The aim of the work presented in this thesis, was to investigate two general hypotheses derived from theories of the development and maintenance of medically unexplained symptoms (MUS) and health anxiety; that individual differences in attention to the body and somatic awareness contribute to the experience of physical symptoms and health anxiety. Three studies (an analogue pilot study, a prospective cohort study with primary care patients, and an analogue study involving a negative mood induction) were conducted to investigate the relationship between attention, somatic awareness, symptom reporting and health anxiety. In the pilot study, enhanced attentional disengagement from neutral material was associated with health anxiety and delayed disengagement from neutral material was associated with symptom reporting. In the primary care study, enhanced disengagement from neutral body-irrelevant material and delayed disengagement from threatening body-relevant material were independently associated with health care utilisation, but not symptom reporting or health anxiety. However, the longitudinal analysis revealed that attentional disengagement was neither a predictor of, or predicted by, health care utilisation. The tendency to experience distortions in somatic awareness was independently associated with symptom reporting, health anxiety and health care utilisation. Longitudinal analysis revealed that symptom reporting and health anxiety were independent predictors of somatic distortion, but that somatic distortion was not a predictor of symptom reporting or health anxiety. The results of a structural equation modeling analysis suggest that a model including both attentional disengagement and the tendency to experience distortions in somatic awareness improves understanding of symptom reporting, health anxiety and health care utilisation. In the negative mood induction study, however, neither attentional disengagement nor the tendency to experience distortions in somatic awareness were significantly associated with symptom reporting or health anxiety. The evidence presented here suggests that complex attentional processes may be associated with health seeking behaviours, possibly via a third unknown variable. This evidence, however, does not support the often-hypothesised general attentional bias for the body as a causative factor in the development of health anxiety or symptom reporting. This research has provided important evidence about attentional differences and how future research might extend the findings reported here. Furthermore, the findings regarding the tendency to experience distortions in somatic awareness provides empirical support for theories that suggest MUS may be associated with a tendency to place greater weight on top-down factors in the creation of somatic awareness (Brown, 2004; Edwards et al., 2013). However, whilst alterations in somatic awareness may be a maintenance factor for symptom reporting and health anxiety, somatic distortion may not be a causative factor in their development.
|Date of Award||31 Dec 2014|
- The University of Manchester
|Supervisor||Richard Brown (Supervisor), Carolyn Chew-Graham (Supervisor) & Ellen Poliakoff (Supervisor)|
- Medically Unexplained Symptoms
- Health anxiety
- Physical Symptom reporting
- Somatic Awareness