated with jaw pain onset in patients with a particular genetic marker, but not others (Slade et al. 2016 ).

Now consider how Slade et al. describe the significance of the OPPERA findings: “The decade of research discoveries summarized above endorses the premise [of the OPPERA study] namely, that TMD is a complex disorder resulting from an interplay of causes from multiple genetic and environmental domains” (Slade et al. 2016 , 1091). They also refer to the factors identified in the OPPERA project as elements of the “complex etiology” of TMD. These claims seem unwarranted. Strictly speaking, the OPPERA results show only that some patients with jaw pain are more likely than controls to have certain genetic variants and to experience various nonspecific pains and psychosocial symptoms before jaw pain onset. These are certainly interesting findings worth exploring further. However, they do not clearly establish that patients have a particular “complex disorder” existing over and above their jaw pain, or that the aforementioned factors are etiological elements of this disorder . 13 One reaches this conclusion only by assuming the factors identified in the OPPERA study are indeed causal/constitutive elements of a disorder called “TMD.” But this essentially involves reading the conclusion into the data.

Slade et al.’s arguments thus appear to beg the question. The evidence they adduce to “endorse the premise” of the OPPERA study—i.e., that TMD is a complex disorder with a particular etiology—appears to have been produced by superimposing that premise on the empirical data , in the context of “apply[ing] the full expanse of the biopsychosocial model” to jaw pain. 14 Again, note the effect of the question-begging arguments: They imply “TMD” is a confirmed disease with a known etiology.

In a highly-cited review article, Ohrbach and Dworkin ( 2016 ) also appear to place the OPPERA findings in a loop of question-begging argumentation. For example, they write:

Findings from OPPERA and other published studies have supported identification of TMDs as a complex disorder within a biopsychosocial illness model, confirming that for almost all cases, TMDs are not a condition localized to pathology in orofacial structures. (Ohrbach and Dworkin 2016 , 1097)

Here we can see at least three question-begging arguments. First, the authors claim that the BPSM was used to “identify” TMD as a “complex disorder,” when the BPSM was actually used to define it as such. The authors’ claim portrays an assumption as a demonstrated fact. Second, the authors claim that the OPPERA findings support the proposition that TMD is a “complex disorder.” However, as discussed, this argument only works if we read the proposition into the empirical findings. The argument thus masks a hidden question-begging maneuver. Third, the authors argue that the apparent resonance between the OPPERA findings and the biopsychosocial approach to jaw pain “confirm[s]” that TMDs have a non-local etiology. However, this claim also begs the question in that the evidence supports the conclusion only if the conclusion is read into the evidence. 15 As shown in the Appendix, Ohrbach and Dworkin ( 2016 ) extend this loop of question-begging argumentation further in their article, and the loop appears in other TMD articles as well.

In sum, we can see the question-begging variety of wayward BPSM discourse—and its power—at work in the TMD literature. While “applying the biopsychosocial model” to jaw symptoms, researchers have used question-begging maneuvers to define TMD as a “complex disease” caused by a vast web of biological and psychosocial factors, and then represented this construction as a fact revealed through empirical research. This reification of TMD helps explain why it seems plausible to say that “TMD,” despite never having been properly validated, is a disease that causes the symptoms by which it is actually defined.

For a non-TMD-related example of question-begging argumentation, see the discussion of chronic pain in the Appendix.

Irritable bowel syndrome

As the BPSM’s status has grown, researchers have increasingly begun to define diseases by appealing directly to its authority. The appeal-to-authority maneuver in wayward BPSM discourse sometimes look like this: According to the BPSM, disease “involves” a “complex interaction” of biological, psychological, and social forces; some problem involves just such a “complex interaction”; therefore, that problem is a disease. Typically, however, no explicit argument will be offered. Instead, the author(s) will take the BPSM as authoritative and then assert that some state of ill health is a disease caused by factors X,Y, and Z, using idiomatic terms like “complex interaction,” “complex disease,” and “biopsychosocial disease” as literary tropes—as though a phrase such as “complex interaction” itself were sufficient for establishing causality.

For an example of the appeal-to-authority argument, consider an article on irritable bowel syndrome (IBS) by Camilleri and Choi ( 1997 ). As the authors note, IBS is a diagnosis of exclusion. To be diagnosed with IBS, a patient must report bowel troubles and also show no signs of “organic disease” (Camilleri and Choi 1997 , 3, 8, 9, 11). Yet Camilleri and Choi classify IBS itself as “a disease.” In fact, they call it “the most common disease diagnosed by gastroenterologists” and say that “it” “affects about 20% of all people at any one time” and “has a large economic impact” (Camilleri and Choi 1997 , 3).

Here we have the same problem seen with TMD. Since IBS is a construct defined entirely by patients’ symptoms, how can the authors claim it is a disease that causes/explains patients’ symptoms? Further, since IBS diagnosis requires ruling out “organic disease,” what type of “disease” is IBS? The closest Camilleri and Choi appear to come to an explanation is as follows: IBS is “a biopsychosocial disorder in which three major mechanisms interact: psychosocial factors; altered motility; and/or sensory function of the intestine” (1997, 3, 6). (Altered motility and sensory functions are the symptoms used to define IBS, while “psychosocial factors” refers to higher levels of somatization, paranoia, and other psychiatric maladies among patients (Camilleri and Choi 1997 , 7)). Camilleri and Choi thus appear to arrive at the “disease” classification by describing patients’ signs and symptoms as parts of a causal “interaction” (the nature of which is not defined precisely), then treating that interaction as constitutive of a “biopsychosocial disorder,” and then treating biopsychosocial disorder as constitutive of “disease.” The authors thus appear to use the terms “interaction” and “biopsychosocial disorder” as tropes by which to frame patients’ symptoms and illness correlates as “a disease.”

