Illness Denial in Medical Disorders: A Systematic Review

Abstract

<b><i>Introduction:</i></b> Illness denial pertains to medical patients who do not acknowledge the presence or severity of their disease or the need of treatment. <b><i>Objective:</i></b> This systematic review was performed to clarify the clinical role and manifestations of illness denial, its impact on health attitudes and behavior, as well as on short- and long-term outcomes in patients with medical disorders. <b><i>Methods:</i></b> The systematic search according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines was conducted on PubMed, Scopus, and Web of Science. <b><i>Results:</i></b> The initial search yielded a total of 14,098 articles; 176 studies met the criteria for inclusion. Illness denial appeared to be a relatively common condition affecting a wide spectrum of health attitudes and behavior. In some cases, it may help a person cope with various stages of illness and treatment. In other situations, it may determine delay in seeking treatment, impaired adherence, and reduced self-management, leading to adverse outcomes. The Diagnostic Criteria for Psychosomatic Research (DCPR) were found to set a useful severity threshold for the condition. An important clinical distinction can also be made based on the DCPR for illness denial, which require the assessment of whether the patient has been provided with an adequate appraisal of the medical situation. <b><i>Conclusions:</i></b> This systematic review indicates that patients with medical disorders experience and express illness denial in many forms and with varying degrees of severity. The findings suggest the need for a multidimensional assessment and provide challenging insights into the management of medical disorders.

Clinical Implications of Illness Denial

“…Patierno and colleagues [2] have made an important contribution to the literature on illness denial with their scholarly systematic review of the clinical importance of this health behavior in the setting of multiple diseases. Key among their findings are the following conclusions.…”

“…Denial is frequently thought to be the primary defense responsible for patient delay [1]. Illness denial is usually diagnosed through a thorough history and clinical examination, sometimes supported by semi-structured interviews or survey instruments.Patierno and colleagues [2] have made an important contribution to the literature on illness denial with their scholarly systematic review of the clinical importance of this health behavior in the setting of multiple diseases. Key among their findings are the following conclusions.…”

Illness Denial in Medical Conditions: The Time Has Come to Include It in DSM Iterations

“…The systematic review by Patierno, Fava, and Carrozzino documents that the category of illness denial in medical disorders is not rare, has limited data about treatment methods, and fosters both morbidity and mortality in patients [1]. Remarkably, illness denial is not included in the most recent DSM-5 iteration except in the discussion of the category Psychological Factors Affecting Other Medical Conditions where there is a brief clause that "maladaptive health behaviors such as denial of symptoms" may be part of the diagnostic features of this category [2].…”

“…A number of clinimetric screening measures further help understand the patients and allow research into elements that "cause" such illness denial. These assessment tools are linked to various studies covered in this systematic literature review [1]. Management of illness denial requires more attention with strategies such as reframing or integrating aspects of well-being therapy into the treatment [20,21].…”

“…The DCPR is a reliable and valid method to diagnose illness denial in medical conditions [22][23][24]. It has been used in a variety of studies about illness denial which are described in this review [1]. In the current, DCPR illness denial in medical conditions contains 2 criteria: criterion A is the actual definition of denial of experiencing a physical disorder which requires treatment as a reaction to such symptoms as refusal to seek evaluation or comply with treatment.…”