• Illness => changes in bodily sensations (increase urination frequency, increase in heart rate…)
◦ Noticed by the individual or by other people
◦ Changes in bodily appearance
• MacBryde:
Bodily signs: can be objectively recognised
Symptoms of illness: require interpretation
◦ Is fever a sign of illness or of physical exertion? Decide.
People’s views about health: depend on their prior experience of illness + understanding of medical knowledge
◦ People learn about health through experience
◦ Illness can challenge a person at a fundamental level
Illness or Disease?
Cassell (1976)
Illness: what a patient feels when they go to the
doctor (not feeling quite right): what a person
experiences
Disease: something of the organ/cell/tissue =>
physical disorder/ pathology
Ill without having an identifiable disease: being hangover
Disease without feeling ill: controlled asthma/diabetes; early-stage cancer.
An illness is managed; A disease is cured. (Google)
1.Symptom Perception
Attentional model of Pennebaker (1982): competition for attention by stimuli => some go unnoticed in some
contexts, but NOT in others
Cognitive-perceptual model of Cioffi (1991): focuses on the processes of interpretation of physical signs +
attribution as symptoms; the role of selective attention
Bodily signs => increased likelihood of symptom perception
They can or can not be symptoms of illness.
◦ Sweating: bodily sign, but not the symptom of illness
Signs which can be detected and identified:
◦ Blood pressure
Symptoms: what is experienced => SUBJECTIVE
◦ They are the result of physiological changes
◦ Only some can be detected by the individual
Symptoms which are likely to receive attention:
Painful or disruptive: a bodily sign with consequences for the person
(Not being able
to perform a
routine
activity)
, Novel: perceived severity of a symptom/ whether or not they will seek medical attention.
◦ A novel symptom (new to oneself) likely to be considered indicative of something rare/serious.
◦ A common symptom => assumption of lower severity => reduced likelihood to seek out medical help
Persistent: a bodily sign is more likely to be perceived a symptom if it lasts LONGER or if it persists in spite of self-
medication
Pre-existing chronic disease: past/current illness had a strong influence => increase number of symptoms
PERCEIVED/ REPORTED
Symptoms: unreliable as an indicated for medical attention
◦ Ones for flu: can be self manages
◦ Cancer: few initial symptoms
Attentional States and Symptom Perception
There are individual differences in the amount of attention people can give to their internal/external states.
Pannebeaker: people are LESS likely to notice somatic sensation if their attention is ENGAGED externally.
◦ More likely to observe somatic sensations if they are NOT distracted.
• Limited attentional capacity => internal and external factors
COMPETE for attention.
Competition of cues theory (Pannebaker 1982): a bodily sign can be undetected in some contexts, and detected in
others.
◦ Cognitive behavioural distraction manipulate attentional focus => useful tool for symptom management
(chapter 13)
High degree of attention => increase sensitivity to new/different bodily signs.
◦ “Mass psychogenic illness”: increase in attendance at doctors during pandemics
◦ Powerful effect of anxiety on our perceptions !!
◦ “Medical student disease”: increase knowledge about disease-specific symptoms
◦ Heightened attention to own bodily signs.
Brown => two attentional systems which influence how symptom information is processed
Primary Attentional System (PAS)
◦ Below the level of consciousness
◦ Acts on stored representations: illness schema which is automatically selected (from when a person over-
attends to bodily experiences)
◦ Symptom can be wrongly matched to a pre-existing schema (e.g. in mass psychogenic illness/medical student
disease)
Secondary Attentional System (SAS)
◦ More amenable to executive control
◦ Attention can be manipulated by conscious thoughts + cognitive processes (rational weighing of likelihood)
◦ Hampered if PAS has already dictated what the person to be focused on + if there is a label on the symptoms
(difficult to change)
Previous experience with a disease => increase attentional bias
Attentional processes can affect a placebo response.
Social Influences on Symptom Perception
• Stereotypical notions about “who gets” certain diseases
• It can interfere with the perception and response to initial symptoms.
• E.g (Martin et al): males -> heart disease
• Motivation to attend to and detect signs and symptoms of illness: depends on the CONTEXT at the time the
symptom presented.
