PSYC 3170 Lecture Notes - Lecture 6: Malingering, Hypochondriasis, Motivational Interviewing

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2 Feb 2013

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The psychology of getting sick and then getting help
Perceiving and Interpreting Symptoms
Generally we're not very accurate at it
Complicated by a number of influences
Not good at having a good sense of what is happening inside our bodies and then accurately
making sense of those symptoms
Language – hard to explain how we feel
Example: I having this pain in my stomach –nauseous, burning, cramping, happens
randomly, I do not know what makes it better or worse.
Terrible ta articulating ourselves
Kids are bad at explaining what they are feeling
We have not evolved enough to perceive our symptoms. Only good at when it is an
extreme or more serious sickness (cancer).
Individual Differences
Some people have more symptoms
There are differences in what people can tolerate
Differ in how much attention is paid to internal states
Internally focused people overestimate bodily changes and experience slower recovery
Personality affects
Neuroticism--predicts quite well how many medical complaints you will report
Monitoring –pay more attention to bodily changes
Panic attacks – have high levels of interoceptive awareness –know when something is
wrong or amiss internally. Have more attacks because they focus on the symptoms such
as heart rate increase and faint feel causing them to get even worse and fall into the fight
or flight response.
Based on whether one sees an increased heart rate as dangerous or not a big deal
because it was probably the coffee they had.
Internally focused people – overestimate bodily changes and experience a slower
recovery in terms of sickness and stress. Heart rate could be average for instance but to
them they perceive it as racing. Example: nervous system may be more hyper aroused
and returns to a normal rate more slowly → could be biological differences.
Personality and Hypertension: Effect of Hypertension Awareness
Refer to graph on ppt.
Study on Personality and Hypertension
Measured people in personality test for neuroticism
Those that were the highest were those who were aware
The second highest were those that were aware they were hypertensive
Difference: whether you aware of your status
Those lower in it do not go to the doctor and therefore are not aware that they are
Those high in it go to the doctor more often and therefore get their blood pressure done
all the time.
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Personality and Hypertension Conclusion
Awareness of hypertension status confounds assessment of the association between
personality characteristics and hypertension
Hypertension label → told you are hypertensive therefore act even more neurotic
Self-selection bias → neurotic people go to the doctors more often
Low level symptoms: headaches, fatigue, diarrhea etc → tend to be associated with
depression and anxiety
They could be experiencing these symptoms due to their mental disorder and attributing
them to their organic thoughts.
Symptom Awareness
General stress is associated with greater reports of symptoms
Mood—positive mood associated with fewer symptom reports than negative mood
Those who are stressed either report more symptoms (feel weak and sick) or actually do
have more symptoms
Stress-- muscle tension, gastrointestinal problems (blood diverted away from stomach),
weak immune system. → many ways for stress signs to come across as illness
This is intuitive even without the scientific studies
Physicians are still biased by thinking in biomedical terms. Example: go to doctor and they
always relate your symptoms to a medical issue and do not consider stress and other
personal factors rather than biological.
High number of people suffering from this is due to anxiety and depression
Psychosocial Influences
Prior experience, beliefs and knowledge influence expectations about symptoms
Ignore unexpected symptoms, amplify expected symptoms
Beliefs abut the disease label, causes, time course, and consequences influence symptom
awareness and experience.
What you are told is going to happen such as being told the symptoms of a drug you
are about to take for a study will cause you to feel like you are showing all
symptoms meanwhile you most likely just took a placebo pill.
Your perceived notion of symptoms is affected due to the information you obtained.
Practitioner—you want people to self-monitor which is good but the problem could
be that people have the wrong or misinterpreted information.
Inert substance or treatments
People can experience real symptoms relief
Furthermore taking placebos faithfully is associated with a lower likelihood of death
There are actual placebo surgeries (people are opened up in a surgery room, but are
not operated on, but then have to heal like normal).
Adherence to placebo makes the difference. Example: take placebo faithfully. If
you are very good at taking your placebo pill everyday and keeping track then
you are also probably someone who follows the good health behaviour practices
outlined by one's doctor.
Maybe faith reduces anxiety and therefore aspects such as your immune
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