A virtually identical argument about IBS is offered in an article by Sandhu and Paul ( 2014 ). After acknowledging that IBS is a diagnosis of exclusion that entails “no serious underlying disease,” the authors nonetheless call IBS “a disorder” and state that it is “the commonest cause of recurrent abdominal pain[…] in children” (Sandhu and Paul 2014 , 613). To construct IBS as a disease with causal power, the authors assert that “IBS can be considered to be a brain-gut disorder possibly due to complex interaction between environmental and hereditary factors” (Sandhu and Paul 2014 , 6013). While acknowledging that the etiology of IBS remains in question, the authors name infection, inflammation, genetic factors, allergy, and the symptoms of IBS itself as being among “the complex interplay of biopsychosocial factors considered to be involved in the development of IBS in children” (Sandhu and Paul 2014 , 6014, 6017). Thus, again, BPSM terminology and the “complex interaction” trope are used to recast the IBS construct as something like a disease with known causes and effects. For another article making similar arguments about IBS, see: Mach ( 2004 ).

These examples (along with those discussed in previous subsections) illustrate that there is typically no specific standard that must be met for a factor to be deemed part of the “complex interaction” that causes/constitutes a “biopsychosocial disease.” The specification of the “complex interaction” is often ultimately a discretionary move in which patient characteristics of uncertain significance are assigned etiological roles via the use of causal language. Such moves are, no doubt, enabled by the BPSM’s lack of scientific content, which makes it a poor tool for vetting knowledge claims.

The appeal-to-authority argument is very common in wayward discourse. It is often intermingled with the question-begging arguments found in the TMD literature. For example, the articles discussed in the previous section each in some way referenced the BPSM’s authority in constructing TMD as a “complex disease” (Ohrbach 2021 ; Ohrbach and Dworkin 2016 ; Slade et al. 2016 ). Examples of the appeal-to-authority argument can also be seen throughout this article’s Appendix, including in the discussions of alcoholism, chronic fatigue syndrome, chronic pain, and the numerous ailments listed in the “Other Illnesses” section. The discussion of “gun violence disease” offered in the next section also constitutes a notable use of the appeal-to-authority maneuver.

The deleterious effects of wayward BPSM discourse

As demonstrated in the previous section and Appendix, wayward BPSM discourse creates a space in which ambiguous illness phenomena (i.e., poorly-understood behaviors, symptoms, and experiences) can be transformed into putative “diseases.” 16 It also allows this transformation to occur in a relatively unconstrained way. Because wayward discourse is not governed by clear epistemic or theoretical principles, it imposes few restrictions concerning which factors can be regarded as constitutive or causative of a particular disease.

This section argues that the rise of wayward BPSM discourse has had significant negative consequences for medicine and society. In particular, wayward discourse has created certain disease construct dysfunctions that may have helped undermine certain lines of medical research. It has also created a potentially potent vector of medicalization in society.

Research construct dysfunction

When confronted with poorly-understood illnesses, it is common for medical experts to create special research constructs that define those illnesses for research purposes. Such constructs can help seed the knowledge creation process. To play this role properly, though, research constructs must be viewed as tentative and carefully updated in light of subsequent research findings. Updating is crucial, because the ultimate goal is validation : Reaching a point where the constructs correspond to distinct causal structures (i.e., diseases) that can be studied and targeted with effective treatments. This process of matching construct to disease can be seen, for example, in the history of the AIDS epidemic. In this subsection, I argue that wayward discourse can undermine the construct updating process in two ways.

First, it can make research constructs difficult to revise . Consider, for example, the cases of TMD and CFS (discussed in the Online Appendix). “TMD” are “CFS” are research constructs. They are essentially labels that identify pools of unexplained symptoms for further study. After these constructs were originally developed, researchers were (as just discussed) supposed to revise them in light of incoming empirical findings in an attempt to validate them, or, alternatively, abandon the constructs if validation failed (Dworkin and LeResche 1992 ; Fukuda et al. 1994 ; Holmes et al. 1988 ). That is not what has happened, however. Although redefinitions of CFS and TMD have been proposed, both constructs have for decades remained relatively unchanged, in the face of little evidence for their validity (Institute of Medicine 2015 ; Ohrbach 2021 ; Ohrbach and Dworkin 2016 ; Schiffman et al. 2014 ).

Almost certainly, wayward BPSM discourse has contributed to this inertia. As we have seen, in wayward discourse, the “CFS,” “IBS,” and “TMD” labels have been equated with diseases and advanced as the causes patients’ symptoms. This framing inherently discourages construct revision. After all, calling IBS or TMD “a disease” implies that the construct has been validated already. This can only reduce the apparent need to revise that construct. In fact, revision may become relatively difficult: Constructs may be revisable, but who can revise a disease ? Thus it seems reasonable to suppose that the reification of illness constructs seen in the wayward BPSM literature has helped ossify these constructs at least to some degree.

Second, and the preceding points notwithstanding, wayward discourse can also yield unstable illness constructs that place research on a fundamentally chaotic path, especially over the longer term. To illustrate this point, let us return to the example of TMD. As noted above and in the Appendix, people meeting the diagnostic criteria for TMD manifest quite varied symptoms and problems (high patient heterogeneity) and also often qualify for other diagnoses (high comorbidity). Because such observations tend to make it less likely that a construct corresponds to a distinct disease, they are normally interpreted as a mark against validity and a sign that a construct may need to be revised. Yet Ohrbach and Dworkin ( 2016 ) seem unsure of what to make of comorbidity and heterogeneity in the case of TMD. At times they appear to argue that the diverse problems manifested by patients (“abundant variables,” “appreciable variability”) mean that the TMD construct 17 is good . These findings are said to show that the TMD construct is “accurate” and “a sufficient marker for underlying complexity”—i.e., the “complexity” ascribed to TMD as a “complex disease.” Elsewhere, however, the authors appear to adopt the more typical position on heterogeneity and comorbidity. They suggest that the variability observed among patients means that the TMD construct should be modified in some way (perhaps decomposed into more homogenous sub-diagnoses) to allow for more “refined assessment” of patient subgroups (Ohrbach and Dworkin 2016 , 1096–97). So, should researchers aggregate disparate presentations to capture the fundamental “complexity” of TMD or disaggregate them to produce groupings that are more scientifically and clinically meaningful (i.e., valid in the normal sense of the term)? The authors appear to take both positions.

