Casual dimensions of college students' perceptions of physical symptoms.

According to attribution theory, controllability, locus, and stability are important dimensions underlying causal explanations. The extent to which these theoretical dimensions underlie lay explanations for physical symptoms is unclear. Accordingly, in this study, attributes relevant to the lay public were empirically derived using a multidimensional scaling (MDS) procedure. Undergraduates (N = 194) provided similarity judgments for 18 potential causes of physical discomfort. The MDS analysis yielded a three-dimensional solution. The first dimension captured the distinction between "physical" and "nonphysical" causes. The second dimension distinguished either "variable" versus "stable" causes or those that are "controllable" versus "uncontrollable" by health care professionals. The third dimension differentiated causes under "low" versus "high" personal control. These findings empirically confirm the theoretically proposed dimensions of "personal control" and "stability" and suggest the utility of considering the "physical/nonphysical" and "controllability by health care professional" distinctions in future work on attributions in the health domain.

The effect of litigation status on adjustment to whiplash injury.

STUDY DESIGN: This retrospective study examined the effect of civil litigation on reports of pain and disability in chronic pain patients who sustained whiplash injuries after a motor vehicle accident. OBJECTIVES: To examine the effect of litigation on adjustment to chronic pain. SUMMARY OF BACKGROUND DATA: A common methodologic weakness with many studies in this area is the composition of the nonlitigant group, which often includes individuals who have completed litigation as well as those who opted not to litigate. This introduces a confound in that litigant and nonlitigant groups differ not only with respect to litigation status but with respect to any factors that predispose one to litigate. METHODS: Questionnaire data were obtained from 41 patients (current litigants) in the process of litigation and 21 patients (postlitigants) who had completed litigation. Subjects completed self-report measures assessing demographic characteristics, psychological distress, sleep disturbance, employment status, and various pain indices. RESULTS: There were no significant group differences in demographic characteristics, employment status, or psychological distress. Litigants, however, reported more pain than did postlitigants. Group differences in pain reports remained statistically significant even after controlling for length of time since accident and initial severity of the injuries. CONCLUSIONS: That litigation status did not predict employment status suggests that secondary gain does not figure prominently in influencing the functionality of these patients. The rather robust effect of litigation status on pain reports is discussed with respect to the potential mediational role of the stress of litigation.

The impact of contextual cues on the interpretation of and response to physical symptoms: a vignette approach.

This study examined the impact of two contextual cues--stress and aging--on conceptualizations of, and health care responses to, physical symptoms. Eighty-three undergraduates each read four vignettes describing a woman experiencing physical symptoms indicative of either heart attack, depression, ulcer, or flu. Subjects were randomly assigned to one of six age/stress cue combinations. Consistent with predictions, physical symptoms presented with stress cues were less likely to be attributed to acute illness and were seen as more variable. The effect was most pronounced for heart attack symptoms, which, when presented with stress cues, were also less likely (1) to be identified as a heart attack, (2) to be attributed to chronic illness, (3) to elicit recommendations to seek medical care, (4) and to be regarded as serious. The age manipulation did not exert an effect. Implications of these findings and limitations of the vignette approach are discussed.

The menopausal hot flush: symptom reports and concomitant physiological changes.

Hot flushes are the most frequently reported menopausal symptom. The primary study goal was to develop criteria for the identification of hot flushes that ultimately could be applied independent of symptom report. Twenty-one postmenopausal women each underwent psychophysiological monitoring. Physiological activity accompanying their 93 subjective flush reports was compared with activity during nonflush periods, and a discriminant function analysis was carried out. The Physiological Flush Profile (PFP), developed on the basis of these analyses, consists of peripheral vasodilation plus an increase in skin conductance (sternal and/or palmar), both of a specified magnitude. The PFP was shown to be both a specific and a sensitive measure of hot flushes. Notably, change in sternal skin conductance was highly positively correlated with subjective flush severity ratings. Potential applications of the PFP toward delineating the role of psychological factors in the reporting of menopausal symptomatology are discussed.

Impact of stress on objectively recorded menopausal hot flushes and on flush report bias.

The hot flush (or flash) is the most widely reported menopausal symptom. Anecdotal reports suggest that women experience more hot flushes when stressed. Although stress may actually trigger hot flushes, another possibility is that women under stress may be more aware of the physiological changes associated with flushes and, therefore, more likely to report them. The goal of this study was to test these hypotheses by investigating the association between stress and both objective (i.e., physiologically recorded) and subjective hot flushes. Twenty-one postmenopausal women who reported having frequent hot flushes each underwent psychophysiological monitoring during stressful and nonstressful laboratory sessions. Significantly more objective flushes were recorded during the stress session than during the nonstress session. The stress manipulation, however, did not affect subjects' propensity to report flushes. These results suggest that the observed association between reported hot flushes and stress is not due to changes in report bias. The physiological mechanisms through which stress may stimulate hot flushes are discussed.

