Capita Selecta - Symptom perception,
interpretation and response
Chapter 9
Illness → generates changes in bodily sensations and functions that a person may perceive
themselves or perhaps have pointed out to them by another person.
Bodily signs → can be objectively recognized
Symptoms of illness → requires interpretation
Views of health are shaped by prior experience of illness and understanding of medical
knowledge.
Illness = what the patient feels when he goes to the doctor; i.e. experience of not feeling
quite right as compared with one’s normal state.
Disease = what a patient has on the way home from the doctor’s office; an objectifiable
pathological abnormality.
→ you can be ill without an identifiable disease & you can have a disease without being ill
Processes underlying 3 stages of response:
1. Perceiving symptoms
2. Interpreting symptoms as illness
3. Planning and taking action
Models of symptom perception:
● Attention model (Pennebaker); describes how competition for attention between
multiple internal or external cues or stimuli leads to the same physical sign or
physiological change going unnoticed in some contexts but not in others
● Cognitive-perceptual model (Cioffi); focuses more on the process of interpretation
of physical signs and influences upon their attribution as symptoms while also
acknowledging the role of selective attention
Bodily signs are physical sensations that may or may not be symptoms of illness; e.g.
sweating when just having exercised.
→ they are subjective
81
,Symptoms receiving attention and interpretation as a symptom are likely to be:
● Painful or disruptive; if a bodily sign has consequences for the person
● Novel; symptom new to oneself or believed not to have been experienced by others
● Persistent; bodily sign is more likely to be perceived as symptom if it persists longer
than normally
● Pre-existing chronic disease; past or current illness experience has a strong
influence upon somatization (i.e. attention to bodily states) and increases number of
other symptoms perceived and reported
Attention = the selection of some stimuli over others for internal processing.
→ somatic sensations are less likely to be noticed when a person’s attention is engaged
externally than when they are not otherwise distracted; e.g. athlete with injury doesn’t notice
it at the end of the race compared to the beginning (due to limited capacity)
→ this limited capacity and thus competition of cues is a theory of Pennebaker, explains
why a bodily sign that may be noticed immediately in some contexts may remain undetected
in others
2 systems to influence how symptom information is processed:
1. primary attentional system (PAS); operate below the level of consciousness and
acts on stored representations
2. secondary attentional system (SAS); considered more amenable to executive
control, i.e. attention here can be manipulated by conscious thoughts and cognitive
processes
People hold stereotypical notions about ‘who gets’ certain diseases and that this can
interfere with perception and response to initial symptoms.
Socialization = the process by which a person learns (from family, teachers, peers) the
rules, norms and moral codes of behavior expected of them.
Individual differences affecting symptom perception
Gender
→ gender socialization provides women with a greater readiness to attend to and perceive
bodily signs and symptoms; men ignore symptoms out of a need to be seen to be strong and
masculine
→ may be that physiological differences arising from puberty and menstruation influence
pain thresholds in the first place, or perhaps the evidence that women talk about symptoms
more does not reflect so much a gender difference in symptom perception as one in
reporting behavior
Life stage
→ increasing age tends to be associated with increased symptom self-report, however older
adults may interpret and respond differently to symptoms when perceived
→ whether children perceive specific symptoms differently to adults is unclear (difficult
communication)
82
,Emotions and personality traits
→ mood is crucial;
● people who are in a positive nood tend to rate themselves as more health and
indicate fewer symptoms;
● negative moods or negative emotional states (e.g. anxiety or depression) report more
symptoms, are more pessimistic about their ability to act to relieve their symptoms
and believe themselves to be more susceptible to illness
→ fear is associated with symptom perception
● fear of pain and fear of recurrence can increase a person’s attention and
responsiveness to bodily signs
● fear of being seriously ill can reduce a person’s attention to and consideration of
possible meanings of their symptoms
Neuroticism = a personality trait reflected in the tendency to be anxious, feel guilty and
experience generally negative thought patterns.
→ linked with greater physiological reactivity to stress, including elevated levels of stress
hormones (cortisol)
Negative affectivity = a dispositional tendency to experience persistent and pervasive
negative or low mood and self-concept (related to neuroticism).
→ can manifest itself either as a state (situation-specific) or trait (generalied, e.g.
neuroticism)
Cognitions and coping style
→ how people think and respond to external or internal events can also influence symptom
perception
→ individuals characterized by time urgency, impatience, hostility and competitive drive (type
A behavior) are less likely to perceive symptoms, perhaps because they’re highly
task-focused or because they avoid paying attention to signs of self-weakness
→ people who cope with aversive events by using repression are less likely to experience
symptoms than non-repressors;
Type A behavior = a constellation of characteristics, mannerism and behavior including
competitiveness, time urgency, impatience, easily aroused hostility, rapid and vigorous
speech patterns and expressive behavior
Repression = a defensive coping style that serves to protect the person from negative
memories or anxiety-producing thoughts by preventing their gaining access to
consciousness.