This sort of uncertainty is characteristic of the TMD literature in general. Some researchers recommend “lumping” different mandible symptoms into aggregative TMD constructs, or even merging TMD with comorbid disorders; others favor “splitting” TMD into separate constructs; and, even within each position, the various proposals differ significantly in terms of their recommendations and rationales (Ohrbach 2021 ; Ohrbach and Dworkin 2016 ; Schiffman et al. 2014 ; Slade et al. 2016 ). Here we see how wayward discourse can produce constructs that set research on an unstable path. Because it is unclear what constitutes a “biopsychosocial disease” or the “complex disease” of TMD in the first place, it is not clear what observed heterogeneity and comorbidity mean for the TMD construct. Their meaning is, as Ohrbach ( 2021 , 90) puts it, “within the eyes of the beholder” in TMD research. But if key empirical observations have no clear theoretical significance because one’s framework and core concepts are vague, then the viability of one’s research program is open to question.

The instability of the TMD construct is actually significantly greater than preceding discussion implies. As described in this article’s Appendix, the current TMD diagnostic system includes two axes: Axis I lists the jaw symptoms that define TMD, while Axis II lists various psychosocial problems that are thought to play some role patients’ illness states. According to Ohrbach and Dworkin, however, the existing TMD diagnostic system does not fully realize a biopsychosocial approach to mandible symptoms. The current Axis I, they argue, is just “a special case of the ‘bio’ in biopsychosocial” (Ohrbach and Dworkin 2016 , 1098). Thus they have proposed adding a third axis to the TMD diagnostic system, which would include “findings from such diverse biologic considerations as genetics, epigenetics, and neuroscience.” Exactly how the new axis would play a role in the definition and diagnosis of TMD is not fully clear. At one point, the authors suggest it would be used to collect information on the mechanisms of TMD as currently defined. At another, they suggest it would be used to redefine TMD from the ground up. And still other proposals are offered in the text (Ohrbach and Dworkin 2016 , 1098). To complicate matters further, Ohrbach, Dworkin, and other field leaders have also proposed adding a fourth Axis to the TMD diagnostic system. This effort apparently would involve trying to produce yet another set of TMD diagnostic categories through statistical analysis of large pools of “biopsychosocial and molecular” data (Schiffman et al. 2014 ).

It is difficult to see how these proposed initiatives could add up to a coherent research program since they would prioritize and organize information in quite different ways. The probability that they would turn out to be complementary or converge on the same endpoint seems extremely small. The TMD literature illustrates how wayward discourse can set research on a chaotic path. Wayward discourse has helped cement the idea that there exists a “complex disease” called TMD that can only be adequately studied from a BPSM perspective. And yet the vagueness of the “complex biopsychosocial disease” concept at the center of TMD research has apparently left researchers without a clear sense of what it is they are looking for, or how to find it. The new axis proposals appear to try to pursue all hypotheses on mandible symptoms at once. (Ghaemi ( 2010 ) has previously noted the BPSM’s tendency towards eclecticism and insufficiently systematized data collection).

This problem of construct instability is not limited to TMD. As discussed in the Appendix, Clauw et al. ( 2019 ) have proposed treating chronic pain as a “biopsychosocial disease.” Yet how is this disease to be defined given the BPSM’s lack of epistemic rules? Clauw et al. define chronic pain disease to include a diverse array of conditions—among them TMD, CFS, fibromyalgia, interstitial cystitis, endometriosis, migraine, low back pain, and rheumatoid arthritis—on the premise that these conditions share, or might share, some common mechanisms. But as Quintner and Cohen ( 2019 ) ask, does this mean that the etiologies of, say, endometriosis and rheumatoid arthritis are effectively the same? Should these maladies be lumped together for research and treatment purposes? Arguably not. And indeed Clauw et al. ( 2019 ) suggest that at least some conditions included in chronic pain disease should be kept distinct based on etiological and treatment differences. But this raises the question of what the value of the “chronic pain disease” super-category is. When should conditions be aggregated as opposed to disaggregated, and on what principle? Since there are many factors associated with pain conditions, which should define “chronic pain disease”? These questions are not adequately resolved in the text, and it is not clear how they ought to be answered given the vague nature of the BPSM and “biopsychosocial disease” concept.

The problems of construct ossification and instability—both of which are symptoms of wayward discourse’s absence of clear theoretical and epistemic principles—matter. When it comes to the sorts of poorly-understood symptoms discussed above, researchers rely heavily on illness constructs to constitute objects of study and direct inquiry (Roberts, forthcoming ). Thousands of studies have cited the TMD criteria, for example, and they are “the dominant if not required diagnostic system for NIH-funded research applications and most TMD peer-reviewed scientific publications” (Ohrbach and Dworkin 2016 , 1096; Skarmeta et al. 2019 ). The TMD construct is the organizing core of the field of TMD research. Thus when a construct like TMD (or IBS, CFS, chronic pain disease, etc.) becomes frozen through reification and/or linked to an illness concept such as “biopsychosocial disease” that does not readily support systematic inquiry, it can easily undermine scientific research into patients’ symptoms . These wayward discourse-related problems could help explain the relative lack of progress in explaining and treating the symptoms associated with TMD, IBS, and CFS.

The medicalizing power of wayward discourse

Wayward BPSM discourse is also a potent and potentially dangerous vehicle of medicalization. In particular, it has the capacity to [1] prematurely represent ambiguous states of suffering as organic problems falling under medicine’s purview, and [2] expand the domain of “disease” in ways that unjustifiably increase the power of medicine and the state.

As a lead in to point [1], consider the following statement from Frederick Wolfe, a leading rheumatologist who helped define the “fibromyalgia” construct: “Perhaps [selecting] tender points, as the essential criterion [for defining ‘fibromyalgia’], was a mistake. By ignoring the central psychosocial and distress features of the syndrome and choosing instead a physical examination item, we allowed FM to be seen as mostly a physical illness. More than that, we removed all traces of the most central features of the illness” (Wolfe 2003 , 1671). Wolfe’s statement illustrates a broader point: By choosing which information to foreground and which to deemphasize when creating an illness construct, one can represent the underlying problem in potentially arbitrary and misleading ways.

