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Psychology of Physical Symptoms - Coggle Diagram
Psychology of
Physical Symptoms
Symptoms
What are physical symptoms?
Experienced ‘in the body’
Subjective, but may also present with objective ‘signs’
Can range from clearly medically explained to medically unexplained
Contentious idea > moved away from because it’s not so clear-cut.
Psychological factors can modify experience.
Can occur with no identifiable disease or pathology.
Stress and symptoms are intertwined.
Case Study: Somatic Symptom Disorder
Common beliefs that more tests are needed because doctors may have missed something
Distrust or disbelief in the patient
What are symptoms?
Biomedical model: A symptom is a departure from normal function or feeling which is noticed by a patient, reflecting the presence of a physiological disturbance, or of a disease
The implication is that if no disease is found, then it must be all in your head.
HOWEVER, diseases don’t always cause symptoms.
Tests of blood antibodies show diseases that people don’t remember having recently > influenza, Zika virus, various STIs (which are largely asymptomatic), high blood pressure and cholesterol, many early-stage cancers, etc.
Why there is such a push for screening.
Much more likely to have symptoms without disease than symptoms with disease > ~90% of people have at least one symptom over a past week.
Psychological and social processes are very big influences.
Responding to everyday symptoms
What do people do when they have symptoms?
Google searches, changing routines, home remedies, seeing a doctor, ignoring them.
Symptoms are the top reason for visiting a GP.
At least 33% of symptoms are medically unexplained > most commonly headaches and back pain.
20-25% of patients have recurring symptoms > most commonly headaches and back pain.
Symptoms are usually comorbid with a mood or anxiety disorder.
Normal psychological influences
on symptom reporting
Symptoms are imprecise representations of body states
Attention to internal sensations
Competition of cues hypothesis
We can pay attention to our physical bodies or the world around us.
Weighing up attentional resources at any point in time, and subconsciously deciding where the attention goes.
Paying more attention to your body = detecting more symptoms
People report more symptoms when exercising indoors compared to outdoors > little environmental interest = feeling more symptoms from the exercise because you’re paying more attention to your body.
Overall: interesting environment = fewer symptoms.
Beliefs and expectations
Selective search for information
Directed attention
Illness schemas > set of beliefs and expectations about an illness/being ill
guide your interpretation of symptoms.
Can be formed by experience, media portrayals, and information you have about an illness
Schema-guided search > being put on alert to look out for certain symptoms
Makes it more likely you’ll notice them and can trigger the experience in the absence of actual illness.
Fictitious enzyme deficiency (Croyle and Sande 1988)
Fake illness diagnosed by saliva test, causing headache, diarrhea, and back pain.
People told they were positive experienced more symptoms than those who were told they were negative (specifically the symptoms mentioned as part of the illness).
Emotions
High negative affect
> anger, anxiety, depression, distress = more physical symptoms
Difference in symptoms, but NOT objectively having a physical disease.
HOWEVER, sometimes, because of trauma and stress, you can have an increase in physical disease.
Distress experienced as symptoms
Somatisation: we can experience negative emotions as physical symptoms
Negative bias
When in negative mood states, people pay more attention to negative information, like unpleasant symptoms
When in negative mood states, people are more likely to preferentially recall negative information from their memory.
Increased self-focus > more likely to notice symptoms.
Spectrum of symptom experience
Normal experiences to persistent physical symptoms
Distressing, occurs most days, over many months, with or without somatic disease, life impairment.
Persistent physical (somatic) symptoms
Common in both the general population and medical settings.
Estimated lifetime prevalence: 5.9-16.3%
Makes up ~20% of consultations in primary care.
About ¼ of individuals with acute symptoms develop persistent somatic symptoms and remain affected after 1 year.
Transition from acute to persistent symptoms
Your brain constructs and experiences based on sensory input from the body and ‘priors’ ( attention, beliefs, emotions, expectations)
At first, your body reacts to mostly sensory input, but over time, your body draws more on your prior experience and expects pain signals to be there, so it continues them.
Pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.
Pain is more or less a warning that something can be damaged.
the subjective experience of actual or impending harm.
Nociception: the nervous system’s process of encoding impending or actual tissue damage (ie noxious stimuli)
Congenital analgesia
Often die quite young because there is no detection mechanism for organ damage, burns, broken bones, etc, so they don’t know to assess risks and take part in safe behaviour to reduce that damage.
Pain processing
Transduction >> transmission >> perception >> modulation
Transmission
Transmission from the localised area to the dorsal horn of the spinal column to the brain, and is then distributed across the brain
Limbic forebrain (emotional reaction)
Thalamus (projecting to other areas of the brain)
Primary sensory cortex (location of pain)
Cortical association areas (interpretation of pain)
Perception
Pain becomes a multidimensional experience > motivational, behavioural, sensory-discriminative, emotional
Biomedical model > pain severity should = amount of tissue damage, and the same injury in different people should cause them the same amount of pain > WRONGGGG
Perception of injury can cause the experience of pain, even when there’s no tissue damage.
Gate control theory
Biopsychosocial view of pain
Hypothetical mechanism of a “gate” at the spinal cord > pain message comes from peripheral nerves, and the spinal cord can let in more or less pain signals, causing more or less perceived pain.
The gate receives input from two directions: ascending messages are biological in nature, and descending messages are psychological in nature.
Transduction
Nerve endings (nociceptors) > primary afferent neurons: sensory neurons in the peripheral nervous system
Respond to noxious stimuli or the potential of it > tissue damage and inflammation
C and A- delta fibres
A: large diameter, myelinated, fast conducting > localised, sharp, stinging, pricking pain
C: smaller diameter, unmyelinated, slow conducting > diffuse, dull, burning, aching pain.
Modulation
Descending modulatory pain pathways can be excitatory or inhibitory > more or less pain.
Psychological factors that modulate pain:
Emotions > negative emotions can increase the experience of pain, positive mood can experience less pain.
Thoughts about pain > what you think is causing the pain, negative beliefs about the pain, the meaning attributed to the pain, previous experience
Benedetti et al (2013)
Telling people to endure a blood pressure cuff to either endure as much pain as possible, or as a benefit to the muscles.
Attention > distraction = less pain, attention on injury = more pain
Acute pain
Typically results from a specific injury or disease process like a wound or infection
Short-lived, resolves when tissue damage heals
Duration: three months or less
Peripheral sensitisation > inflammatory soup
Nociceptive neurons: reduced threshold, augmented response, inflammatory processes, common after injury.
Chronic pain
Begins as acute pain
Lasts longer than three months
Beyond the expected healing time
Unrelated to injury or disease
In excess of injury or disease
Cortical sensitisation > neurons in the dorsal horn:
Amplify incoming information
‘wind-up’
Persistent state of high reactivity
Lowered pain threshold
Cortical reorganisation > Nociceptive neurons
Remodels in response to repeated input
Neuroplasticity
Greater and more widespread activation to nociceptive input.
Treating chronic pain
Helping address negative emotions, CBT, slowly rewire the brain to fix cortical reorganisation.
Fear avoidance model
People who have a pain experience and start catastrophising experience pain-related fear, leading to avoidance and hypervigilance, and eventually disuse, depression, and disability.