Psychological Masquerade

Lessons from Psychological masquerades the interplay of physical and mental health

My interest in clinical health psychology came from one of my very early training placements: in my first two years as a trainee I spent up to two days a week in as a well supervised trainee in a GP based counselling service. I was lucky the doctors were amazingly supportive of trainees, generous with their time and psychologically aware. I always thought the patients were really lucky with their GPs!

The GPs would obviously refer payment patients with potential mental health issues to our service for assessment and therapy and being on site with the GP able to prescribe medication when appropriate taught me so much about wealth get working in healthcare teams. Very quickly though, this placement brought me face to face with some of the major interactions between physical and mental health. Mental health can create physical health issues and vice versa.

The basics of interaction

It's well documented that even mild psychological issues could increase the likelihood of physical illness. The main connection seems to be the deterioration of mental health often comes to the physical impact on our immune system and/or a tendency to self-neglect which means we're less likely to eat well get decent sleep or exercise.

Did you know that many medications come with psychological as well as physical side effects another sometimes dramatic example of the interaction between physical and mental health. Ironically, many psychoactive medications come with side effects such as low mood anxiety and in extreme cases even suicidal ideation. That's why healthcare professionals use these with caution and schedule regular check-ins with anyone taking them Some steroids prescribed in chemotherapy regimens can even cause psychosis. That doesn't mean you should deny yourself medication or stop taking it without talking to your healthcare team. It does mean you should read patient information leaflets carefully (yes, I hate the flimsy paper in small print too, but I do read them!) and talk to a healthcare professional urgently if you do experience any of these issues.

Similarly, some illnesses create psychological symptoms as well. Dementia and Parkinson's disease perhaps most obviously but endocrine conditions, epilepsy and nutritional deficiencies as well autoimmune and inflammatory diseases can cause cognitive issues, delirium low mood and even psychosis. A common issue in the care of older adults is the complex challenge of differentiating between the potential causes of coveted function or delirium is the patient dehydrated suffering with the UTI or experiencing significant psychological symptoms. Physically the symptoms are the same, but the root cause and treatment differ widely….

And here's a fact that might attract your interest: patients who undergo joint replacement surgery have a rate of significant postoperative depression of between 10 and 30% depending on which research studies you read. That's higher than the incidence of blood clots if they comply with the full prophylactic regimen. One of my soapboxes: most surgical patients will be well informed about the physical complications surgery but how many surgeons mention this?

So that brings us to psychological masquerade: Are the symptoms, your patient's experiencing the result of a physical mental health issue, or (arguably most commonly) both? Is this psychology masquerading as a physical disease or vice versa?

What are the most rewarding aspects of my work as a clinical health psychologist is helping people realise that mental health isn't something separate from their physical health. - It's deeply entwined. For too long, mental, and physical health had been treated as distinct areas, often by different professionals working independently of each other. Thankfully, there's growing recognition of how interconnected these two domains are, leading us toward a more holistic approach to healthcare. Don't be too surprised if your psychologist or therapist asks you to check in with your healthcare team.

The hidden link between mind and body.

But it isn't just physical illness that can interact with our psychological well-being. Imagine for a moment waking up feeling tired and anxious after a poor night's sleep- Perhaps because you're worrying about something (we’d think of that as a psychological cause) or managing symptoms of chronic pain (a physical cause). Anxiety makes it harder to follow your treatment plan, get on with your day, do what you need to do, and pain creates anxiety, stress, and low mood. It really is a vicious cycle sometimes. Again, physical health a mental health interacting.

Think about chronic pain for a moment. Over time, pain isn't just physically draining, it takes a significant emotional toll. Chronic pain can lead to feelings of frustration, isolation, or even despair, increasing the risk of developing conditions like depression or anxiety. The emotional impact of living with illness or injury can sometimes become as significant as the physical symptoms themselves. It's a much-debated area in the treatment of chronic pain, but it is often argued that psychological techniques can help live well in the face of chronic pain and even reduce the perception of pain, even though they may not be seen as having a physical impact on whatever is causing the pain. For patients who have no formal diagnosis of cause, this can seem as if their healthcare team are saying “it’s all in your mind.” That’s rarely the case, it’s more often “we don’t have a physical treatment for this, but we do know that psychological techniques can improve this type of physical symptom.” To me, that's a bit of magic – using the complex interaction of physical and mental health to alleviate objective physical symptoms.

