At the beginning of the 1980s a systematic research effort developed into evaluating how psychological factors influenced the experience of physical symptoms. A number of studies demonstrated that, while a wide range of physical symptoms are experienced frequently in the community, the vast majority of these symptoms are self-managed and only a small percentage of people seek medical assistance.(35) Moreover, some individuals routinely seek out health care for minor symptoms while others with serious medical problems delay or fail to seek care.(36) These findings point to an important role for psychological factors in the appraisal of symptoms and interpretation of illness. There is considerable evidence that bodily symptoms and functions are not perceived with a high degree of accuracy and individuals vary widely in what symptoms are attended to and whether symptoms are reported.(37) Important explanatory concepts to explain these findings are the role of competition for cues, and cognitive schemas.
The probability that individuals will attend to somatic information will depend on the competition for attention from other sources of available stimuli. An illustration of this is the fact that symptoms perception is strongly influenced by environmental factors. When the environment is lacking in stimulation individuals tend to pay more attention to bodily symptoms. Conversely, when an individual's attention is drawn to the external environment, bodily symptoms are less likely to be noticed. This finding has wide day-to-day applications ranging from why people cough in the boring parts of movies to explain demographic differences in symptoms reports such as increased symptom reporting among the socially isolated and the unemployed.(37) It also has clinical applications in chronic pain and other chronic medical conditions where patients' isolation may exacerbate the condition by increasing preoccupation with symptoms.
Cognitive schemas can also strongly influence the reporting of physical symptoms by guiding the way individuals pay attention to their body. Schemas determine the organization of incoming information and retrieval of stored information, and guide behaviour. There is a strong tendency for individuals to search for information that is consistent with existing schemas and disregard information that does not fit. Individuals also attach more importance to symptoms consistent with a current cognitive schema than other symptoms. Schemas may develop through personal experience with the condition or by having come across the illness through family, friends, or in the media.(38) Illness schemas can vary from vague ideas about the types of symptoms that represent an illness to more elaborate and detailed conceptions of individual illnesses. Medical students' disease and episodes of mass psychogenic illness are more dramatic demonstrations of this phenomenon, but the process is seen on a more subtle level with response to placebos (see below). Here, following treatment, a cognitive schema may develop that shifts attention towards symptoms that indicate recovery rather than those of the illness.
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