Coping with epilepsy: Do illness representations play a role?

Objectives. To determine the relative contributions of neuroepilepsy, coping and illness representation variables to psychological adjustment in epilepsy. Design. The study was a cross-sectional design, contrasting the adjustment of recently diagnosed and chronic patients. Neuroepilepsy, illness representation, coping and adjustment variables were all measured. Method. A total of 94 patients were studied comprising three groups: recently diagnosed patients, chronic patients cared for in hospital clinics, and chronic patients cared for by their GP. A measure was developed to assess each patient's illness representations of epilepsy. Results. Overall, the epilepsy patients showed significant adjustment problems relative to a normative group, There were, however, significant differences between epilepsy subgroups: recently diagnosed and chronic (clinic) patients exhibited problems, but chronic (GP) patients were relatively well adjusted. After controlling for the effects of group membership and neuroepilepsy variables, coping and illness representations, each explained significant additional variance on measures of psychological adjustment. Patients presenting with adjustment difficulties were characterized by high seizure frequency, avoidance rather than problem-focused coping, doubt about their diagnostic label and belief in poor containment. Conclusions. We conclude that the illness representations paradigm has value in understanding psychosocial adjustment to epilepsy. This approach offers the potential to identify the critical factors in patients' adaptation to illness. Such insights into the coping process may contribute to the development of effective clinical interventions.