This chapter describes how clinical psychologists work with medical professionals to treat disorders, help patients to cope with the stress of medical conditions, and to adhere to medical treatment recommendations. It also describes factors that contribute to disease, focusing on relationships between psychosocial factors (such as stress and unhelpful patterns of thinking) and physical factors (such as nervous system activity, circulation, and immune system functioning). The chapter also includes a description of behavioral and psychological risk factors that enhance the likelihood of illnesses such as cardiovascular disease, chronic pain, and cancer. Also discussed are programs for preventing or minimizing the impact of those risk factors.

Narrative health psychology is a subdiscipline of health psychology that brings narratives into illness to help patients make sense of their illness in the context of their lives. Narrative health psychology can be effective in helping people with chronic conditions and with serious health problems such as cancer and heart disease because these diseases have such a large impact on people's lives (not just patients but carers and families) that it is important to consider how the disease fits in with the whole life experience of the patient.

In this chapter, Dr Roisin Mooney, an academic researcher and fitness model, interviews James Hollingshead, a professional bodybuilder, about his experiences and perceptions of the bodybuilding industry in relation to exercise addiction. Many people engage in weightlifting and bodybuilding as a hobby, or as part of a healthy lifestyle, and then make the transition to semi-professional or professional status. The popularity of bodybuilding is continually growing, offering an opportunity to combine an activity one is passionate about with a seemingly glamorous lifestyle, company sponsorship, and the opportunity to inspire others. The rise of social media has further increased its appeal, and has the potential to positively reinforce engagement with unhealthy extremes of behaviour. In a fast-paced society, people frequently look for short cuts to professional status, including the use of steroids and/or excessive exercising. Better governance is needed to enable amateur and professional bodybuilders to maintain a balanced and healthy lifestyle.

Distinguishes between malingering, factitious, and somatic symptom disorders. Discusses the various models and treatments for somatic symptom disorders. Describes the architecture of sleep. Discusses the various ways psychologists measure and track sleep. Describes the types of sleep--wake disorders. Discusses the various models and treatments for sleep disorders. Describes some of the techniques psychologists use as primary and adjunctive treatments for medical conditions. Lists some common medical conditions that are treated by psychological means.

How to talk about variations in sex development is a major theme for impacted individuals and families. This is the topic of Chapter 12. The author summarizes the research literature with caretakers and with adults about the difficulties of disclosure. Considerable criticism has been levied at health professionals for failing to role model affirming communication. For sure there are gaps in health professionals’ talk, but the biggest contributor to the difficulties is to do with the widespread misunderstanding about the biological variations. Psychological care providers are not there to put a cheerful gloss over clients’ negative expressions. However, they can be part of the favorable social condition in which a wider range of meanings about bodily differences are negotiated. In the practice vignette, the author highlights how tentative and uncertain the enabling process is, where a negative view of sex variations is still widely endorsed in the social context.

In a gendered world, doctors and caretakers took for granted that making atypical bodies more typical was a humane way out of a difficult situation for child and family. Had the professionals carried out proper research, they would have learned from their young patients that the approach was physically and psychologically risky. But research on the long-term effects was not carried out, certainly not from the patients’ perspective. There was also no comparison group made up of people growing up with unaltered genital variations. Research with adults is the topic of Chapter 4 of this book. Since the 1990s, a number of outcome studies with adults have identified many problems of childhood surgery, such as multiple operations, scarring, shrinkage, sensitivity loss, unusual genital appearance and sexual difficulties.

Chapter 8 begins by pointing out the current lack of collective clarity about the role of psychological care providers (PCPs) and suggests that researchers and practitioners make collective effort to develop the role of PCPs in sex development in future. Meanwhile it outlines the psychological consultation process that is generic and familiar to most PCPs. The author provides an initial assessment template and summarizes the popular psychotherapeutic interventions. The template is visible in several of the practice vignettes in the ensuing chapters of the book. The author ends the chapter by arguing that the tertiary environment is set up for diagnostic workup and treatment and unsuitable for the kind of ongoing psychosocial input that is needed by individuals and families living in their communities. The author makes a case for PCPs in DSD centers to collaborate with peer support workers to enable nonspecialist providers in the community to contribute to ongoing support for individuals and families.