◦ Noticed by the individual or by other people
◦ Changes in bodily appearance
• MacBryde:
Bodily signs: can be objectively recognised
Symptoms of illness: require interpretation
◦ Is fever a sign of illness or of physical exertion? Decide.
People’s views about health: depend on their prior experience of illness + understanding of medical knowledge
◦ People learn about health through experience
◦ Illness can challenge a person at a fundamental level
Illness or Disease?
Cassell (1976)
Illness: what a patient feels when they go to the
doctor (not feeling quite right): what a person
experiences
Disease: something of the organ/cell/tissue =>
physical disorder/ pathology
Ill without having an identifiable disease: being hangover
Disease without feeling ill: controlled asthma/diabetes; early-stage cancer.
An illness is managed; A disease is cured. (Google)
1.Symptom Perception
Attentional model of Pennebaker (1982): competition for attention by stimuli => some go unnoticed in some
contexts, but NOT in others
Cognitive-perceptual model of Cioffi (1991): focuses on the processes of interpretation of physical signs +
attribution as symptoms; the role of selective attention
Bodily signs => increased likelihood of symptom perception
They can or can not be symptoms of illness.
◦ Sweating: bodily sign, but not the symptom of illness
Signs which can be detected and identified:
◦ Blood pressure
Symptoms: what is experienced => SUBJECTIVE
◦ They are the result of physiological changes
◦ Only some can be detected by the individual
Symptoms which are likely to receive attention:
Painful or disruptive: a bodily sign with consequences for the person
(Not being able
to perform a
routine
activity)
, Novel: perceived severity of a symptom/ whether or not they will seek medical attention.
◦ A novel symptom (new to oneself) likely to be considered indicative of something rare/serious.
◦ A common symptom => assumption of lower severity => reduced likelihood to seek out medical help
Persistent: a bodily sign is more likely to be perceived a symptom if it lasts LONGER or if it persists in spite of self-
medication
Pre-existing chronic disease: past/current illness had a strong influence => increase number of symptoms
PERCEIVED/ REPORTED
Symptoms: unreliable as an indicated for medical attention
◦ Ones for flu: can be self manages
◦ Cancer: few initial symptoms
Attentional States and Symptom Perception
There are individual differences in the amount of attention people can give to their internal/external states.
Pannebeaker: people are LESS likely to notice somatic sensation if their attention is ENGAGED externally.
◦ More likely to observe somatic sensations if they are NOT distracted.
• Limited attentional capacity => internal and external factors
COMPETE for attention.
Competition of cues theory (Pannebaker 1982): a bodily sign can be undetected in some contexts, and detected in
others.
◦ Cognitive behavioural distraction manipulate attentional focus => useful tool for symptom management
(chapter 13)
High degree of attention => increase sensitivity to new/different bodily signs.
◦ “Mass psychogenic illness”: increase in attendance at doctors during pandemics
◦ Powerful effect of anxiety on our perceptions !!
◦ “Medical student disease”: increase knowledge about disease-specific symptoms
◦ Heightened attention to own bodily signs.
Brown => two attentional systems which influence how symptom information is processed
Primary Attentional System (PAS)
◦ Below the level of consciousness
◦ Acts on stored representations: illness schema which is automatically selected (from when a person over-
attends to bodily experiences)
◦ Symptom can be wrongly matched to a pre-existing schema (e.g. in mass psychogenic illness/medical student
disease)
Secondary Attentional System (SAS)
◦ More amenable to executive control
◦ Attention can be manipulated by conscious thoughts + cognitive processes (rational weighing of likelihood)
◦ Hampered if PAS has already dictated what the person to be focused on + if there is a label on the symptoms
(difficult to change)
Previous experience with a disease => increase attentional bias
Attentional processes can affect a placebo response.
Social Influences on Symptom Perception
• Stereotypical notions about “who gets” certain diseases
• It can interfere with the perception and response to initial symptoms.
• E.g (Martin et al): males -> heart disease
• Motivation to attend to and detect signs and symptoms of illness: depends on the CONTEXT at the time the
symptom presented.