→ associated with higher levels of comparative optimism & poor physical health
Comparative optimism = initially termed ‘unrealistic optimism’; describes an individual’s
estimate of their risk of experiencing a negative event compared with similar others.
→ related to poor physical health
Monitors = generalized coping style involves attending to the source of stress or threat and
trying to deal with it directly, e.g. through information-gathering/attending to threat-relevant
information (as opposed to blunters)
Blunters = general coping style involves minimizing or avoiding the source of threat or
stress, i.e. avoiding threat-relevant information
83
, Once a symptom has been perceived, people do not generally consider it in isolation, but
relate it to other aspects of their experience and to their wider concepts of illness.
Symptoms can influence how we think, feel and behave.
→ culture, gender, life stage, past experiences, illness beliefs and representations will
influence the meanings and labels the individuals ascribe to symptoms
Cultural influences in processing symptoms
→ differences in the extent to which individuals respond to perceived physical symptoms &
differences in willingness to accept treatment
Individual differences = aspects of an individual that distinguish them from other individuals
or groups (e.g. age, personality, etc.).
→ exist in how symptoms are interpreted
Somatization disorder = the experience of multiple or medically unexplained symptoms,
more common in females.
Women will interpret a bodily sign as symptomatic of underlying illness more than men.
Medically unexplained (physical) symptoms (MU(P)S) → explanations include
psychodynamic accounts of dissociation, poor attachment and early conflict; cognitive
behavioral theories of attention and misinterpretation
→ many of those symptoms (e.g. fatigue, pain, gastrointestinal discomfort) are common for
many diseases and, depending on where your GP refers you, will lead to different diagnoses
→ MUS can be highly distressing and debilitating; people question the competency of their
doctors and get increasingly frustrated
Life stage in processing symptoms
→ young children are distinct from adolescents in their cognitive awareness of illness and its
implications by virtue of the stage of cognitive development attained & life experience.
→ convincing evidence that children have similar multidimensional illness representations to
adults
Personality can affect how symptoms are interpreted
→ high in NA or neuroticism exaggerate the meaning and implications of perceived
symptoms, and as a result of their negative interpretations of symptoms are more likely to
seek health care (can be positive) than those low in N
Social identity = a person’s sense of who they are at a group, rather than personal and
individual, level. (e.g. student, female)
→ interpretation of symptoms may depend on currently salient identity
Prior experience affects interpretation of and response to symptoms in that having a history
of particular symptoms or vicarious experience leads to assumptions about the meaning and
implications of some symptoms.
84
interpretation and response
Chapter 9
Illness → generates changes in bodily sensations and functions that a person may perceive
themselves or perhaps have pointed out to them by another person.
Bodily signs → can be objectively recognized
Symptoms of illness → requires interpretation
Views of health are shaped by prior experience of illness and understanding of medical
knowledge.
Illness = what the patient feels when he goes to the doctor; i.e. experience of not feeling
quite right as compared with one’s normal state.
Disease = what a patient has on the way home from the doctor’s office; an objectifiable
pathological abnormality.
→ you can be ill without an identifiable disease & you can have a disease without being ill
Processes underlying 3 stages of response:
1. Perceiving symptoms
2. Interpreting symptoms as illness
3. Planning and taking action
Models of symptom perception:
● Attention model (Pennebaker); describes how competition for attention between
multiple internal or external cues or stimuli leads to the same physical sign or
physiological change going unnoticed in some contexts but not in others
● Cognitive-perceptual model (Cioffi); focuses more on the process of interpretation
of physical signs and influences upon their attribution as symptoms while also
acknowledging the role of selective attention
Bodily signs are physical sensations that may or may not be symptoms of illness; e.g.
sweating when just having exercised.
→ they are subjective
81
,Symptoms receiving attention and interpretation as a symptom are likely to be:
● Painful or disruptive; if a bodily sign has consequences for the person
● Novel; symptom new to oneself or believed not to have been experienced by others
● Persistent; bodily sign is more likely to be perceived as symptom if it persists longer
than normally
● Pre-existing chronic disease; past or current illness experience has a strong
influence upon somatization (i.e. attention to bodily states) and increases number of
other symptoms perceived and reported
Attention = the selection of some stimuli over others for internal processing.
→ somatic sensations are less likely to be noticed when a person’s attention is engaged
externally than when they are not otherwise distracted; e.g. athlete with injury doesn’t notice
it at the end of the race compared to the beginning (due to limited capacity)
→ this limited capacity and thus competition of cues is a theory of Pennebaker, explains
why a bodily sign that may be noticed immediately in some contexts may remain undetected
in others
2 systems to influence how symptom information is processed:
1. primary attentional system (PAS); operate below the level of consciousness and
acts on stored representations
2. secondary attentional system (SAS); considered more amenable to executive
control, i.e. attention here can be manipulated by conscious thoughts and cognitive
processes
People hold stereotypical notions about ‘who gets’ certain diseases and that this can
interfere with perception and response to initial symptoms.
