Feeling bad but looking good: sick role features that lead to favorable interpersonal judgements

Abstract

Despite the presumed stigma of medical illnesses and injuries, persons with factitious disorder (FD) actively work to occupy the role of medical patient. They do so for reasons that are distinctly psychological, not for any obvious instrumental benefits. There is little empirical evidence that addresses the psychological benefits that accrue from the sick role. The self-enhancement model of factitious illness behavior suggests that the psychological benefits of the sick role might include protection or enhancement of the patient's self-esteem or self-image. Specifically, the model suggests that the sick role can be self-enhancing by (a) serving as a vehicle for the accumulation and display of prized medical knowledge, (b) providing the patient with a sense of uniqueness, and (c) providing vicarious self-esteem by bringing the patient in contact with prestigious physicians. We tested the self-presentational value of these sick role features by asking participants to provide interpersonal judgments of a fictitious medical patient. Participants made significantly more favorable judgments of the patient when the patient was described as medically knowledgeable, and when the patient had a unique, as opposed to a common, medical problem. No evidence was found to support the hypothesis that patients are seen more positively through their association with prestigious physicians. These results provide preliminary support for an important assumption of the self-enhancement model, namely that the sickrole, or at least certain enactments of the sick-role, can have positive self-presentational outcomes.