Hypnotic susceptibility and its relationship to outcome in the behavioral treatment of asthma: some preliminary data.

12 subjects from an experiment on relaxation therapy for asthma were given the Harvard Group Scale of Hypnotic Susceptibility, Form A. Full scale hypnotic susceptibility scores were positively correlated, at a borderline significance, with improvement in the methacholine challenge test, a measure of asthma severity. Performance on the amnesia item of the Harvard Group Scale was correlated with improvement in self-reported symptoms of asthma.

Women's attitudes toward the menopause: an update.

A sample of 244 pre-, peri-, post-menopausal and hysterectomized women were administered a 10-item Menopause Attitude Questionnaire which assessed women's agreement with several controversial menopausal issues (i.e., whether the women subscribed to a view of menopause as a normal developmental stage or as a deficiency disease; attitudes toward hormonal replacement; and whether female sexuality was perceived as compromised during and subsequent to menopause). Results revealed that even a fairly homogeneous population of well-educated women held a considerable diversity of beliefs about the menopause. Respondents were clearly divided regarding the issue of hormone replacement therapy and its associated risks, but were united in holding optimistic beliefs about maintaining their femininity and sexuality subsequent to menopause. The implications of this research are discussed in terms of the current zeitgeist regarding menopause.

Relaxation decreases large-airway but not small-airway asthma.

Eleven asthmatic subjects were each offered sixteen sessions of relaxation therapy, consisting of progressive relaxation, desensitization, and EMG biofeedback to the trapezius and frontalis areas, while 9 subjects were offered a complex placebo. Subjects in the relaxation condition showed greater improvement than subjects in the placebo condition in performance on a methacholine challenge test which, as a measure of airway reactivity, reflects degree of asthma. Subjects in both conditions showed improvements in various self-report measures of asthma symptoms and psychopathology. Subject in the relaxation condition reported a significantly greater decrease in frequency of emotional precursors to asthma attacks than subjects in the control condition. Overall improvement on the methacholine challenge test was predicted almost perfectly by heliox spirometry. Only subjects showing predominant large-airway obstruction obstruction improved on the methacholine challenge test. The relative contribution of large airway obstruction to asthma was found to correlate with psychopathology.

Sexual expression and its determinants in the post-menopausal woman.

Anatomic, hormonal, psychosocial and psychosexual variables of sexual expression were evaluated in 69 non-patient post-menopausal women. Subjects received a 2-h individually administered interview, a gynecologic examination with subjective scoring of vaginal atrophy, and serum determinations of estrone, estradiol, and androstenedione, testosterone, FSH and LH. Sexual repertoire of the 34 coitally active (coitus greater than 3 X monthly) was compared to the 29 coitally inactive (coitus less than 10 X yearly) subjects. The majority of subjects engaged in traditional sexual activities, with emphasis on physical affection and coitus. The active and inactive women were similar on all demographic variables except family income and weight/height ratio. The inactive women were slightly more obese and had lower incomes. Post-menopausal patterns of sexual activity correlated with post-menopausal sexual expression as did partner availability and function. The active women had a significantly higher LH level. No correlation was found between current or ideal sexual frequency and androgen or estrogen levels.

Vaginal atrophy in the postmenopausal woman. The importance of sexual activity and hormones.

The effect of sexual activity on vaginal atrophy was investigated in a group of 52 postmenopausal women (mean age, 57 years). Subjects were divided into two groups: sexually active (intercourse frequency, three or more times monthly) and sexually inactive (intercourse frequency, less than ten times yearly). Two gynecologists examined all subjects and completed an index of vaginal atrophy that assessed six genital dimensions. Blood samples were also analyzed by radioimmunoassay for levels of circulating estrone, estradiol, androstenedione, testosterone, follicle-stimulating hormone, and luteinizing hormone (LH). As predicted, less vaginal atrophy was apparent in the sexually active women as opposed to the sexually inactive women. Further, women with less vaginal atrophy had significantly higher mean levels of androgens (androstenedione and testosterone) and gonadotropins (particularly LH). We discuss herein the implications of this study, particularly the importance of androgens in reducing atrophy and maintaining sexual interest.