Wayward BPSM discourse’s lack of clear epistemic standards makes it prone to this problem. Let us briefly return to the case of TMD. It is well known that TMD patients often exhibit many other nonspecific bodily symptoms and high levels of psychosocial distress (Bair et al. 2013 ; Li and Leung 2021 ; Slade et al. 2016 ). On the basis of these sorts of observations, some have argued that mandible pain might, in cases, be a primarily psychogenic illness or an aspect of somatization or some other psychological disturbance (Dimitroulis 1998 ; Kumar and Brennan 2013 ). However, the TMD diagnostic system in some ways discourages such interpretations. It isolates patients’ mandible symptoms and makes them the defining diagnostic features of the disorder “TMD,” while relegating various somatization and psychosocial symptoms reported by patients to a secondary axis meant for supplemental information gathering (Dworkin and LeResche 1992 , 303, 330). By partitioning patients’ symptoms in this way, the TMD construct makes it easier to portray patients as suffering from a distinctive disorder centering on the jaw that causes or coexists with psychological troubles, rather than a primarily psychological problem of which their jaw pain is a symptom. And indeed, we see this line of interpretation being pursued quite often in the TMD literature (see, e.g.: Dworkin and LeResche 1992 , 303–4, 330, 332; Kumar and Brennan 2013 , 426–7; Li and Leung 2021 , 6–7). The point here is not that any one position on jaw pain is right or wrong. The etiology of much TMD jaw pain has yet to be explained definitively. The point is that wayward discourse allows information to be partitioned and prioritized in ways that are at least potentially arbitrary and capable of misleading us about the nature of patients’ suffering.

Although wayward discourse could be used to psychologize what are really best understood as organic diseases (Weiner 2008 ), medicalization appears to be the greater threat. The texts discussed throughout this article often acknowledge that “biopsychosocial diseases” can involve major psychological, moral, or attitudinal elements; that their physical aspects may be unknown, trivial, or secondary to other problems; and that they may best be treated with nonmedical or multidisciplinary approaches (Camilleri and Choi 1997 ; Gatchel et al. 2014 ; Maltzman 1994 ; Sandhu and Paul 2014 ; Wallace 1990 ). Notably, however, such acknowledgments rarely seem to lead to the conclusion that the ailments in question are not medical diseases, or that they should be relinquished to other epistemic communities for primary study and treatment. Instead, from Engel on, discussions of the “complex” nature of human suffering have shown a remarkable tendency to collapse back into the language of “medical disease.” This framing has important consequences. It tends to perpetuate a focus on biological factors (see, especially the discussion of alcoholism in the Appendix) and edge out existential, spiritual, philosophical, depth psychological, and other nonmedical approaches to suffering (Ghaemi 2011 ).

This suggests we ought to be skeptical of claims that the BPSM is a humanizing or de -medicalizing force (see, e.g., Engel ( 1977 ) and Gatchel and Turk ( 2008 )). Yes—it does seek to incorporate non-biological factors into accounts of suffering. This, in principle, seems like a welcome development. However, as argued in this article, BPSM-based discourse has also produced an operative concept of disease so vague that potentially any instance of human suffering can be counted a “medical disease.”

Giving patients labels that selectively emphasize certain aspects of their suffering and imply diseasehood without due justification is problematic. In addition to having the potential to undermine research in the ways discussed above, it creates ethical problems. Patients have a right to know the true state of medical knowledge on their ailments. If one’s malady consists of poorly-understood symptoms, sensations, and behaviors, then one should be told that, and not that one has a “complex biopsychosocial disease.” Although some patients may want to be told they have a disease, this is no basis for offering such a diagnosis, especially since proffering disease labels can actually increase stigma and worsen patient prognosis (Hadler 1997 ; Speerforck et al. 2014 ).

There is another significant problem associated with the medicalizing power of wayward discourse. The word “disease” has powerful social ordering effects. It implies that the problem at hand is one that can only or best be understood by medical experts, and, therefore, that those experts ought to be granted authority over the problem. This authority can extend into the legal, political, and social domains. When, for example, a disease is declared a public health concern, health experts and agencies may be granted expanded powers to regulate commercial activities, constrain the movement of individuals, and shape the policies of public and private organizations in profound ways. This brings us to point [2] mentioned at this section’s outset. By loosening the criteria for declaring problems “diseases,” wayward discourse can be used to expand the reach and power of medicine and the state in ways that are not necessarily justified.

We can see a relatively transparent attempt to harness this power of wayward discourse in the violence-as-a-disease literature. In recent years, a group of health researchers have been invoking the BPSM to argue that gun violence is “a complex biopsychosocial disease” encompassing a vast amount of human activity, which health professionals should regulate as a form of “disease control and prevention” (Barron et al. 2021 , 1–3; Grossman and Choucair 2019 ; Hargarten et al. 2018 , 1024; Kohlbeck and Nelson 2020 , 4–5).

For example, several researchers have argued that “fram[ing] gun violence as a biopsychosocial disease” allows us to assert that “the vector of disease [is] the gun itself, as it ‘transmits’ the agent to the host” (Kohlbeck and Nelson 2020 , 3). For Hargarten et al. ( 2018 , 1025), this makes “the gun… a necessary focus of intervention.” Health professionals, they argue, should be involved in “specific examination of the gun and its design/safety characteristics” and also given de jure or de facto regulatory powers of some kind (Hargarten et al. 2018 , 1025–26). Options to be pursued include lowering magazine capacity, “banning” bump stocks, and “requiring background checks on all gun sales.”

The biopsychosocial disease of gun violence is said to include far more than just the firearm, however. Other “aspects of the disease” include, literally, “high-risk youth; adults and elderly; […] and the environment.” Culture and attitudes can play roles in “’spreading’ the risk of the disease” as well. Therefore, it is claimed, these factors must also be “treated from [a] biopsychosocial perspective” (Hargarten et al. 2018 , 1025–26).

