Understanding the Biopsychosocial Model

Written by Stanley E. Althof, PHD

Professor Emeritus, Case Western Reserve University School of Medicine Member,

SHE+ Foundation Medical Advisory Board 

Please do not stop reading this blog because it starts with a big - actually, a very big word - biopsychosocial. Hang in there for a bit, and let me explain why this is important to you. 

Women who suffer from sexual dysfunction or pelvic pain go to their gynecologist, and are looking for medical diagnosis, and medical treatment. And, in many cases, this is exactly what they need. 

However, sexual complaints and pain disorders are often more complicated - and call for a holistic, integrative approach. 

Most gynecologists and mental health professionals stay in their own lanes. That is to say - neither professional generally thinks outside of the box - the box meaning a medical perspective for gynecologists, and a mental health perspective for therapists. 

That is where the biopsychosocial model comes into the mix. 

The biopsychosocial way of thinking brings together all of the medical, psychological, relational, and social/cultural factors, and weaves together an understanding of the root cause of the problems a woman is experiencing. 

Usually - it comes from more than one place. But - let’s break it down. What could each of these facets of life mean? 

Medical: 

• Illnesses 

• Surgeries 

• Medication

• Hormones

• Blood Flow

• Nervous System Regulation

Psychological

• Anxiety

• Depression

• PTSD

• Abuse 

Relational

• Quality of a sexual relationship

• Infidelity 

• Traumas from past relationships 

Social & Cultural

• Cultural norms

• Religious values. 

I find it helpful to use examples to describe the complexity - and the importance - of the biopsychosocial model. 

The first example involves a woman - who consults her gynecologist because she is having trouble reaching orgasm. She used to regularly reach orgasm with manual or oral stimulation, and about half of the time with intercourse. She is perimenopausal, and has just discovered her partner is having an affair. She first consults her gynecologist, who does an exam and blood work. The doctor explains that it is common for perimenopausal and menopausal women to experience a change in orgasm due to a decrease in estrogen. She describes that women recognize a change in the quality of their orgasm as well - it takes longer, and the sensations are less intense. The doctor explains the risks and benefits of hormone therapy, and suggests the woman consider starting hormone replacement therapy. 

From the gynecologist's perspective, the question and the answer is medical. The doctor does not ask about her relationship, or the discovery of her partner's recent affair. 

Should this same woman have gone to a mental health clinician, the focus might have been on the infidelity, and her anger and disappointment in her partner. The mental health clinician may not have considered the hormonal changes (medical) that might contribute to the problem. 

What this patient really needs is a clinician who can integrate how her feelings regarding the infidelity, and the biological changes she is experiencing, come together to interfere with her ability to have an orgasm. 

The point is that neither the gynecologist, nor the mental health clinician, fully comprehend her situation. Again, I call this staying in your own lane. Generally, these professionals have not been trained in a biopsychosocial model - which integrates biology, psychology, relationship, and social and cultural concerns that are part of all of us. 

In the image below, you will find a visualization of the biopsychosocial model - and notice how the circles overlap. That is because always, one area can impact the other. Additionally, the biopsychosocial model is a dynamic model - meaning it changes overtime. 

For instance, if a woman had started an antidepressant medication, she may notice a change in her sexual interest, ability to become aroused, and difficulty with orgasm. 

So, while the model looks one way while she is taking the medication, if the dose is decreased or if the medication is discontinued, the model will change. 

The model brings together all of the facets of the human experience that interweave to create sexual or pain problems.

If you are struggling - I invite you to consider all of the pieces of the puzzle. One perspective is often not enough to deal with the root cause of your concern. 

I know it is not easy to find a provider who is familiar with the biopsychosocial model. Doctors and therapists aren’t announcing it. 

However, if you look at the website for the International Society for the Study of Women’s Sexual Health (www.ISSWSH.org) you will find the “Find a Provider” tab that lists clinicians by city, and state. 

Many, if not all, are well versed in the biopsychosocial model, and are ready and willing to offer a holistic perspective for you.