Biopsychosocial models (BPSM) are a class of trans-disciplinary models which look at the interconnection betweenbiology,psychology, andsocio-environmental factors. These models specifically examine how these aspects play a role in a range of topics but mainlypsychiatry, health and human development.
The term is generally used to describe a model advocated byGeorge L. Engel in 1977. The model builds upon the idea that "illness and health are the result of an interaction between biological, psychological, and social factors".[1]
The idea behind the model was to express mental distress as a triggered response of a disease that a person is genetically vulnerable to when stressful life events occur. In that sense, it is also known as vulnerability-stress model.[2]
It then became referred to as a generalized model that interpreted similar aspects,[3] and became an alternative to thebiomedical and/or psychological dominance of many health care systems.
As of 2017 the BPSM had become generally accepted.[1] It grew in interest for researchers in healthcare and active medical professionals in the decade to 2020.[4]
A 2024 review proposed use of the BPSM because the biomedical model did not fit the social and psychological aspects of health problems.[5]
A 2023 review said that in the previous decades substantial evidence had arisen supporting BPSM, although the theory of it remained unclear.[6]
A 2021 review found a substantial gap between healthcare professionals knowledge of the BPSM and their adoption of it in clinical practice.[7][8]
A 2018 review found that BPSM in primary care could lead to improved clinical outcomes, through creating awareness of factors impacting health and enhancing self-management of patients' illnesses.[9]
A 2007 review said that the biopsychosocial model was widely accepted as the mostheuristic approach to understanding and treatingchronic pain.[10]
A 2004 review said the BPSM was widely used as both a philosophy of clinical care and a practical clinical guide useful for broadening the scope of a clinician's gaze. It proposed the model had evolved into a biopsychosocial and relationship-centered framework for physicians. It proposed three clarifications to the model, and identified seven established principles.
Self-awareness.
Active cultivation of trust.
An emotional style characterized by empathic curiosity.
Self-calibration as a way to reduce bias.
Educating the emotions to assist with diagnosis and forming therapeutic relationships.
Using informed intuition.
Communicating clinical evidence to foster dialogue, not just the mechanical application of protocol.[11]
In the decade to 2015 there was a rising interest among healthcare researchers and practicing medical professionals in the biopsychosocial model.[4] However, despite the rising interest, medical schools had limited use of the model in their curriculums relative to the increasing literature about the model.[12]
Thebiomedical model, which was historically prevalent, takes a reductionist approach by focusing on biological factors and treating diseases through medical interventions.[13] It sees diseases as isolated physical abnormalities.
While this approach was once deemed sufficient, research within psychology and the social sciences cast doubt on its effectiveness.[14]
The biopsychosocial model adopts a holistic viewpoint, acknowledging the complex interplay of biological, psychological, and social factors in shaping health and illness.[13] It sees diseases as outcomes of dynamic interactions among various dimensions. The model emphasizes the interconnectedness of these dimensions, recognizing their mutual influence on an individual's health.[15]
The BPSM has been extended to consider additional holistic elements influencing the perceived necessity for healthcare and the focus on health-related matters: Information, Beliefs, and Conduct. Based on the model's dependence on perception, it has been considered imperative to actively engage the individuals or communities whose requirements are being addressed,[16] regardless of whether the focus is on their health, education, employment, housing, or any other needs. A key term in the biopsychosocial model is "syndemic" which refers to a set of health problem factors that interact synergistically with each other ranging fromsocioeconomic status to genetics.[16]
Treatment under the biopsychosocial model is comprehensive, involving medical, psychological, and social interventions to address overall well-being.[15]
Health inequities, often rooted insocial determinants of health, highlight the disparities in health outcomes experienced by different populations.[17]
The BPSM provides a framework for comprehending how health disparities arise and persist, which makes it a model of interest in targeting health inequities.[18]
Some patients that fall under the biopsychosocial model may not fall under the biomedical model, as the biopsychosocial model considers factors that may not physiologically manifest in a person.[19] These patients include those affected by health inequities and those at risk of infirmity.
