# Chronic Illness and Quality of Life Psychology I · Society and Health · https://tryals.app/learn/psychology-i/chronic-illness-and-quality-of-life ## Living With a Long-Term Condition **Chronic illnesses** (such as diabetes, heart disease, or chronic pain) progress slowly and require ongoing management, differing fundamentally from acute illness. Sociologist Michael Bury described serious chronic illness onset as **biographical disruption**: the illness forces a person to re-evaluate their past, present, and future self, disrupting assumed bodily reliability. Adapting successfully requires navigating changes to **identity** and **social roles**, as a formerly independent person renegotiates their place in family, work, and friendships. ## Measuring Patient Impact Because chronic illness touches multiple dimensions of life, researchers use **Health-Related Quality of Life (HRQoL)**: a multidimensional construct capturing a patient's subjective sense of how health status affects physical, mental, and social functioning. | Concept | Focus | | --- | --- | | Biographical disruption | Re-evaluating one's life story | | Identity change | Renegotiating who one is with limitations | | Social role change | Renegotiating place in relationships | | HRQoL | Subjective impact on daily functioning | > **Common pitfall:** assuming HRQoL is just clinical severity. It captures the patient's **subjective experience**, which can diverge from lab results. ## Practice questions 7 of this lesson's 12 practice questions, with answers. The full set is in the app. ### 1. Chronic illness forces identity and social-role renegotiation in a way acute illness usually does not. Why does duration change the psychological task? A. Because an indefinite condition has to be built into who one is B. Because chronic illness always involves visible physical change C. Because chronic illnesses are generally more severe D. Because acute illnesses do not involve any psychological adjustment **Answer:** A. Because an indefinite condition has to be built into who one is **Why:** Temporariness is what protects identity. When the condition is permanent the old self is not waiting on the other side, so the work is reconstruction rather than recovery. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/chronic-illness-forces-identity-and-social-role-renegotiation-in-a ### 2. Two patients have indistinguishable scans and identical lab results. One rates their quality of life at 80, the other at 30. What does the gap tell you about **HRQoL** as a measure? A. That the scans are insufficiently sensitive and better imaging would explain the difference B. That it measures something the clinical numbers do not contain C. That one of the two is misreporting, since identical pathology should give identical quality of life D. That HRQoL is too subjective to be used as a clinical outcome **Answer:** B. That it measures something the clinical numbers do not contain **Why:** A measure earns its place by diverging from the ones you already have. Identical pathology and a 50-point gap means something real is going unrecorded by the scan, and it is the half the patient actually lives in. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/two-patients-have-indistinguishable-scans-and-identical-lab-results ### 3. Sort each part of adapting to chronic illness by what it primarily involves. **Answer:** - Managing physical symptoms: Taking insulin on a strict schedule, Monitoring blood sugar throughout the day, Managing recurring pain flare-ups - Navigating identity and social-role change: Renegotiating one's role as the family breadwinner, Rebuilding a sense of who one is after diagnosis, Adjusting friendships around new physical limits **Why:** Insulin, monitoring, and pain management target physical symptoms; renegotiating breadwinner status, rebuilding identity, and adjusting friendships address identity and social roles. Adapting successfully requires both - not symptom control alone. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/sort-each-part-of-adapting-to-chronic-illness-by-what-it-primarily ### 4. Biographical disruption names an illness forcing a person to re-evaluate their whole life story. Why is that treated as a distinct concept rather than as distress? A. Because distress is physiological and disruption is psychological B. Because it applies only to terminal diagnoses C. Because it is measured on a standardised clinical scale D. Because it identifies a specific loss to be rebuilt, not relieved **Answer:** D. Because it identifies a specific loss to be rebuilt, not relieved **Why:** Distress is a state; disruption names what broke. Treating the two as the same suggests reassurance, when the task is reconstructing a story about the future. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/biographical-disruption-names-an-illness-forcing-a-person-to ### 5. Two patients with identical diagnoses and identical lab results report very different quality of life. What does that dissociation show? A. That quality of life is subjective and multidimensional B. That quality of life tracks severity but with measurement error C. That laboratory measures are unreliable indicators of disease D. That one of the two patients must be misreporting **Answer:** A. That quality of life is subjective and multidimensional **Why:** The dissociation is the finding, not noise. It is why patient-reported outcomes are collected separately from clinical ones rather than inferred from them. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/two-patients-with-identical-diagnoses-and-identical-lab-results ### 6. Bury called serious chronic diagnosis a **biographical disruption**. What does that name claim that 'a difficult diagnosis' does not? A. That the damage is psychological rather than physical B. That the story the person was living in has broken C. That the disruption is temporary, and biography resumes once treatment stabilises D. That the diagnosis interrupts the medical record, complicating future care **Answer:** B. That the story the person was living in has broken **Why:** The claim is that what breaks is the narrative, not merely the mood: who I am, what I assumed my sixties held, what I can promise anyone. That is why symptom control alone can leave a patient adrift, the medicine treats the body and the biography is still in pieces. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/bury-called-serious-chronic-diagnosis-a-biographical-disruption-what ### 7. Select every statement that is TRUE about chronic illness and quality of life. A. Chronic illness differs from acute illness only in lasting longer, with no other demands. B. Biographical disruption unsettles taken-for-granted assumptions about one's life. C. Adapting involves identity and role changes, not just symptom control. D. HRQoL is subjective and multidimensional. E. HRQoL is simply equal to an objective clinical severity score. **Answer:** B. Biographical disruption unsettles taken-for-granted assumptions about one's life.; C. Adapting involves identity and role changes, not just symptom control.; D. HRQoL is subjective and multidimensional. **Why:** HRQoL's subjectivity, biographical disruption, and identity/role adaptation are all true. HRQoL is not an objective severity score, and chronic illness differs from acute illness in the ongoing life demands it creates - so those two are false. Page: https://tryals.app/practice/psychology-i/chronic-illness-and-quality-of-life/select-every-statement-that-is-true-about-chronic-illness-and-quality