Handbook of Psychology

CHAPTER 8

Arthritis and Musculoskeletal Conditions

HEATHER M. BURKE, ALEX J. ZAUTRA, MARY C. DAVIS, AMY S. SCHULTZ, AND JOHN W. REICH

169

DIATHESIS 170
Biological Diathesis Factors 170
Psychological Diathesis Factors 173
Social Diathesis Factors 175
STRESS 176
Biological Stress Systems 176
Psychological Stress Factors 182
Social Stress Factors 183

IMPLICATIONS FOR TREATMENT 183

Biological Treatment 183

Psychosocial Treatment 184

FUTURE DIRECTIONS 184

REFERENCES 185

While the diseases discussed in other chapters of this volume
are most striking in their threats to survival, arthritis and
musculoskeletal conditions are notable due to the profound
disability they create. Arthritis and other musculoskeletal
conditions collectively represent the most common cause of
disability in the United States. Currently, more than 40 mil-
lion Americans suffer from some form of arthritis (Lawrence
et al., 1998). The widespread prevalence and disability asso-
ciated with these conditions emphasize the importance of
identifying mechanisms that affect arthritis onset, course, and
outcome. Traditionally, researchers attempting to understand
these chronic diseases have focused on indices of disease ac-
tivity to evaluate the effectiveness of treatment. However, the
lack of a one-to-one correspondence between objective dis-
ease activity and subjective suffering underscores the futility
of applying a strict biomedical model to these conditions.
Instead, consideration of psychosocial in addition to tradi-
tional biomedical factors may yield more accurate predic-
tions of treatment outcomes. Engel•s (1977) biopsychosocial
model offers a broader view in urging simultaneous consider-
ation of the role of biological, psychological, and social fac-
tors in the health and well-being of individuals.
One extension of the biopsychosocial model is its distinc-
tion between illness and health. According to the traditional
medical model, •healthŽ refers to the absence of disease.

However, according to the biopsychosocial model, •healthŽ

refers to overall biological, psychological, and social well-

being. This feature of the biopsychosocial model may be es-

pecially salient to musculoskeletal conditions, since these are

diseases that are currently not medically curable. Thus, ap-

proaches to treatment that focus on strictly medical out-

comes, such as objective disease activity, yet overlook the

well-being and psychosocial adaptation of an individual are

shortsighted. In this chapter, we present evidence that a diag-

nosis of a musculoskeletal condition does not necessarily

translate into a lifetime of disability and despair. Instead,

there are psychological and social factors that in”uence the

course and prognosis of these challenging conditions.

Just how do biopsychosocial factors in”uence disease

onset, course, and outcome inmusculoskeletalconditions? The

stress-diathesis approach, although initially developed in

studies of schizophrenia, has recently been applied to better

understand the complex mechanisms underlying other disor-

ders such as depression and chronic pain (Banks & Kerns,

1996; Monroe & Simons, 1991). According to this approach,

a predisposing vulnerability (e.g., diathesis) and a precipitat-

ing environmental agent (e.g., stress) interact to produce dis-

ease. Traditionally, diathesis factors have been considered to

be sources of vulnerability that interact with stress to produce

negative outcomes. However, just as there exist predisposing

sources ofvulnerability,there may exist predisposing sources

ofresilienceto stress. These resilience factors may either

serve to buffer, or protect against, the negative effects of stress,

or to interact with stress to produce positive outcomes. We

propose that health psychology researchers and practitioners

This research was supported by grants from the National Institute on
Aging, 1 F31 AG05850...01 (Heather M. Burke, Predoctoral Fellow)
and the Arthritis Foundation (Alex J. Zautra, Principal Investigator).