The construct of “chronic physical diseases” (CPDs) encompasses a number of heterogeneous
conditions that have persisting lifelong effects on the quality of life (QoL) and
subjective well-being (Sprangers et al., 2000). According to epidemiological studies,
CPDs are constantly increasing, not only in Western countries but also in developing/emerging
countries, with certain prevalent differences regarding CPD type (Vos et al., 2016),
raising questions on the multifactorial genesis of this phenomenon. The role of psychiatric
disorders is, for example, well-known as comorbid conditions able to affect the course
of CPD with a number of sequelae and complications (Daré et al., 2019).
The most common CPDs (namely, cardiovascular disease, diabetes mellitus, neoplastic
diseases, asthma, arthritis, and osteoporosis) are often complicated by psychiatric
symptoms or emotional/psychological subjective suffering (Martino G. et al., 2019;
Rosa et al., 2019), a datum that underlines the close correlation that exists between
such conditions. However, the relationships and the mutual influences between CPD
and psychopathological manifestations are far from established (Marchini et al., 2018;
Miniati et al., 2018; Martino G. et al., 2019).
Findings on psychological/psychopathological dimensions in patients with CPD, both
from a cross-sectional and from a lifetime perspective, are available in the literature,
with an emphasis on their impact on cognitive functioning, emotional processing, exposition
to stressful events (SLEs) and adversities, medical and psychological outcomes, and
combined interventions and therapies (Bernard et al., 2018; McGilton et al., 2018;
Shao et al., 2019). A number of studies have, for instance, already explored the impact
of signs and symptoms belonging to the realm of psychopathological disorders on the
most common CPDs, with a measure of the subjective perception of well-being and QoL
(Megari, 2013). More specifically, alexithymia, anxiety, depression, psychological
distress, sleep quality, and emotional dysregulations have been systematically assessed
in patients with fibromyalgia, Type 2 diabetes, psoriasis, and osteoporosis (Palagini
et al., 2016; Catalano et al., 2018; Martino et al., 2018a,b; Cristina et al., 2019;
Kelly et al., 2019; Marchi et al., 2019; Martino M. L. et al., 2019; Settineri et
al., 2019a,b). This datum represents the increasing tendency of the scientific community
to take an interest in the aforementioned connection between the psychological and
physical spheres, hypothesizing a positive correlation between the two, where a higher
psychological and QoL malaise correspond to the increasing severity of the pathology.
In nearly all of the abovementioned conditions, cognitive functioning and performances
were impaired, as enhanced by studies with cognitive tasks, again raising questions
as to the different weight and role of metabolic dysregulations vs. comorbid anxiety
or depressive disorders in determining the severity of cognitive dysfunctions (Guicciardi
et al., 2019). For example, emotional processing and depression has been found to
enhance “pain catastrophization,” which could be described as the cognitive attitude
of interpreting the experience of pain in an excessively negative manner, during upper
endoscopy in young, especially female, patients, when exposed for the first time to
diagnostic procedures and pain therapies (Sullivan et al., 2001; Lauriola et al.,
2019). A number of studies also highlight the reciprocal influences between psychological
and medical conditions in affecting cognitive performances and emotional reactions
among children and young adults, with relevant sequelae in adulthood and in the elderly,
while other studies have opened up debate on the interaction of age, gender, and medical
conditions on mental status (see the association between early childhood SLEs, depression,
cognitive functioning, and lipids' metabolism alterations; Stewart et al., 2000; Péterfalvi
et al., 2019). Other studies demonstrate how an early diagnosis of a neuropsychiatric
condition (such as ADHD) may change the electrophysiological characteristics and the
overall subjective neuropsychological profile during adulthood (Angela et al., 2018;
Klein et al., 2019), as possibly determined by the occurrence of manic symptoms and
PTSD in young adults (Dell'Osso et al., 2014) or the emotional suppression or oneiric
perturbation in subjects affected by psychosomatic illnesses (Settineri et al., 2019a,b).
Overall, these studies demonstrate the importance of a multidisciplinary approach
in treating patients affected by CPD and both psychological and psychopathological
disorders. Both psychological and physical interventions in patients with CPD could
ameliorate prognosis, considering the described relationships between psychological
factors and CPD, as identified by studies on the positive impact of a healthy psychological
functioning on CPD (Schiavon et al., 2017; Gentili et al., 2019). Psycho-educational
interventions, mindfulness-based cognitive therapy, non-invasive brain stimulation
techniques, peer-to-peer supports, and a health-based approach have been all tested
with promising results in patients with CPD (Castelnuovo et al., 2015; De Jong et
al., 2016; Naro et al., 2016; Callus and Pravettoni, 2018; Conversano et al., 2019).
In conclusion, it could be inferred that the bidirectional association between CPD
and psychopathological factors might lead to an exacerbation of both conditions, with
mechanisms that are only partially known and described. However, a relevant corpus
of knowledge supports the need for an integrated approach (physical, psychological,
and psychopathological) that takes into account the subjective experience of the single
patient from a lifetime perspective. As a consequence, it is necessary to consider
the corollary of symptoms that the patient who suffers from a chronic disorder manifests
as a unitary corpus, where it is possible to intervene both with medical and psychological
science to improve QoL and therefore physical symptoms. In the history of the patient's
illness, the weight of psychological variables plays a fundamental and non-negligible
role when the doctor's interest is that of treating the patient from a long-term perspective.
The development of therapeutic interventions able to fuse different perspectives into
a tailor-made interdisciplinary management approach in a single patient and the development
of a quality body of research on the topic are future challenges in order to improve
QoL and the subjective well-being of patients with CPD and psychopathological signs
and symptoms.
Author Contributions
CC was responsible for writing the entire opinion article, for checking the adequacy
of references and of all aspects of layout.
Conflict of Interest
The author declares that the research was conducted in the absence of any commercial
or financial relationships that could be construed as a potential conflict of interest.