Preventative medicine considers preventative measures to stop patients from obtaining infirmity in the first place.[20] By combatting preventable chronic diseases which make up a majority of deaths in patients of the US, the BPSM has been considered a potential tool to improve patient outcomes.[21]SAMHSA has promoted BPSM approaches in preventing opioid use.[22]
Within the framework of the biopsychosocial model, gender is regarded by some as a complex and nuanced construct, shaped by the intricate interplay of social, psychological, and biological factors.[23] This perspective, as echoed by the Gender Spectrum Organization, defines gender as the multifaceted interrelationship between three key dimensions: body, identity, and social gender.[24]
In essence, this characterization aligns with the fundamental principles of the biopsychosocial model, emphasizing the need to consider not only biological determinants but also the profound influences of psychological and social contexts on the formation of gender.[23][25]
According to the insights of Alex Iantaffi and Meg-John Barker, the biopsychosocial model provides a comprehensive framework to understand the complexities of gender.[23] They illustrate that biological, psychological, and social factors are not isolated entities but rather intricately intertwined elements that continually interact and shape one another. In this dynamic process, a person's gender identity emerges as the result of a complex interplay between their biological characteristics, psychological experiences, and social interactions.[23] This holistic perspective is in harmony with the biopsychosocial model's approach, which acknowledges the inseparable connection between these various dimensions in influencing an individual's overall well-being.
In essence, within the biopsychosocial paradigm, gender is not merely a product of biological determinants; rather, it is a dynamic and interconnected aspect of human identity.[1][23] This perspective urges a more nuanced understanding, encouraging researchers and medical professionals to consider the intricate interplay of social, psychological, and biological factors when exploring and addressing the complexities of gender.[1]
Kozlowska's Functional Somatic Symptoms approach sees attachment relationships and other factors as causes ofsomatic problems.[28][29] Siegel'sInterpersonal Neurobiology (IPNB) model is similar to Kozlowska's approach, but sees the individual brain and mind, and interpersonal relationships, as part of one reality, rather than separate elements.[30]
When Engel first proposed the biopsychosocial model it was for the purpose of better understanding health and illness. While this application still holds true the model is relevant to topics such as health, medicine, and development. Firstly, as proposed by Engel, it helps physicians better understand their whole patient. Considering not only physiological and medical aspects but also psychological and sociological well-being.[11] Furthermore, this model is closely tied tohealth psychology. Health psychology examines the reciprocal influences of biology, psychology, behavioral, and social factors on health and illness.
BPSM can improve primary care clinical outcomes, through creating awareness on the interactions among biological, psychological, sociocultural, and spiritual factors, and enhancing self-management of patients' illnesses.[9]
BPSM can be applied in relation to pain. Several factors outside an individual's health may affect their perception of pain. For example, a 2019 study linked genetic and biopsychosocial factors to increased post-operative shoulder pain.[35] Future studies are needed to model and further explore the relationship between biopsychosocial factors and pain.[36]
One advantage of applying the biopsychosocial model todevelopmental psychology is that it allows for an intersection within thenature versus nurture debate. This model provides developmental psychologists a theoretical basis for the interplay of bothhereditary andpsychosocial factors on an individual's development.[11]
Wickrama and colleagues have conducted several biopsychosocial-based studies examining marital dynamics. In alongitudinal study of women divorced midlife they found that divorce contributed to an adverse biopsychosocial process for the women.[42] In another study of enduring marriages, they looked to see if hostile marital interactions in the early middle years could wear down couples regulator systems through greater psychological distress, more health-risk behaviors, and a higherbody mass index (BMI). Their findings confirmed negative outcomes and increased vulnerability to later physical health problems for both husbands and wives.[43]
Kovacs and colleagues meta-study examined the biopsychosocial experiences of adults with congenital heart disease.[44] Zhang and colleagues used a biopsychosocial approach to examine parents own physiological response when facing children'snegative emotions, and how it related to parents' ability to engage in sensitive and supportive behaviors.[45] They found parents' physiological regulatory functioning was an important factor in shaping parenting behaviors directed toward children's emotions.
