The role of patients' illness representations in coping and functioning with Addison's disease

Objective. To examine the relationship between illness representations, coping behaviour and adaptive outcome in patients with Addison's disease (AD). Design. Cross-sectional. Following Leventhal's self-regulation model (Leventhal, Meyer & Nerenz, 1980), it was hypothesized chat illness representations are directly associated with coping and, via coping, with adaptive outcome. Method. The illness representations held by 63 patients with a diagnosis of Addison's disease were explored using a questionnaire and a comprehensive interview, including questions on beliefs about the identity, course, cause, treatment possibilities and consequences of their illness, the coping strategies they use, and their physical and psychological well-being. Results. AD patients differ highly in the subjective experience of their disease. Patients who view their illness as a serious condition with both frequent and serious symptoms and consequences, patients who believe their illness is chronic, and patients who consider their illness uncontrollable were found to engage more in passive coping strategies and to report higher levels of disability with regard to physical functioning, social functioning, mental health and general vitality than those who believed the opposite. Regression analyses indicated that illness representations were better predictors of adaptive outcome than were coping scores. Conclusion. Illness representations seem to play an important role in functioning in Addison's disease. The implications of these findings for the design of health care-related interventions for AD patients are discussed.