Socialization = the process by which a person learns (from family, teachers, peers) the
rules, norms and moral codes of behavior expected of them.
Individual differences affecting symptom perception
Gender
→ gender socialization provides women with a greater readiness to attend to and perceive
bodily signs and symptoms; men ignore symptoms out of a need to be seen to be strong and
masculine
→ may be that physiological differences arising from puberty and menstruation influence
pain thresholds in the first place, or perhaps the evidence that women talk about symptoms
more does not reflect so much a gender difference in symptom perception as one in
reporting behavior
Life stage
→ increasing age tends to be associated with increased symptom self-report, however older
adults may interpret and respond differently to symptoms when perceived
→ whether children perceive specific symptoms differently to adults is unclear (difficult
communication)
82
,Emotions and personality traits
→ mood is crucial;
● people who are in a positive nood tend to rate themselves as more health and
indicate fewer symptoms;
● negative moods or negative emotional states (e.g. anxiety or depression) report more
symptoms, are more pessimistic about their ability to act to relieve their symptoms
and believe themselves to be more susceptible to illness
→ fear is associated with symptom perception
● fear of pain and fear of recurrence can increase a person’s attention and
responsiveness to bodily signs
● fear of being seriously ill can reduce a person’s attention to and consideration of
possible meanings of their symptoms
Neuroticism = a personality trait reflected in the tendency to be anxious, feel guilty and
experience generally negative thought patterns.
→ linked with greater physiological reactivity to stress, including elevated levels of stress
hormones (cortisol)
Negative affectivity = a dispositional tendency to experience persistent and pervasive
negative or low mood and self-concept (related to neuroticism).
→ can manifest itself either as a state (situation-specific) or trait (generalied, e.g.
neuroticism)
Cognitions and coping style
→ how people think and respond to external or internal events can also influence symptom
perception
→ individuals characterized by time urgency, impatience, hostility and competitive drive (type
A behavior) are less likely to perceive symptoms, perhaps because they’re highly
task-focused or because they avoid paying attention to signs of self-weakness
→ people who cope with aversive events by using repression are less likely to experience
symptoms than non-repressors;
Type A behavior = a constellation of characteristics, mannerism and behavior including
competitiveness, time urgency, impatience, easily aroused hostility, rapid and vigorous
speech patterns and expressive behavior
Repression = a defensive coping style that serves to protect the person from negative
memories or anxiety-producing thoughts by preventing their gaining access to
consciousness.
→ associated with higher levels of comparative optimism & poor physical health
Comparative optimism = initially termed ‘unrealistic optimism’; describes an individual’s
estimate of their risk of experiencing a negative event compared with similar others.
→ related to poor physical health
Monitors = generalized coping style involves attending to the source of stress or threat and
trying to deal with it directly, e.g. through information-gathering/attending to threat-relevant
information (as opposed to blunters)
Blunters = general coping style involves minimizing or avoiding the source of threat or
stress, i.e. avoiding threat-relevant information
83
, Once a symptom has been perceived, people do not generally consider it in isolation, but
relate it to other aspects of their experience and to their wider concepts of illness.
Symptoms can influence how we think, feel and behave.
→ culture, gender, life stage, past experiences, illness beliefs and representations will
influence the meanings and labels the individuals ascribe to symptoms
Cultural influences in processing symptoms
→ differences in the extent to which individuals respond to perceived physical symptoms &
differences in willingness to accept treatment
Individual differences = aspects of an individual that distinguish them from other individuals
or groups (e.g. age, personality, etc.).
→ exist in how symptoms are interpreted
Somatization disorder = the experience of multiple or medically unexplained symptoms,
more common in females.
Women will interpret a bodily sign as symptomatic of underlying illness more than men.
Medically unexplained (physical) symptoms (MU(P)S) → explanations include
psychodynamic accounts of dissociation, poor attachment and early conflict; cognitive
behavioral theories of attention and misinterpretation
→ many of those symptoms (e.g. fatigue, pain, gastrointestinal discomfort) are common for
many diseases and, depending on where your GP refers you, will lead to different diagnoses
→ MUS can be highly distressing and debilitating; people question the competency of their
doctors and get increasingly frustrated
Life stage in processing symptoms
→ young children are distinct from adolescents in their cognitive awareness of illness and its
implications by virtue of the stage of cognitive development attained & life experience.
→ convincing evidence that children have similar multidimensional illness representations to
adults
Personality can affect how symptoms are interpreted
→ high in NA or neuroticism exaggerate the meaning and implications of perceived
symptoms, and as a result of their negative interpretations of symptoms are more likely to
seek health care (can be positive) than those low in N
Social identity = a person’s sense of who they are at a group, rather than personal and
individual, level. (e.g. student, female)
→ interpretation of symptoms may depend on currently salient identity
Prior experience affects interpretation of and response to symptoms in that having a history
of particular symptoms or vicarious experience leads to assumptions about the meaning and
implications of some symptoms.
84
