ILLNESS BEHAVIOUR

It is 13 years since Waddell developed[1] criteria for measuring and interpreting abnormal Illness Behaviour in patients with low back pain.

The presence of Waddell signs is commonly adduced as evidence of a nonorganic basis for the plaintiff's chronic symptoms. Such abnormal behaviour is seen in Chronic Fatigue Syndrome, the cause of which is unknown but is thought by many to be psychological.

The pathological basis of Multiple Sclerosis, on the other hand, is known to be patchy destruction of myelin, the electrical insulation of nerve trunks. Patterns of abnormal Illness Behaviour in the two conditions were indistinguishable in a 1995 British study[2].

PRACTICE POINT Abnormal Illness Behaviour does not prove nonorganic cause

The origins of patterns of Illness Behaviour were explored in two recent studies from Norway and the United States. Childhood imprinting, particularly from female relatives and sibs[3], was a strong predictor of adult responses to headaches, neck and shoulder pain. The responses were largely unaffected by spousal patterns.

Similarly, childhood reinforcement and modeling of responses to colds, menstrual and bowel problems strongly determined adult illness behaviour[4].

PRACTICE POINT Patterns of Illness Behaviour are learned in childhood and signify more about the client than about the nature of the illness or injury

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