Objective: We developed and validated a drawing test version of the Pictorial Representation of Illness and Self Measure (PRISM), a visual method to assess the perceived burden of illness and illness perception. Our aim was to test whether the drawing version would allow patients more freedom to deliberately vary both the size and position of circles symbolizing illness and individual coping resources, as well as gain more information about illness representations and available resources. Design and Main Outcome Measures: We applied the PRISM-D test to 500 patients with severe somatic diseases under active hospital treatment. We used Spielberger's State and Trait Anxiety Inventory and Beck's Depression Inventory to assess convergent validity. Results: The PRISM-D test is applicable for inpatients and it can be used to explore their subjective representations. The modifications did not cause any loss in convergent validity as the Self-Illness Separation and the Illness Perception Measure are significantly correlated with levels of depression and anxiety. Conclusion: The drawing test enables more detailed measurement of suffering caused by illness, illness perception and more complex assessment of important factors in a patient's life. The test is adequate for clinical use as well as research among a wide range of somatic inpatients.

Pain is the most common complaint people would see a doctor about (Komoly & Palkovits, 2018). In order to understand the complex experience of pain, besides psychological theories, it is also important to understand what happens on the biological level when someone is experiencing pain. The book chapter attempts to integrate psychological theories and research findings that use imaging techniques to help this understanding. Based on these, we connect the experience of chronic pain to early, traumatic experiences, as the sensitivity of the nervous system can be suspected as the reason for both of them.

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Introduction Psychosocial representation of the illness means those personal and mental meanings and thoughts which the patient connects with his/her own condition. The examination of representation of the illness is very important to understand the behavior of the patients because these representations contain of the patients' beliefs about their illness or injury. These beliefs influence the cure, the duration of recovery and these beliefs affect the strategies, which the patients use to cope with the illness. In clinical environment, the nonverbal methods help the exploration of representations of the illness, since the physical status can hamper the verbal expression of burdens (for example: pain, suffering). In such cases, we can use the PRISM task (Pictorial Representation of Illness Self-Measure) to measure the burden of suffering. Methods and Materials: In our research, there have been 110 inpatients (52 men). We have examined the patients before lumbar surgery, using the following tests: Psychological Vulnerability Questionnaire, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale and PRISM-D (drawing version of PRISM task) and we followed how many days the patients stayed at the clinic after the operation. Using the PRISM-D, we are observing the patients drawing the in some spatial formations, which are the following: 1. Self-shield (the patient draws the important things around herself/himself), 2. Illness-shield (the patient draws the important things around the illness), 3. Protective line (the patient draws the important things in horizontal or/and vertical line), 4. Network (the important things and the illness are diffused in space of the current life), 5. Fusion (the important things and the illness intersect with the self or every circle intersect with each other), 6. Self-part (the illness is drawn in the self and the other important things are located far away from the self). Results We have found that those patients who have drawn their illness in their own Self (Self-part), went home later than the other patients (Self-shield: p = 0,004, Fusion: p = 0,026, Illness-shield: p = 0,008, Protective line: p = 0,036, Network: p = 0,004). But those patients, who represented their illness in Self-shield spatial formation, went home earliest (mean: 4,14 days). Although, these patients were the most vulnerable in the whole population. Conclusion Our results suggest the illness modifies the self-identity because the information related to the pain becomes the most essential in the organization of the self. It could be problematic, if majority of the self-scheme consists of illness-scheme. We can see this in Self-part spatial formation, thus it is affirmable if the illness-scheme increase within the Self, the recovery will slow down. This is often the case with the patients having low back pain.