Conceptualizations of Chronic Illness

One of the controversies within the medical coping literature focuses on the use of a categorical versus a noncategorical approach to conceptualizing the childhood illness experience (R.J. Thompson and Gustafson 1996). In categorical approaches, illnesses are grouped in terms of specific diseases, such as inflammatory bowel disease or asthma. These approaches consider the different rates and presentations of psychological problems in childhood within each category of illness (e.g., cancer, heart disease). This method has the advantage of being able to identify important differences between conditions and to identify specific targets for intervention. However, as pediatric psychosomatic medicine has evolved, an increasing focus has been placed on the characteristics that pediatric illnesses have in com mon, and efforts have been made to categorize these conditions along a variety of dimensions.

In noncategorical approaches, pediatric medical conditions are classified based on general dimensions that are considered common to the illness experience regardless of the specific condition a child has, such as visible/invisible, fatal/nonfatal, and stable/unpredictable. These noncategorical approaches take into account a child's premorbid emotional functioning and developmental stage, as well as the degree of psychosocial stress in his or her environment. Noncategorical approaches view the stressors that physically ill children and families experience as being due to a variety of environmental factors that are not related to the child's condition or to the experience of the illness.

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