A biopsychosocial approach was used to assess race and ethnic differences in aging and to develop the Michigan Cognitive Aging Project.[46] Banerjee and colleagues used a biopsychosocial narrative to describe the dual pandemic of suicide and COVID-19.[47]
A biopsychosocial approach is also used to explain elusive factors in higher mortality rate known as the 'Glasgow effect'.[48]
Despite its theoretical robustness and growing empirical support, the implementation of this model in clinical practice remains inconsistent, hindered by systemic, professional, and cultural barriers.[49]
Artificial intelligence-driven tools are also being explored to integrate biopsychosocial data into clinical decision-making, enabling personalized treatment plans that reflect the complexity of each patient's condition.[50]
engendered an undisciplinedeclecticism that provided no safeguards against either the dominance or the under-representation of any one of the three domains of bio, psycho, or social.[54]
Psychiatrist Hamid Tavakoli argued that Engel's biopsychosocial model should be avoided because it
unintentionally promoted an artificial distinction between biology and psychology, and
caused confusion in psychiatric assessments and training programs,
ultimately it has not helped the cause of trying to de-stigmatize mental health.[55] The perspectives model does not make that arbitrary distinction.[56]
A number of these criticisms have been addressed. For example, the biopsychosocial pathways model describes how it is possible to conceptually separate, define, and measure biological, psychological, and social factors, and thereby seek detailed interrelationships among these factors.[57]
In a series of articles, Hunt, St-John Smith and Abed further criticised the biopsychosocial model for its lack of interaction with evolutionary theory, proposing that integrating evolutionary theory could address many of its criticisms. This 'evobiopsychosocial' approach is suggested to offer clarity on the relationship between the biological, psychological and social levels, and grounds the model more explicitly in fundamental biological theory, with implications for research, treatment, and conciliation.[58][59][60]
As of 2017 whilst Engel's call to arms for a biopsychosocial model had been taken up in several healthcare fields and developed in related models, it had not been adopted in acute medical and surgical domains.[61]
The biopsychosocial model (BPSM) was proposed in the late 20th century.[61]
The idea that there are several factors that may contribute to one's mental suffering is not a new concept.[62]
Urie Bronfenbrenner wrote extensively on social and environmental influences on human development.
Adolf Meyer's psychobiology model is considered the forerunner to the biopsychosocial model by many. Meyer emphasised understanding mental illness in the context of a patient's personal history over diagnostic categories.[63] Meyer laid down the groundwork for understanding the interplay of psychology and biology but tended to view these as interacting domains rather than a unified framework. Engel's model later incorporated biological, psychological, and social factors within a single conceptual approach.
The WHO definition of health adopted in 1948 implied a broad socio-medical perspective.[64]
Roy Grinker coined the term 'biopsychosocial' prior to Engel's work.[65] However, Grinker emphasized biological aspects of mental illness rather than proposing an integrative model of general health.
Engel broadened medical thinking by challenging the dominance of the biomedical approach. The idea ofmind–body dualism goes back at least toRené Descartes. Engel emphasized that the biomedical approach is limited because biological factors alone do not account for illness.[66] Instead, psychological and social factors play a significant role in how illness is experienced and treated. Engel proposed a dialogue between the patient and the doctor in order to find the most effective treatment solution.[67]
George L. Engel andJohn Romano of theUniversity of Rochester in 1977 are widely credited with proposing the biopsychosocial model.[68] Engel struggled with the then-prevailingbiomedical approach to medicine as he strove for a more holistic approach by recognizing that each patient has their own thoughts, feelings, and history.[69][61]
The biopsychosocial model is not just one of many competing explanations of health. Its emergence is best understood within a historical context. The model's development in psychiatry was influenced by ongoing debates about the scientific foundations of the discipline.
By the 20th century, psychiatry was still a relatively new field. In theVictorian era, psychiatry faced challenges in establishing medical authority over mental illness. This position was challenged by the problem of shell shock afterWorld War I, which exposed limitations of purely biological explanations and contributed to the recognition ofneurosis and the acceptance ofpsychoanalysis in psychiatric discourse. Institutions such as theTavistock Clinic played a role in promoting psychosomatic approaches. These developments provided a context in which the biopsychosocial model gained influence.[70]
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