Consistent with this view, researchers have begun recommending that physicians scan patients’ genetic profiles, medical histories, psychological attributes, behaviors, and cultural and familial backgrounds in an attempt to gauge their propensity to commit violence; patients who “screen positive” can be given “appropriate behavioral interventions” to prevent violence before it occurs (Barron et al. 2021 ; Grossman and Choucair 2019 , 1641). When a patient is hospitalized for a violent injury and the “perpetrator” is present, the latter can be given behavioral modification therapy to help them avoid “recidivism,” thereby helping to “prevent and control” gun violence disease (Grossman and Choucair 2019 , 1641; Hargarten et al. 2018 , 1025–26) (note the blending of public health and criminal justice discourse). Other options for disease control include controlling firearm access for “at-risk” individuals, sharing hospital data with law enforcement, and creating behavior modification interventions that prevent violence by “addressing biopsychosocial aspects of students’ lives” (Barron et al. 2021 , 4; Grossman and Choucair 2019 , 1641–43; Kohlbeck and Nelson 2020 , 4).

Kohlbeck and Nelson carry these lines of argument further. Invoking the BPSM and writings of Paolo Freire, they argue that gun violence disease can be attributed to an underlying “disease of oppression” embedded in “our violent society.” “Public health,” they write, “has a role to address the disease of oppression” (Kohlbeck and Nelson 2020 , 3). Instead of merely providing public education, health professionals should engage directly in the “dismantling of violent structures of power” and in fostering “liberation” (Kohlbeck and Nelson 2020 , 4–5). This effort would entail helping to redistribute resources in society to eradicate the perceived root causes of violence and steering public discourse on violence to align with the authors’ own views (Kohlbeck and Nelson 2020 , 4–5). Thus, Kohlbeck and Nelson would have health professionals working to restructure society and manipulate the parameters of public debate as forms of disease control and prevention.

It is worth noting that the wayward BPSM discourse on gun violence is almost transparently political rather than scientific. The literature in this area does not provide a meaningful definition of “biopsychosocial disease” and then demonstrate that gun violence qualifies. Instead, it uses that construct in an explicitly opportunistic way. The articles on the topic consistently argue that gun violence “ can ” and “ should ” be “ framed as a biopsychosocial disease” to expand medical jurisdiction over the problem (Barron et al. 2021 , 1; Grossman and Choucair 2019 , 1640; Hargarten et al. 2018 , 1024–26; Kohlbeck and Nelson 2020 ). “Without this framing,” Hargarten et al. warn, “we limit progress… [and] will be limited to education of our patients” (2018, 1025). Despite its almost conspicuously contrived nature, “gun violence disease” is treated as though it were a disease like any other. Medical and health professionals are said to have a right and a responsibility to “prevent and manage gun violence, just as they… prevent and treat other diseases,” like HIV infection and tuberculosis (Barron et al. 2021 , 2; Hargarten et al. 2018 ). (These arguments, it is important to note, also rely on the appeal-to-authority maneuver described above).

The “gun violence disease” literature is concerning for several reasons. One problem is that physicians do not possess the epistemic competence needed to treat gun violence disease as it is defined. 18 Their training does not qualify them to redesign society’s power structures or to accurately identify and treat personal or cultural propensities for violence. Another problem is that the etiological factors of the “biopsychosocial disease” of violence include people’s attitudes, values, customs, thoughts, and volitions. Although people are not entitled to commit violence, they are entitled to a level freedom in thought and action that may result in violence. Efforts to prevent violence must therefore be balanced against the need to respect people’s civil liberties and autonomy. What the appropriate balance in this regard is and how it shall be achieved are political questions that deserve public debate. In wayward BPSM discourse, however, people’s beliefs, etc., are treated as disease “risk factors” to be altered by medical and public health actors (Barron et al. 2021 ; Hargarten et al. 2018 ). Thus we find physicians taking up and exercising criminal justice functions (e.g., identifying “perpetrators” and giving them counseling to “prevent recidivism,” sharing data with law enforcement, potentially controlling access to firearms) and harnessing the regulative powers of schools and the state (school-based behavior modification programs, firearm regulation) under the banner of “disease control.” The fusing of medical authority and state power seen in BPSM violence interventions is troubling. Along with “national security,” “public health” is one of the few imperatives that readily justifies state abrogation of individual rights. Thus, the production of a new and expansive public health problem in the “gun violence disease” discourse has the potential to significantly increase the power of the state, and not just that of the medical field per se.

It is important to note that the wayward BPSM argument on gun violence has been set forth in the leading health policy journal Health Affairs (Grossman and Choucair 2019 ). It also received considerable attention at at least one conference put on by prestigious health institutions (National Academies of Science 2019 ) and is echoed in the “Social-Ecological Model” of violence used by the U.S. Centers for Disease Control and Prevention (Centers for Disease Control and Prevention 2022 ). These points suggests that “gun violence disease” is not necessarily a fringe argument, and that its potential to shape medical and political practices should be taken seriously.

The medicalizing dimension of wayward BPSM discourse discussed in this subsection can be seen as a culmination of changes initiated by Engel himself. From one point of view, biomedicine’s physical reductionism has certain virtues. It places limits on what can rightfully be called “a disease”; this, in turn, places boundaries on the domain of medicine. Engel explicitly rejected this approach to defining disease and medicine. He wanted medicine to have a vastly expanded role in managing human suffering (Engel 1977 , 133). He believed the definition of disease should be modified to fit that role. It should be broad and flexible enough to facilitate and justify the treatment of conditions assigned to medicine through political, cultural, and social processes (see especially Engel ( 1977 , 129–30, 132)). Thus we have Engel’s very expansive concept of disease, the constitutive elements of which include such broad categories as “social behavior,” “alterations… in feelings,” and “behavioral aberrations” (Engel 1977 , 130). This definition would allow physicians to bring many problems into medicine’s ambit as “medical diseases.”

Constructing a “gun violence disease” to promote medical intervention into society is therefore quite consistent with Engel’s vision. Yet it is also concerning. For here we see a concept of “disease” that, instead of constraining scientific and political forms of authority, becomes a mechanism for their amplification.

In sum, the BPSM can serve as a useful tool for highlighting psychosocial factors important to health outcomes. It is not, however, a valid, authoritative, or superior explanatory model of disease. Treating it as such has created an epistemic void that has produced the wayward form of BPSM discourse described here. Participants in wayward discourse typically suggest they are presenting insights about disease gleaned through applications of the BPSM. Upon closer inspection, however, we find that key claims advanced often rest on flawed arguments and rhetorical maneuvers.

