Conclusion

A significant problem in estimating the true impact and role of psychosocial factors in this area relates to the fact that the studies conducted have largely been based on unrepresentative samples drawn either from hospital clinics or self-help organisations. Such groups may not be representative of the whole population of people affected and probably contain people whose conditions are more severe, in early onset, or that have had a greater impact upon them. Clearly, more research needs to be conducted within community and primary care settings in order to replicate and enhance the findings described above.

This chapter makes the case for adjustment being seen as a complex, multifac-eted, and ongoing biopsychosocial process, operating not only at the level of the individual with the condition but also at a societal level. Indeed, encountering negative reactions of others maybe unavoidable (Grandfield et al., 2004), although clearly individual differences in adjustment seem undoubtedly linked to the ways people think and in turn react to both internal and external threats. It is likely that complex interactions between underlying cognitive factors (such as shame-proneness) and social reactions are largely responsible for mediating the nature of coping and in turn the degree of distress and disability experienced. Research has only just begun to examine the roles of such factors in the implementation of psychosocial interventions and further research is needed here.

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