premenstrual symptoms. This indicates an association between cognitive state and
symptom perception. Pennebaker also reported that symptom perception is related to
an individual’s attentional state and that boredom and the absence of environmental
stimuli may result in over-reporting, whereas distraction and attention diversion
may lead to under-reporting (Pennebaker 1983). One study provides support for
Pennebaker’s theory. Sixty-one women who had been hospitalized during pre-term
labour were randomized to receive either information, distraction or nothing (van
Zuuren 1998). The results showed that distraction had the most beneficial effect on
measures of both physical and psychological symptoms suggesting that symptom per-
ception is sensitive to attention. Symptom perception can also be influenced by the ways
in which symptoms are elicited. For example, Eiser (2000) carried out an experimental
study whereby students were asked to indicate their symptoms, from a list of 30 symp-
toms, over the past month and the past year and also to rate their health status. However,
whereas half were asked to endorse their symptoms (i.e. mark those they had had), half
were asked to exclude their symptoms (i.e. mark those they had not had). The results
showed that those in the ‘exclude’ condition reported 70 per cent more symptoms than
those in the ‘endorse’ condition. In addition, those who had endorsed the symptoms
rated their health more negatively than those who had excluded symptoms. This suggests
that it is not only focus and attention that can influence symptom perception but also the
ways in which this focus is directed.
Environment: Symptom perception is therefore influenced by mood and cognition.
It is also influenced by an individual’s social context. These different factors are
illustrated by a condition known as ‘medical students’ disease’, which has been described
by Mechanic (1962). A large component of the medical curriculum involves learning
about the symptoms associated with a multitude of different illnesses. More than
two-thirds of medical students incorrectly report that at some time they have had the
symptoms they are being taught about. Perhaps this phenomena can be understood in
terms of: Mood: medical students become quite anxious due to their workload. This anxiety
may heighten their awareness of any physiological changes making them more
internally focused.
Cognition: medical students are thinking about symptoms as part of their course,
which may result in a focus on their own internal states.
Social: once one student starts to perceive symptoms, others may model themselves
on this behaviour.Therefore, symptom perception influences how an individual interprets the problem
of illness.Social messages
Information about illness also comes from other people. This may come in the form of
a formal diagnosis from a health professional or a positive test result from a routine
health check. Such messages may or may not be a consequence of symptom perception.60 HEALTH PSYCHOLOGY