This article has detailed how wayward BPSM discourse has served as a wellspring of questionable claims in medicine. Its participants have argued that various poorly-understood states of suffering and undesirable behaviors are “diseases.” These “diseases” are often asserted to be caused by various factors that have no proven etiological significance. In some cases, the “diseases” are said to be caused by hypothetical factors (as in the case of schizophrenia), or to cause themselves (e.g., IBS, TMD). I have also shown that several disease constructs created and reinforced via wayward discourse may have mispresented the nature of patients’ suffering and set scientific research on epistemically unstable paths. Furthermore, wayward discourse has created a potentially potent and dangerous vector of medicalization in society.

In highlighting these problems, this study provides further evidence that the sorts of fallacious arguments in medicine noted by Binney ( 2019 ) are relatively widespread, consequential, and in need of remediation.

Fixing the problems associated with wayward discourse will likely require reimposing conceptual rigor on BPSM discourse where it has been lost. It is reasonable enough to “take a biopsychosocial perspective” on some illness, or to use the BPSM as a tool for presenting existing research findings. However, the limitations of the BPSM should be kept at the forefront of the discussion. It should be remembered that the standard BPSM, as it stands, offers no tools for generating valid claims about diseases and their causes. It should also be appreciated that there are no such things as “biopsychosocial diseases” or “complex diseases” in the sense implied in wayward discourse. Disease states can indeed involve “complex interactions” of factors. But “complex interactions” of factors per se do not constitute disease, and the “complex interaction” trope ought not be used to construct new diseases. Given that such guidelines for the correct use of the BPSM are at least to some extent acknowledged in the literature already, enforcing them should be possible. Doing so would, however, likely mean some significant scaling back of the claims currently being made within wayward BPSM discourse.

Below is the link to the electronic supplementary material.

Acknowledgements

I am grateful to Louisa Roberts for her helpful comments on drafts of this article.

Declarations

The author has no competing interests to declare.

1 And a disease would refer to a subset of this phenomenon defined by some characteristic abnormality, agent, or pathophysiological process or mechanism (Roberts, forthcoming ; Weiner 2008 ).

2 Nor, as will be discussed further below, does the BPSM provide us with a workable alternative (i.e., non-biomedical) definition of disease.

3 For another point of view, see Ghaemi ( 2011 , 2012), who argues that the BPSM has been less effective as pedagogical tool than is commonly appreciated.

4 Italics added to quotations for emphasis throughout this article.

5 Bolton and Gillet ( 2019 , 4, 14) describe the significance of the psychosocial findings on disease correctly: They indicate that “we need” a BPSM, not that we have a valid one already.

6 To be sure, researchers also present legitimate scientific arguments validated through other means under the heading of “applying the BPSM.” These uses of the BPSM are simply not the focus of this article.

7 Engel calls schizophrenia a “mental disease,” but tacitly acknowledges it does not meet the criteria for disease (i.e., “somatic disease”) used in medicine.

8 Had Engel stayed on the terrain of disease as commonly understood, he would not have been able to define schizophrenia as a medical disease (because it lacks a known defining biological abnormality). Likewise, had Engel stayed on the subject of illness, he would only have been able to establish that diabetes and schizophrenia are alike as human experiences, and not that the latter is a medical disease.

9 Referencing the work of Kety, Engel argues that both schizophrenia and diabetes belong under “the medical model” because “both are symptom clusters or syndromes,” and share certain broad similarities qua syndromes (Engel 1977 , 131).

10 Engel also appears to argue that a person’s not knowing why they are suffering or what to do about it is a necessary condition for classifying that suffering a disease (Engel 1977 , 133). This seems clearly wrong. For example, if I get food poisoning or catch a cold, then I may be convinced I know why I am suffering and what to do about it. Yet this does mean that E. coli and rhinovirus infections are not diseases.

11 To be sure, diseases can involve or produce syndromes. However, this is not what Engel argues. He argues that “diseases” are “syndrome[s]” (Engel 1977 , 131, 133). This argument seems clearly wrong. Disease labels are generally supposed to refer (explicitly or implicitly) to causes rather than symptoms or syndromes. Thus physicians say that one patient has rotavirus, another norovirus, another cholera, etc., and not that all have diarrhea-vomiting disease. Moreover, the same disease can sometimes produce quite variable patterns of symptoms. Physicians do not regard every distinctive manifestation of, say, tuberculosis or COVID 19 as a separate disease that gets its own label.

12 The context makes it clear that, by “may,” Engel means “can” or “do in fact sometimes”; he is not stating a mere possibility here, in other words.

13 To justify the claims made by Slade et al. in the quoted passage, the OPPERA project would have had to identify a genuine disease or disorder in participants (e.g., a common, characteristic abnormality or pathological process) and then show that the illness correlates identified in the study actually play a meaningful causal role in that disease. Nothing in the relevant literature indicates this occurred (Bair et al. 2013 ; Slade et al. 2016 ).

14 Slade et al.’s arguments may also indicate that the vagueness of the BPSM and “complex disorder” idea effectively grant researchers wide discretion in deciding what observations would be validating of a construct like TMD. I address this aspect of wayward discourse further in the next subsection.

15 See Appendix for additional details on this point.

16 In some cases (e.g., TMD, chronic pain, and violence, discussed below), wayward discourse has played a leading role in the reification of illness constructs as diseases. In other cases (e.g., CFS, IBS, fibromyalgia, and alcoholism), it has played a supporting role.

17 The authors are actually here discussing a simplified version of the TMD construct used in the OPPERA studies. This is not a crucial distinction for my purposes.

