what is sensation
stimulus-driven process by which our sense organs respond to and translate environmental stimuli into nerve impulses that are sent to brain
function of low-level biochemical and neurological events that begin with the impinging of a stimulus upon the receptor cells of a sensory organ
passive process of bringing info from outside world into body and brain- we don’t have to be consciously engaging in a ‘sensing’ process
sensory systems provide info about balance (vestibular sense), body position and movement (proprioception and kinesthesia), pain (nociception), and temperature (thermoception)
what is perception
the way sensory info is organised, interpreted and consciously experienced
shaped by learning, memory, motivation, expectation
what is top-down processing
previous experience and expectations are used to recognise stimuli
what is bottom-up processing
we sense basic features of stimuli and then integrate them
what is a symptom
a characteristic sign or indication of the existence of something else
(ie a disorder or disease, a change from normal function)
subjective indication, that may be accompanied by objective signs of disease as abnormal lab test results or findings during a physical examination
what did Petrie et al find
asked ppts what symptoms/sensations they’d had in the past 7 days
median amount of symptoms was 5
females had more than men
what is the difference between symptoms and signs
symptoms = subjective, not outwardly visible to others ie pain/nausea/fatigue
signs = objective, can be felt/heard/seen by a medical professional ie bleeding, bruising, swelling, fever
what did tibblin et al 1990 find
sleeping disturbances, pain in the joints, pain in the legs, breathlessness, impaired hearing all INCREASE with age
general fatigue, abdominal pain, nausea, diarrhoea, cough and headache DECREASE with age
what is symptom perception
Benzett et al 2000 = patient’s consciously appreciated sensation of a physiologic problem
Posey, 2006 = what a person believes his or her symptoms mean in the physical and psycho-social-spiritual contexts
what are the processes of symptom perception
physical symptoms are generally preceded by physiological changes ie fluctuations in normal bodily processes, organic disease (acute and chronic), emotions, induced by environmental conditions
these changes trigger receptors throughout the body, generating info about the state and function of internal organs and organ systems
only a small proportion of this info gives rise to awareness of bodily changes
humans have limited attention capacity so a selection takes place in info processing but only some of available info is consciously processed
regulation decides to what degree somatic info is selected for processing
awareness of often mild and ambiguous physical sensations depends on the attention we pay to it or can pay to it
what is a cognitive-perceptual model of somatic interpretation
Cioffi, 1991
somatic interpretation is a multiprocess elaboration upon a real or perceived physiological change, best characterised as an interaction between stimulus-driven and top-down influences
physiological change may produce no somatic awareness, or awareness with several diff interpretations
physical state obtains a somatic label (ie cold hands), then is given attributions (ie perceived causes/consequences), which also interact with mediators such as goals/coping strategies etc and prior hypotheses ie concerns about illness
mediators and physical state influence behaviour
what is the symptom perception model
kolk et al, 2003
rather than passively receiving external or internal info, individuals are actively engaged in the perceptual process
STAGE 1: information input; pathology, physiology, emotions and environment influence the SOMATIC INFO we receive
STAGE 2: attention; negative affectivity, selective attention and external info all interact
STAGE 3: detection; somatic sensations
STAGE 4: attribution; sensation leads to psychological attribution and somatic attribution
STAGE 5: experience; psychological attribution leads to psychological symptoms AND somatic attributions lead to physical symptoms
why is symptom perception important
perceptions influence decision to seek medical help, type of info or help people seek, urgency with which they seek help
interpretation of a sensation is guided by illness schemas and cognitive structures based upon earlier experiences with and ideas about illness/disease
same sensation (ie perspiring) can receive multiple interactions and attributions ie sensation can be attributed to a somatic disease like fever OR to emotional distress like nervousness
attribution given to a specific somatic sensation determines whether physical or psychological symptoms are experienced (Kolk et al, 2003)
what is health anxiety
excessive or inappropriate fear that one has a serious illness based on misinterpretation of bodily sensations or changes (Abramowitz and Braddock, 2008)
exists on a continuum with mild concern to severe anxiety (Ferguson, 2009; Longley et al., 2010)
severe health anxiety persists despite medical reassurance and creates clinical levels of distress of functional impairment, believing they have a serious, terminal or degenerative disorder (Taylor & Asmundson, 2004)
profound sense of ongoing threat
catastrophic misinterpretation
anxious preoccupation
selectively attend to health-related info that confirms their illness beliefs
what is adaptive concern about health
most ppl show some level of concern about health
generally viewed as adaptive if it provides motivation to engage in appropriate actions ie take prescribed medications or seek needed medical attention (Abramowitz & Braddock, 2008)
adaptive concerns are typically short-lived, replaced by more urgent thoughts or dispelled through medical consultation
what behaviours may those with health anxiety engage in
repeatedly checking body for symptoms or changes
dwell on worst consequences with vivid images of terminal illness and death
avoidance behaviour = avoiding situations that may activate health anxiety ie touching/looking at body OR avoid ‘risky’ activities ie physical exercise OR not attending medical consultations
what frameworks are used for health anxiety diagnoses in DSM-5
illness anxiety disorder
somatic symptom disorder
what is the IAD symptoms for health anxiety in DSM-5
excessive fears of having/acquiring serious disease, high health anxiety, behavioural symptoms
care-seeking or care-avoidant
narrowly defined criteria
excludes those with somatic symptoms
what is the SSD criteria in DSM-5 for health anxiety
presence of one or more distressing/disabling somatic symptoms that disrupt daily functioning
also need excessive thoughts, feelings, behaviours related to symptoms and health concerns
what did petrie et al 2019 find were the most common symptoms searched on google at diff times of the day
10pm= cancer, increased appetite, sexual problems
1am= back or neck pain, drowsiness, breathing problems, death, fatigue or loss of energy
2am= low blood pressure, numbness, nightmares, headache, joint pain/stiffness, suicide
3am= skin rash/itching, diarrgoea, congested or runny nose, painful menstruation, irritability, abdominal pain, anxiety, hot flushes, vomiting
4am= dry mouth, irregular heartbeat, hair loss, depression, convulsions, upset stomach, cough, dizziness, hangover
5am = nausea, vision or hearing problems, tremor or muscle spasms
6am= muscle pain
7am= difficulty concentrating
what did te poel et al 2016 find about online health seeking behaviours
4-wave longitudinal study
5322 respondents
studies link between online health info seeking and health anxiety (cyberchondria)
more health anxious = more online searching
BUT not found in subsample of clinically health anxious ppl - online health-info seeking did NOT exacerbate health anxiety levels, but may maintain it?
what are individual differences affecting symptom perception
pennbaker (1983); focusing on internal states = overestimating heart rate
Kohlmann 2001; neg correlation between cardiac vigilance and heart-beat detection (more aware, underestimate health rate)
Miller et al 1987; internal focus = perceptions of slow recovery
Kohlmann 2001; internal focus = more health-protective behaviours
what factors affect symptom perception
individual differences
mood
sex
what studies support the impact of symptom perception
emotional factors, pain intensity and disability = Meredith, Strong & Feeney, 2006
depression = Arnstein et al 1999
anger = Okifuji, Turk and Curran, 1999