Research supports these observations, showing that individuals living with mental health conditions such as depression or anxiety have a significantly higher risk of developing political youngsters like heart disease, diabetes, or autoimmune conditions. Conversely, people managing chronic. Physical illness experiences high rates of mental health conditions, creating a reciprocal relationship that demands our attention. And cardiac patients who report symptoms of psychological trauma related to incidents of, for example, my cardiac infarction, are much less likely to engage with and comply with recovery plans and treatment.

Embracing the biopsychosocial model

To counter psychological masquerade, I often use the biopsychosocial model in my practise. This framework encourages us to understand health through the interaction of biological, psychological, and social factors, rather than focusing on symptoms in isolation.

· Biological Factors: Chronic illness, hormonal changes, or neurological conditions such as Parkinson's disease or multiple sclerosis have clear biological components that directly impact mental health. Recognising this helps us to manage both the physical and psychological aspects of treatment more effectively.

· Psychological Factors: Our emotional health significantly shapes how we cope with illness. And of course, illness has a significant impact on our mental health. For example, patients experiencing anxiety often find it difficult to follow necessary but challenging treatment regimens. In contrast, those who maintain a hopeful outlook or have developed strong coping strategies. Tend to fare better physically as well as emotionally. However, beware of using forced optimism or positivity.

· Social factors column. Humans thrive on connection. During my clinical work I've seen again and again how crucial social support can be for recovery. Strong social network significantly boosts resilience, reducing the emotional burden of chronic illness, an ageing faster physical recovery.

Practical steps Apps. towards using the interplay of physical and mental health in integrated care

While a holistic approach that considers physical, psychological, social needs together. Might seem like a dream in today's complex world. It shows so much promise that I am absolutely convinced It's worth striving for. Here are some strategies that can help bridge the gap:

· Interdisciplinary collaboration column working together across healthcare disciplines. GPS, nurses, psychologists, physiotherapists, dieticians. Secondary care physicians- ensures patients receive consistent and comprehensive care. Communication among healthcare teams reduces fragmented care, helps everyone understand the patients full experience, and reduces error and improve safety.

· Routine mental health screening: Early identification of mental health issues within primary care is critical, especially for people recently diagnosed with chronic illness or managing long term conditions. Regular screenings can highlight emotional struggles early, allowing healthcare providers to offer timely support before issues escalate.

· Patient empowerment and education: Helping patients understand the close connection between physical and mental health empowers them to engage actively in their own care. Providing accessible resources, clear explanations, and silken coping techniques can make managing illness less overwhelming and skill the patient in managing their own psychological symptoms with less support. New line holistic and tailored treatment plans: Effective treatment isn't one-size-fits-all. Integrating mental health Interventions such as cognitive behaviour therapy, bracket CDT, bracket, mindfulness, stress management alongside Traditional medication medical treatments can significantly improve quality of life and health outcomes. These technologies address the emotional and psychological factors that can often influence physical recovery.

Real life impact

Let me share a brief example from my own practise: One of my early patience in that lovely GP service was a delightful person who had recently undergone major abdominal surgery for a life-threatening condition. Physically, they were recovering well but had, understandably, become very anxious and depresses about their future. They also had a sibling who had recently been diagnosed with cancer and wanted to fly and visit and support this much-loved sibling.

This lovely patient developed an incapacitating fear of flying which prevented them from travelling to their sibling. When we talked, we began to connect physical concerns about lower cabin pressure, risking their stitches bursting, the fact that they thought the flight would be the symbol of a final journey to a dying sibling and the fact that they were using medication that does have anxiety provoking side effects.

The GP was able to provide reassurance about the stitches and changed their medication, and we used a few therapy sessions to explore psychological techniques for managing anxiety. This combination allowed the patient to fly to their sibling.

This scenario isn't unusual. It's the essence of why integrating psychological care into physical health treatment matters so much. It’s why I am committed to Clinical Health Psychology and being part of unravelling psychological masquerade!