18 Barron, Hargarten, and Webb ( 2021 ) tacitly acknowledge this when they note that “gun violence disease” would not fit well into existing medical school curricula, and recommend working discussion of the “disease” into classes on medical ethics.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

• Bair E, et al. Multivariable modeling of phenotypic risk factors for first-onset TMD. Journal of Pain. 2013; 14 (12):T102–T115. doi: 10.1016/j.jpain.2013.09.003. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Barron A, Hargarten S, Webb T. Gun violence education in medical school: A call to action. Teaching and Learning in Medicine. 2021 doi: 10.1080/10401334.2021.1906254. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Berghmans R, de Jong J, Tibben A, de Wert G. On the biomedicalization of alcoholism. Theoretical Medicine and Bioethics. 2009; 30 (4):311–321. doi: 10.1007/s11017-009-9103-7. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Binney N. Meno’s paradox and medicine. Synthese. 2019; 196 (10):4253–4278. doi: 10.1007/s11229-017-1654-y. [ CrossRef ] [ Google Scholar ]
• Boisaubin EV, McCullough LB. Prescribing viagra in an ethically responsible fashion. Journal of Medicine and Philosophy. 2004; 29 (6):739–749. doi: 10.1080/03605310490883055. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Bolton, D., and G. Gillett. 2019. The Biopsychosocial Model of Health and Disease: New Philosophical and Scientific Developments . Palgrave MacMillan. https://www.ncbi.nlm.nih.gov/books/NBK552029/ . [ PubMed ]
• Boorse C. On the distinction between disease and illness. Philosophy and Public Affairs. 1975; 5 (1):49–68. [ Google Scholar ]
• Brendel DH. Reductionism, eclecticism, and pragmatism in psychiatry. Journal of Medicine and Philosophy. 2003; 28 (5–6):563–580. doi: 10.1076/jmep.28.5.563.18814. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Camilleri M, Choi MG. Review article: irritable bowel syndrome. Alimentary Pharmacology &amp; Therapeutics. 1997; 11 (1):3–15. doi: 10.1046/j.1365-2036.1997.84256000.x. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Centers for Disease Control and Prevention. 2022. The Social-Ecological Model: A Framework for Prevention [Online]. https://www.cdc.gov/violenceprevention/about/social-ecologicalmodel.html . Accessed 30 Oct 2022.
• Clauw DJ, Essex MN, Pitman V, Jones KD. Reframing chronic pain as a disease not a symptom. Postgraduate Medicine. 2019; 131 (3):185–198. doi: 10.1080/00325481.2019.1574403. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dimitroulis G. Temporomandibular disorders: A clinical update. British Medical Journal. 1998; 317 (7152):190–194. doi: 10.1136/bmj.317.7152.190. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders. Journal of Craniomandibular Disorders. 1992; 6 (4):301–355. [ PubMed ] [ Google Scholar ]
• Edwards RR, et al. The role of psychosocial processes in the development and maintenance of chronic pain disorders. The Journal of Pain. 2016; 17 (9 Suppl):T70–92. doi: 10.1016/j.jpain.2016.01.001. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Engel GL. The need for a new medical model: A challenge for biomedicine. Science. 1977; 196 (4286):129–136. doi: 10.1126/science.847460. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Evans AS. Causation and disease: The henle-koch postulates revisited. The Yale Journal of Biology and Medicine. 1976; 49 (2):175–195. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Fukuda K, et al. The chronic fatigue syndrome: A comprehensive approach to its definition and study. Annals of Internal Medicine. 1994; 121 (12):953–959. doi: 10.7326/0003-4819-121-12-199412150-00009. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gask L. In defence of the biopsychosocial model. The Lancet Psychiatry. 2018; 5 (7):548–549. doi: 10.1016/S2215-0366(18)30165-2. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gatchel RJ, Turk DC. Criticisms of the biopsychosocial model in spine care: creating and then attacking a straw person. Spine. 2008; 33 (25):2831–2836. doi: 10.1097/BRS.0b013e31817d24ad. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Gatchel RJ, McGeary DD, McGeary CA, Lippe B. Interdisciplinary chronic pain management. American Psychologist. 2014; 69 (2):119–130. doi: 10.1037/a0035514. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ghaemi SN. The rise and fall of the biopsychosocial model. The British Journal of Psychiatry. 2009; 195 (1):3–4. doi: 10.1192/bjp.bp.109.063859. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Ghaemi SN. The Rise and Fall of the Biopsychosocial Model. Baltimore: Johns Hopkins University Press; 2010. [ Google Scholar ]
• Ghaemi SN. The biopsychosocial model in psychiatry: A critique. Existenz. 2011; 6 (1):1–8. [ Google Scholar ]
• Grossman DC, Choucair B. Violence and the US health care sector: Burden and response. Health Affairs. 2019; 38 (10):1638–1645. doi: 10.1377/hlthaff.2019.00642. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hadler N. Fibromyalgia, chronic fatigue, and other iatrogenic diagnostic algorithms. Postgraduate Medicine. 1997; 102 (2):161–172. doi: 10.3810/pgm.1997.08.284. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Hargarten SW, et al. Gun violence: A biopsychosocial disease. Western Journal of Emergency Medicine. 2018; 19 (6):1024–1027. doi: 10.5811/westjem.2018.7.38021. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Herman J. The need for a transitional model: A challenge for biopsychosocial medicine? Families, Systems, & Health. 2005; 23 (4):372–376. doi: 10.1037/1091-7527.23.4.372. [ CrossRef ] [ Google Scholar ]
• Holmes GP, et al. Chronic fatigue syndrome: A working case definition. Annals of Internal Medicine. 1988; 108 (3):387–389. doi: 10.7326/0003-4819-108-3-387. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Institute of Medicine . Beyond Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: Redefining an Illness. Washington, DC: National Academies Press; 2015. [ PubMed ] [ Google Scholar ]
• Kelly MP, Kelly RS, Russo F. The integration of social, behavioral, and biological mechanisms in models of pathogenesis. Perspectives in Biology and Medicine. 2014; 57 (3):308–328. doi: 10.1353/pbm.2014.0026. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kingma E. Naturalism about health and disease: Adding nuance for progress. Journal of Medicine and Philosophy. 2014; 39 (6):590–608. doi: 10.1093/jmp/jhu037. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Kohlbeck S, Nelson D. Initiating a dialogue about gun violence: Shifting the focus. Violence and Gender. 2020; 7 (1):3–5. doi: 10.1089/vio.2019.0018. [ CrossRef ] [ Google Scholar ]
