Biopsychosocial model
生物-心理-社会医学模式
What is the biopsychosocial model?
The biopsychosocial model is a medical model proposed by George Engel in 1977. He argued that the dominant biomedical model left no room for the psychological, social and behavioral dimensions of illness, and that clinicians must attend to its biological, psychological and social dimensions together.[1][2]
Schematic; sorting Mr. J’s causes into the three circles is this site’s own grouping, and circle size and overlap do not show how much each domain matters.
Select a circle or box for details.
Biological · e.g. too much salt Bodily factors such as genes, physiology and disease processes. Borrell-Carrió and colleagues note that genes may help cause schizophrenia, yet no clinician would ignore the social factors that can set off or contain it. Mr. J’s salty diet sits here, matched with blood pressure medicine or eating less salt.
Psychological · e.g. an over-responsible personality Emotions, personality and thoughts. Engel’s psychosomatic research showed that fear, rage, neglect and attachment have physiological and developmental effects on the whole organism. Mr. J’s over-responsible, guilt-prone personality sits here, matched with a stress-reduction course or a psychotherapist to ease his guilt.
Social · e.g. a stressful job, little support Work, family, social support and culture. Mr. J has a stressful job and poor support. Borrell-Carrió and colleagues add that every encounter carries social norms: clinicians should usually understand and adapt to a patient’s values and cultural norms before trying to change anything.
The patient · All three at once Engel held that to understand and respond to a patient’s suffering, and to leave the patient feeling understood, clinicians must attend to the biological, psychological and social dimensions of illness at the same time. The patient’s subjective experience, the doctor–patient relationship and whether the person takes on the sick role all count.
Biomedical model · Body only In 1977 Engel argued that the dominant biomedical model left no room for the social, psychological and behavioral dimensions of illness. He criticized it for splitting mind from body, reducing everything to cells and molecules, and fostering a cold, technical style of care. He did not deny the advances biomedical research had brought.
Where to start · Many causes, actions need an order Mr. J’s causes may feed one another in loops. But any treatment plan quietly ranks them: which contributes most, which will respond best, what one more step adds to those already taken, and which gives the most benefit with the least harm and cost. Borrell-Carrió and colleagues argue that a ranked, structural model of causes is what usually guides action.
Turned into assessment · Five axes and the 4Ps Owen (2023) treats two approaches as practical versions of it. DSM-III’s multiaxial diagnosis recorded five things for each case: the clinical syndrome; lifelong conditions such as personality disorder or intellectual disability; physical health problems; the severity of psychosocial stressors; and the best social and occupational functioning in the past year. The 4P case formulation sorts predisposing, precipitating, perpetuating and protective causes into biological, psychological and social columns. Both have largely died out, and DSM-5 removed the axes.
Origins · From Meyer to Engel Adolf Meyer, a Swiss-born psychiatrist, held that a patient’s complaint had to be understood through the life course of all their organ systems, instincts and life events, and gathered it in a “life chart.” Grinker used the term “biopsychosocial” in a 1964 paper in the American Journal of Psychiatry. Engel’s 1977 paper in Science extended the model to all of medicine, and his 1980 paper showed its clinical use with a heart attack patient.
Critics · Who decides what matters Benning (2015) reviews several critiques: the model lacks philosophical coherence; it lets clinicians stress the bio, the psycho or the social as they please, with no rule for choosing; it gives patients’ subjective experience too little weight, as when a physician committed to it still had misunderstandings with Native American patients; and as orthodoxy it has not stopped biomedical work dominating research, with 86% of papers at a major American psychiatric meeting in 1992 biomedically focused. Defenders reply that it remains useful in teaching and practice.
Save as image (PNG) This figure image is licensed CC BY 4.0: reuse it with credit and a link back to this page. How to reuse
Key points
- Engel faulted the biomedical model for splitting mind from body, ignoring what cells and molecules cannot explain and treating patients as objects; he held subjective experience can be studied scientifically.[2]
- Engel’s 1980 case was a heart attack patient: the arrhythmia that followed, he suggested, might stem not just from damaged heart muscle but from lacking confidence in the doctor.[4]
- DSM-III’s five-axis diagnosis and the 4P case formulation both tried to turn it into an assessment format; both have largely fallen out of use, and DSM-5 dropped the axes.[3]
- It had forerunners: Adolf Meyer read symptoms against a patient’s whole life course, and Grinker used the word before Engel, who extended the approach to all of medicine.[3][4]
An example
A checkup shows Jay’s blood pressure is high. Besides asking how salty he eats, the doctor asks about work and sleep: newly promoted, he often works past midnight and has dropped weekend basketball with friends. They agree he will cut salt, keep regular bedtimes and play again, then recheck in a month before deciding on medication.
Misreadings and limits
Its value lies in applying medical knowledge to each patient, not in discovering new laws of causation.[2] Critics say it offers no rule for which domain to prioritize in a given case, inviting arbitrary choices, and that even as psychiatry’s orthodoxy it has not stopped biomedical approaches from dominating research.[4]
Sources
- 1 Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129–136. doi:10.1126/science.847460
- 2 Borrell-Carrió, F., Suchman, A. L., & Epstein, R. M. (2004). The biopsychosocial model 25 years later: Principles, practice, and scientific inquiry. Annals of Family Medicine, 2(6), 576–582. doi:10.1370/afm.245
- 3 Owen, G. (2023). What is formulation in psychiatry?. Psychological Medicine, 53(5), 1700–1707. doi:10.1017/S0033291723000016
- 4 Benning, T. B. (2015). Limitations of the biopsychosocial model in psychiatry. Advances in Medical Education and Practice, 6, 347–352. doi:10.2147/AMEP.S82937
Last checked against sources: October 28, 2026