Chapter 11 of the book reviews potential psychological contributions in the highly charged process of assigning legal gender to a newborn with genital variations. Although a number of psychological theories exist for understanding gender development, it is the brain gender framework that has been singularly privileged in intersex and DSD medicine. However, the decades of research cannot contribute to the certainty professionals and caretakers seek. Psychological care providers (PCPs) have other frameworks to draw from in order to work ethically and pragmatically with families. In the practice vignette, the author envisions how a highly skilled PCP in a high-functioning DSD team could work substantially to help caretakers to cope with uncertainty and minimize the need for psychosocially motivated medical interventions. In the vignette, the psychological care path is in position before medical investigations begin. It remains highly active long after the medical and legal processes are completed. Although the vignette is built around a child diagnosed with 17β-hydroxysteroid dehydrogenase-3 deficiency, the care principles are relevant to legal binary gender assignment for children born with a range of sex development variations.

Difficulties with communication about bodily differences are strongly linked to sexual experiences. In Chapter 13, the author critiques the dominant ways of talking about sexuality in the wider society. These oppressive ideas can give rise to insecurities, self-objectification and body shame for people in general. Adults who have been medically managed are particularly vulnerable to the effects of objectification and shame. The author outlines typical components of sex therapy programs. However, rather than fix sexual problems, which can perpetuate people’s sense of inadequacy, the author suggests that psychological care providers support clients to process any trauma and develop a more relaxed and appreciative relationship with the body. This work, which requires generic therapy knowledge and skills, can be integrated with a range of specific sex therapy techniques and resources to reimagine a sexual future that focuses on bodily pleasure rather than gender performance. Although the practice vignette is built around a female couple, one of whom has partial androgen insensitivity syndrome, the care principles have wide applications for people with variations more generally.

Inconsolable distress is neither a universal nor inevitable response to inability to have biological children. In Chapter 14, the author criticizes research with clinic samples that has produced a problem-saturated account of childlessness that obscures a wide range of alternative responses. The author examines the influence of pronatalist ideology on people who are impacted by infertility including many people with sex variations. Away from the treatment context, psychological input can guide individuals, couples and groups to explore personal meaning of nonparenthood. It can facilitate service users to grieve for what is not possible, challenge feelings of deviance and shame, reengage with a range of life goals and, perhaps most important of all, recast adult identities. Through the practice vignette built around a heterosexual couple, one of whom has a late diagnosis of Klinefelter syndrome, the author teases out the difficulties of working psychologically in a treatment context, where complex existential issues and relational dynamics are compressed into the frame of pressurized treatment decisions.

Chapter 9 tackles the theme of choosing “normalizing” interventions, which applies to children and adults with variations. It explores the limits of choice regarding invasive and irrevocable “normalizing” interventions in the field of sex development. It considers the role of emotion in decision-making and the complexities of obtaining informed consent. In the practice vignette, demand for surgery by a young person (with CAH) is a foregone conclusion – a familiar scenario in DSD services and one that places the psychological care provider (PCP) in an ambiguous position. The service user also has clear psychosocial care needs. She brings a unique suite of intersecting social circumstances that place demand on the PCP to be fluid and responsive to the dynamic and challenging referral context. The PCP in the vignette does not have the answers, but it is hoped that the story opens up conversations on the theme.

Psychological care is endorsed in DSD medicine. Psychosocial research has been on the increase. But these positive moves have not given psychological practice the kind of collective focus that is enjoyed by the biomedical disciplines. However, psychological care providers have a wide variety of thinking tools and practice techniques to draw on, if to work in an ad hoc way at times. These tools and techniques do not change, but some are more useful and relevant than others for this service context. In Chapter 7, the author discusses the strengths and weaknesses of key theoretical frameworks in healthcare psychology. A major weakness of the individualistic models is their lack of capacity to address structural inequalities in psychological wellness and distress. The author introduces aspects of the Power Threat Meaning Framework and describes how to draw from its theoretical richness to think systemically about what sex variations pose to individuals and families in the social context and how they are responded to. The Framework provides the theoretical backbone for some of the practice vignettes in the final section of the book (Chapters 9–14).

