From illness perceptions to illness reality? Perceived consequences and emotional representations ... in p/with vertigo & dizziness, 2020, Wolf et al

Andy

Andy

Retired committee member
Full title: From illness perceptions to illness reality? Perceived consequences and emotional representations relate to handicap in patients with vertigo and dizziness
Highlights
• Illness perceptions relate to handicap in patients with vertigo and dizziness.
• Perceived illness consequences are the most substantial predictor of handicap.
• Psychological impairment occurs as well in patients with purely structural diagnoses.

Abstract
Objective
Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD.

Methods
In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires.

Results
Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p < .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms.

Conclusion
Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.
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Paywall, https://www.sciencedirect.com/science/article/abs/pii/S0022399919307834
Sci hub, https://sci-hub.se/10.1016/j.jpsychores.2020.109934
 
Perhaps I'm misunderstanding this, but it almost sounds like they're suggesting that if patients would only "lighten up" about consequences of dizziness and vertigo then they wouldn't be so handicapped.

I'm perfectly willing to let any interested investigators test this theory by riding along with me on as I drive on treacherous, winding mountain roads while listening to some old Steve Martin records.
 
Problem is that almost all of that perception comes from people who are not experiencing the illness in the first place and clearly have a very poor understanding of the impact. It's a distortion of reality, complexity compressed to oversimplistic carricatures invented to fit expectations.

Actually this is relatively easy to test, as vertigo and dizziness can be induced. Let's have the researchers experience them chronically and see how their perception changes. No takers? Figures.

False attribution error syndrome, yet again. This is straight in line with "the only poverty is in the mind", that the perception of being poor is somehow more significant than the actual impact of being poor. Something only a person who has never experienced it would ever think.

Where medicine cannot measure things, frankly things are about exactly as poor as they were a full century ago. Zero significant progress, just embarrassing.
 
• Perceived illness consequences are the most substantial predictor of handicap.
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Unless I'm misunderstanding something, illness consequences is conceptually very similar to handicap. Two terms for similar things. Unsurprisingly, the closer two things are conceptually, the more tightly they will correlate, or "predict" each other.
 
strategist said:
Unless I'm misunderstanding something, illness consequences is conceptually very similar to handicap. Two terms for similar things. Unsurprisingly, the closer two things are conceptually, the more tightly they will correlate, or "predict" each other.
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Ironically enough, this is, yet again, strong evidence that people suffering from chronic illness are generally reliable witnesses to our life experience and actually pretty good at predicting progression and assessing our limits. For roughly the same reasons that asking someone if they can jump 6m in the air, they will say no. Not because they don't want to but because no human has ever done that and we generally know what we are capable of, give or take a few exceptions.

You know, the exact opposite of the current illness model. It would actually be interesting to specifically research this, it only ever has in the wrong direction, which is the only reason this is believed in the first place. The entire paradigm is built on the idea that this perception is itself the illness, when it's actually evidence of the opposite.
 
Snow Leopard said:
Perhaps the handicap comes first and the illness perceptions come second... :rolleyes:
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strategist said:
Unless I'm misunderstanding something, illness consequences is conceptually very similar to handicap. Two terms for similar things. Unsurprisingly, the closer two things are conceptually, the more tightly they will correlate, or "predict" each other.
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It looks to me like they are abusing the fact that 'predict' and 'explain' mean something different in statistical models versus typical communication. Very shabby.

Clearly this being a cross-sectional study, there is no 'prediction' or 'explanation'/causality in the non-statistical sense. However, when I read the following:
Perceived illness consequences are the most substantial predictor of handicap.
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Using a newly developed scale for illness beliefs, this study found that patients' fear of losing control over the illness helped explain their handicap.
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Our findings also support suggestions that depression and anxiety were important explanatory factors relating to handicap [64–66]. However, when trying to fully explain VD related handicap, illness perceptions Perceived Consequences and Emotional Representations should be considered.
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Academically, our results support a close relation of somatic symptoms and psychological factors when explaining handicap
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In conclusion, findings of the present study provide evidence for illness perceptions, specifically perceived consequences and emotional representations, to be highly relevant for explaining VD related handicap.
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In other syndromes, illness perceptions showed to be a valuable predictor of handicap
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... I find it difficult to think that they would not like you to interpret those words in the typical rather than statistical sense.


They seem to acknowledge their equivocation here:
However, our study showed some limitations. First, the cross-sectional study design did not allow for a clear answer on the direction of the underlying relation. We hypothesized that illness perceptions would explain VD related handicap, however, the adverse could have been true as well
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In which case one wonders, why talk a whole bunch of crap in the first place.


Statistics has been stuck with some rather unfortunate word choices, 'significant' being the other best example I can think of. However it should not be that hard for research scientists to navigate this and make their meaning clear. (Or for reviewers and editors to identify and call out such misleading language.)
 
Milo said:
You can’t explain stupid. It happens. Obviously these researchers need a good dose of reality and go on to get vertigo themselves. And taste their own medicine to see what stupid tastes like.
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Yeah, I'm not sure how you can tell if a "patient's cognitive and emotional concepts" of their dizziness and vertigo are inappropriately impacting their degree of handicap - unless you had experienced similar symptoms over a similar duration - and how would you know if the severity of symptoms was equivalent?

I'm reminded of the Native American proverb "Help me never to judge another until I have walked in his moccasins," and Shakespeare's "There was never yet philosopher that could endure the toothache patiently."

[Also, note to self: Remember to never tell the doctor that your "VD" is flaring up. ]
 
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Mithriel said:
Yes, I did find it strange that they talk about perceptions and then continually use the term VD. Has it been long enough that the public don't think VD means venereal disease any more after decades when it did?
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The authors are German, VD never referred to venereal disease in their country. Instead they call them geschlechtskrankheit, which just rolls off the tongue!
 
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