Global versus Specific Symptom Attributions: Predicting the Recognition and Treatment of Psychological Distress in Primary Care

Greer, Joseph A.; Halgin, Richard P.; Harvey, Elizabeth A.

doi:10.1016/j.jpsychores.2004.02.020

Cited by 23 publications

(26 citation statements)

References 23 publications

(33 reference statements)

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“…This aspect was investigated further by Greer, Halgin, and Harvey (2004) who examined the extent to which patients' specific beliefs about their presenting symptoms versus their global symptom attribution styles predicted physician recognition of psychological distress. They found that patient gender, age, severity of psychological distress, and specific beliefs about their presenting symptoms were reliable predictors of physician recognition and treatment recommendations.…”

Section: Attribution Styles and Somatization-the Evidencementioning

confidence: 99%

Somatization, somatosensory amplification, attribution styles and illness behaviour: A review

Dhananjayan

Isaac

Chaturvedi

2006

International Review of Psychiatry

153

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Somatic symptoms have been conceptualized in many different ways in literature. Current classifications mainly focus on the numbers of symptoms, with relative neglect of the underlying psychopathology. Researchers have emphasized the importance of a number of experiential, perceptual and cognitive-behavioural aspects of somatization. This review focuses on existing literature on the role of somatosensory amplification, attribution styles, and illness behaviour in somatization. Evidence suggests that somatosensory amplification is neither sensitive nor specific to somatizing states, and that other factors like anxiety, depression, neuroticism, alexithymia may also have an influence. Attribution research supports the existence of multiple causal attributions, which are related to the numbers of somatic symptoms. While somatizing patients have more organic attributions, depressed patients have more psychological attributions. A global somatic attribution style is associated with the number of obscure somatic symptoms, while a psychological attribution style is associated with both--psychological and somatic-- symptoms of depression and anxiety. There are conflicting findings with respect to the role of normalizing attributions in reducing physician recognition of anxiety and depression. Specific symptom attributions appear to explain physician recognition of psychological distress, but global attribution styles do not appear to explain any further variance in physician recognition beyond that explained by specific causal attributions. Illness behaviour has been studied in two distinct ways in literature. Research focusing on attendance rates as a form of illness behaviour suggests that somatization is associated with high levels of health care utilization. There is also some evidence that health care utilization, amplification and attributions styles may be interrelated among somatizing patients. More structured ways to assess illness behaviour have found high levels of abnormal illness behaviour in this population. Overall, research appears to suggest a complex (and as yet unclear) relationship between somatic symptoms and underlying cognitions/illness behaviours. While it is clear that somatization is closely related to a number of perceptual and cognitive-behavioural factors, the precise nature of these relationships are yet to be elucidated.

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Section: Attribution Styles and Somatization-the Evidencementioning

confidence: 99%

Somatization, somatosensory amplification, attribution styles and illness behaviour: A review

Dhananjayan

Isaac

Chaturvedi

2006

International Review of Psychiatry

153

View full text Add to dashboard Cite

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“…This item possesses adequate face validity and has been shown in a previous study to relate to physician recognition and treatment of psychological distress in primary care (23). In addition, physicians and patients each provide a global rating of how they would characterize one another on their respective versions of the questionnaire (i.e., CEQ/Cooperative scale from 1 ϭ "extremely cooperative" to 7 ϭ "extremely difficult").…”

Section: Clinical Encounter Questionnaire (Ceq)mentioning

confidence: 99%

“…For this analysis, the CEQ/Attribution difference scores were regressed on the following variables: patient demographic characteristics, level of psychological distress (i.e., SCL-90-R ratings), general health, recent stress, history of taking psychotropic medication or seeing a professional for counseling, and reason for office visit. These specific variables, which were simultaneously entered into the regression equation, have been shown empirically to relate to the interpretation of symptoms and recognition of psychological distress by providers in primary care settings (23)(24)(25). The results of the regression analysis (see Table 4) demonstrated that physicians were more likely to disagree with patients and believe that the presenting symptoms were more psychological in nature when the patient was female, indicated having taken medication for emotional reasons in the past, or presented with symptoms with no clear medical cause.…”

Section: Physician-patient Agreement On Symptom Etiologymentioning

confidence: 99%

Predictors of Physician-Patient Agreement on Symptom Etiology in Primary Care

Greer

Halgin

2006

Psychosomatic Medicine

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“…Psychological accounts of somatic symptoms can be perceived as referring to personal weaknesses and thus create a tension in the patienttherapist relationship because the therapist may assimilate narratives of psychological events to emotional disturbances. Practitioners' recognition of psychological symptoms and distress is not always selfevident [53]. Practitioners' resonance with the patient's expressed experience is an important component of the therapeutic alliance and is known to represent a key tool of the patient-practitioner relationship.…”

Section: Discussionmentioning

confidence: 99%

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem

Cedraschi¹,

Girard²,

Luthy³

et al. 2013

Journal of Psychosomatic Research

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Objective: Fibromyalgia (FM) is a chronic musculoskeletal pain disorder characterized by widespread pain. This study focuses on patients' attributions of illness and of symptom onset. Methods: Semi-structured interviews were conducted with 56 women to elicit patients' views on what triggered their FM. The transcripts of the interviews were analyzed using a classical indexing technique to identify key themes. Content analysis was performed by two independent coders. Results: Primary causal attributions fell into five categories: psychological problems (28 respondents); somatic concerns (N=12); violence/abuse during childhood (N=7), gynaecological/obstetrical problems (N=6), and fatigue (N=3). Patients' attributions were internal and external in the same proportions, more frequently unstable than stable, and more often described uncontrollable than controllable. Participants expressed decrements in self-esteem and feelings such as self-blame or despair; global perceptions of persistent pain and long-lasting problems, evoking chronicity and hopelessness; and low perceived control over their lives as well as beliefs that nothing can be done, thus increasing a feeling of guilt and vulnerability. Patients' narratives emphasized disruptive circumstances surrounding symptom onset. Conclusion: Attributions often referred to the psychological dimension of the events surrounding FM onset, even though some of them also had a clear somatic dimension. Many narratives mentioned successive disruptive events and suggested an increasing loss of control. Addressing these illness representations may contribute to tailor the treatment and to help patients gain self-coherency by providing means to understand pain onset but also to guide future behaviours, particularly in terms of adjustment and help-seeking.

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Global versus Specific Symptom Attributions: Predicting the Recognition and Treatment of Psychological Distress in Primary Care

Cited by 23 publications

References 23 publications

Somatization, somatosensory amplification, attribution styles and illness behaviour: A review

Somatization, somatosensory amplification, attribution styles and illness behaviour: A review

Predictors of Physician-Patient Agreement on Symptom Etiology in Primary Care

Primary attributions in women suffering fibromyalgia emphasize the perception of a disruptive onset for a long-lasting pain problem

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