In Chapter 10, the author suggests immense possibilities for psychological care providers (PCPs) to contribute to compassionate care following the birth of a child with variations (and in the antenatal period). Psychosocial research and first-person accounts inform us of caretakers’ brokenness, which is often responded to by “normalizing” the child. Here, the author suggests that PCPs work with caretakers in a grief-informed way. Grief is a language that everyone understands and compels services to privilege psychological safety as a first care principle. The practice vignette is built around an expectant mother in difficult circumstances with an unborn child with TS. However, the concept of grief is also relevant for older children and adolescents who are newly diagnosed. Indeed processing loss is integral to adjustment, whereby taken-for-granted ideas of selfhood give way to new identities.

In this chapter we consider the ways in which the study of identities has been approached in Critical Health Psychology. Critical approaches to health psychology move away from individualistic concerns to consider the ways in which wider social-psychological, socio-political and socio-cultural processes may influence the choices available to us in relation to our health and well-being practices. Using exemplars from different aspects of health psychology research, we consider the enacted, situated, relational, and embodied nature of identities. To illustrate the work on identities in critical health psychology, our focus in the chapter moves to focusing on women’s identities in healthcare contexts, noting also the gendered aspects and expectations within these contexts. Firstly, we consider early motherhood, using infant feeding as an example, and consider the ways in which identities are enacted, situated, relational, and embodied in infant feeding discourses. Secondly, we focus on women’s health, particularly the decisions made following mastectomy and their consequences in relation to changed identities. We discuss the ways in which women negotiate their embodied identities and the ways in which choices made are intertwined with relationships both with self and others. We conclude that our examples draw attention to the multiplicity of identities in everyday life, demonstrating how they are played out in a variety of ways. Furthermore, we argue that identities should form a key area of study within critical health psychology, specifically to consider the differential effects and experiences of actors within social and health settings.

Smartphones and associated wearable devices have gained a greater prominence directly within health psychology. Not only can such devices track health and answer a variety of research questions in relation to physical and mental health, but real-time feedback can also be augmented to support subsequent behaviour change interventions. There are literally 1000s of smartphone health apps that aim to change behaviour. Hence, health psychologists have been heavily involved with the design and testing of interventions (Ellis and Piwek, 2018). In addition, there are increasing numbers of interdisciplinary groups who focus on such interventions. However, while the research landscape is now littered with many well-publicised successes and failures, very little is known when it comes to understanding why such results are occurring even for users who engage with a long-term smartphone/wearable intervention. Despite having plenty of scope for development, progress has stalled because existing adaptations continue to be poorly designed from both a theoretical and patient perspective.

With these issues in mind, this chapter points towards where psychological research is using smartphone sensing methods that can quantify health related behaviours on a larger scale. It also considers how psychology can make a key contribution in the future. For example, while the process of behaviour change remains complex, additional research is urgently needed to understand how individuals, devices, and related technologies can be designed and implemented if interventions are to become widespread across healthcare systems in the future (Piwek et al., 2016; Ellis and Piwek, 2018)

This chapter revises and describes statistical models for analyzing data from dyadic systems such as therapist-client, mother-children, or romantic partners, among others. It defines interdependence as the key characteristic of dyadic systems, and then identifies clinical research questions related to dyadic systems and processes that unfold over time. These questions are used to select a set of statistical models and data-analytic techniques for answering clinical research questions related to dyadic research. Emphasis is placed on dynamic models that allow transitioning from asking questions about the outcomes (i.e., Did the therapy work?) to questions about the processes and mechanisms (i.e., How did it work?).