Self-concept as a "BMT patient", illness intrusiveness, and engulfment in allogeneic bone marrow transplant recipients

Objective: The experience of cancer and its treatment by bone marrow transplantation (BMT) can enhance the salience of one's status as a patient in the evolution of self-concept. Illness and the patient role can come to dominate the sense of self, resulting in feelings of hopelessness, helplessness, and distress ("engulfment"). Illness-induced lifestyle disruptions ("illness intrusiveness") introduce adaptive demands, challenging preexisting conceptions of self Illness intrusiveness and engulfment may interact, leading affected individuals to construe themselves as highly similar to a prototypical "BMT patient". Methods: Ninety allogeneic BMT outpatients completed the Illness Intrusiveness Ratings Scale, Modified Engulfment Scale, and a semantic differential measure of self-concept as a BMT patient in an interview context. Results: Illness intrusiveness correlated significantly with engulfment (r=.58, P<.0001) and with self-concept as a BMT patient (r=.27, P<.016). Engulfment did not correlate significantly with self-concept as a BMT patient (r=.15). Multiple regression analysis, controlling for relevant covariates, indicated a significant Illness Intrusiveness x Engulfment interaction effect on self-concept as a BMT patient [F(1,84)=4.93, P<.029]. Conclusions: Self-concept as a BMT patient increases as cancer and its treatment introduce increasing lifestyle disruptions (illness intrusiveness). These effects are amplified when self-experience is dominated by disease and treatment and patients feel helpless, hopeless, and distressed (engulfment). (C) 2003 Elsevier Inc. All rights reserved.