• Kumar A, Brennan M. Differential diagnosis of orofacial pain and temporomandibular disorder. Dental Clinics of North America. 2013; 57 (3):419–428. doi: 10.1016/j.cden.2013.04.003. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Li DTS, Leung YY. Temporomandibular disorders: Current concepts and controversies in diagnosis and management. Diagnostics. 2021; 11 (3):459. doi: 10.3390/diagnostics11030459. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Lindau ST, Laumann EO, Levinson W, Waite LJ. Synthesis of scientific disciplines in pursuit of health: The interactive biopsychosocial model. Perspectives in Biology and Medicine. 2003; 46 (3 ):S74–86. doi: 10.1353/pbm.2003.0055. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Mach T. The brain-gut axis in irritable bowel syndrome–clinical aspects. Medical Science Monitor. 2004; 10 (6):25–31. [ PubMed ] [ Google Scholar ]
• Maltzman I. Why alcoholism is a disease. Journal of Psychoactive Drugs. 1994; 26 (1):13–31. doi: 10.1080/02791072.1994.10472598. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McLaren N. A critical review of the biopsychosocial model. Australian and New Zealand Journal of Psychiatry. 1998; 32 (1):86–92. doi: 10.3109/00048679809062712. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McLaren N. The biopsychosocial model: Reality check. Australian and New Zealand Journal of Psychiatry. 2021; 55 (7):644–645. doi: 10.1177/0004867420981409. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• McWhinney IR, Freeman T. Textbook of Family Medicine. Oxford University Press; 2009. [ Google Scholar ]
• Murphy, D. 2020. Concepts of Disease and Health. Stanford Encyclopedia of Philosophy [Online]. https://plato.stanford.edu/entries/health-disease/ . Accessed 18 Aug 2020.
• National Academies of Science. 2019. Health Systems Interventions to Prevent Firearm Injuries and Death Proceedings of a Workshop. Washington, DC: National Academies Press. 10.17226/25354. [ PubMed ]
• Ohrbach R. The co-occurrence of diseases. Quintessence. 2021; 35 (2):89–91. [ Google Scholar ]
• Ohrbach R, Dworkin SF. The evolution of TMD diagnosis: past, present, future. Journal of Dental Research. 2016; 95 (10):1093–1101. doi: 10.1177/0022034516653922. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Quintner, J., and M. Cohen. 2019. Is Chronic Pain Really a Disease? [Online]. https://blog.apsoc.org.au/2019/05/27/is-chronic-pain-really-a-disease/ . Accessed 30 Oct 2022.
• Roberts, A. Forthcoming. The disease loophole: Index terms and their role in disease misclassification. The Journal of Medicine and Philosophy .
• Sandhu BK, Paul SP. Irritable bowel syndrome in children. World Journal of Gastroenterology. 2014; 20 (20):6013–6623. doi: 10.3748/wjg.v20.i20.6013. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Saraga M, Fuks A, Boudreau JD. George Engel’s epistemology of clinical practice. Perspectives in Biology and Medicine. 2014; 57 (4):482–494. doi: 10.1353/pbm.2014.0038. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schiffman E, et al. Diagnostic criteria for temporomandibular disorders (DC/TMD) for clinical and research applications. Journal of Oral &amp; Facial Pain and Headache. 2014; 28 (1):6–27. doi: 10.11607/jop.1151. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Schwartz PH. Defining dysfunction: Natural selection, design, and drawing a line. Philosophy of Science. 2007; 74 (3):364–385. doi: 10.1086/521970. [ CrossRef ] [ Google Scholar ]
• Skarmeta NP, et al. Changes in understanding of painful temporomandibular disorders. Quintessenz. 2019; 50 (8):662–669. [ PubMed ] [ Google Scholar ]
• Slade GD, et al. Painful temporomandibular disorder: Decade of discovery from OPPERA studies. Journal of Dental Research. 2016; 95 (10):1084–1092. doi: 10.1177/0022034516653743. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Solli HM, Da Silva AB. The holistic claims of the biopsychosocial conception of WHO’s international classification of functioning, disability, and health (ICF) Journal of Medicine and Philosophy. 2012; 37 (3):277–294. doi: 10.1093/jmp/jhs014. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Speerforck S, Schomerus G, Press S, Angermeyer MC. Different biogenetic causal explanations and attitudes towards persons with major depression, schizophrenia and alcohol dependence: Is the concept of a chemical imbalance beneficial? Journal of Affective Disorders. 2014; 168 :224–228. doi: 10.1016/j.jad.2014.06.013. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Spurgeon A. Models of unexplained symptoms associated with occupational and environmental exposures. Environmental Health Perspectives. 2002; 110 (4):601–605. doi: 10.1289/ehp.02110s4601. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Turk DC, Wilson H, Swanson KS. The biopsychosocial model of pain and pain management. In: Ebert MH, Kerns RD, editors. Behavioral and Psychopharmacologic Pain Management. Cambridge: Cambridge University Press; 2011. pp. 16–43. [ Google Scholar ]
• van Oudenhove L, Cuypers S. The relevance of the philosophical ‘mind–body problem’ for the status of psychosomatic medicine: A conceptual analysis of the biopsychosocial model. Medicine, Health Care and Philosophy. 2014; 17 (2):201–213. doi: 10.1007/s11019-013-9521-1. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Vogele C. Behavioral medicine. In: Wright J, editor. International Encyclopedia of the Social &amp; Behavioral Sciences. Netherlands: Elsevier; 2015. [ Google Scholar ]
• Waddell G. Simple low back pain: Rest or active exercise. Annals of the Rheumatic Diseases. 1993; 52 (5):317–319. doi: 10.1136/ard.52.5.317. [ PMC free article ] [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wade DT, Halligan PW. The biopsychosocial model of illness: A model whose time has come. Clinical Rehabilitation. 2017; 31 (8):995–1004. doi: 10.1177/0269215517709890. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wallace J. The new disease model of alcoholism. The Western Journal of Medicine. 1990; 152 (5):502–505. [ PMC free article ] [ PubMed ] [ Google Scholar ]
• Weiner BK. The biopsychosocial model and spine care. Spine. 2008; 33 (2):219–223. doi: 10.1097/BRS.0b013e3181604572. [ PubMed ] [ CrossRef ] [ Google Scholar ]
• Wolfe F. Stop using the American College of Rheumatology criteria in the clinic. The Journal of Rheumatology. 2003; 30 (8):1671–1672. [ PubMed ] [ Google Scholar ]