Symptom attribution to a [MUS] is associated with greater perceived severity and bothersomeness of symptoms in US military veterans, 2021, Phillips et

Andy

Andy

Retired committee member
Full title: Symptom attribution to a medically unexplained syndrome is associated with greater perceived severity and bothersomeness of symptoms in US military veterans

Abstract

Objective
Medically unexplained symptoms (MUS) are prevalent among veteran and non-veteran populations. Current biopsychosocial theory implicates a multitude of factors in MUS development and perpetuation. The current study tests whether physical symptom attribution to MUS is associated with perceived symptom severity and bothersomeness and thereby might function to perpetuate MUS, as suggested by existing theory.

Design and main outcome measures
Military combat veterans (n = 243) answered postal-mail questions about their physical symptoms, severity of experienced symptoms, and attributions of these symptoms to MUS (e.g. Gulf War Illness) versus non-MUS conditions.

Results
Independent t-tests showed support for the first hypothesis—that those who experience the symptom and attribute it to MUS will perceive it to be more severe and bothersome than those who experience the symptom but do not attribute it to MUS. Paired-sample t-tests showed support for the second hypothesis—that experienced symptoms attributed to MUS by an individual will be perceived as more severe and bothersome than experienced symptoms the individual does not attribute to MUS.

Conclusions
Results highlight a potential role of symptom attribution in MUS perpetuation, through greater perceived severity and bothersomeness of MUS-attributed symptoms. Possible intervention targets may include behavior ramifications, such as coping strategies; more research is needed.

Paywall, https://www.tandfonline.com/doi/full/10.1080/08870446.2021.1952581

 
Even if these results represent meaningful correlation there are so many alternative possible interpretations.

My personal favourite is that the worse an individual’s condition, the less likely they are to swallow a nonsense MUS diagnosis.

Someone with a very slight limp my be happy to accept an explanation that it represents their psychological insecurities, their reluctance to step out boldly into frightening world, whereas someone experiencing severe pain with every step, might suspect rather that they have a broken bone or some other serious anatomical issue, especially if their doctor is refusing to X-ray the leg because of a belief that such will undermine the patients willingness to accept a psychological diagnosis.
 
JemPD said:
It drives me mental. 99% of people who die were lying down for at least a few seconds before death... wow better make sure no one ever lies down again.
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Not only that, but a significant percentage actively made the choice to lie down prior to dying. So obviously their death is a symptom of an underlying functional disorder, and consequently the best response is to undertake a specially developed course of CBT for those that are functionally dead or positively displaying functional non-functioning disorder.
 
@Peter Trewhitt yes and we'd better get their family in as well, to make sure they are not 'enabling' the death by being sympathetic to the dead person's lack of desire to stand up. After all the secondary gains of being dead are huge, all the attention focussed on them at the funeral... the kudos of having died of a mysterious 'chronic lifelessness syndrome' ( N.B. an illness not a disease)
I mean they get out of the job they hated forever now right?





***For anyone new to the forum/who hasnt read the literature over the last few decades, pls excuse me this is sarcasm based on the offensive drivel frequently written about us/MUS/BDS/PPS/FND etc
 
Relevant trivia, recently came across a diary entry from a visit to a chateau in Brittany. Think this note must have related to the design of their bedroom furniture.
Former generations of Bretons slept sitting up as they associated lying down with death.
 
So MUS seems to mean things like GWI in this study.

To me, therefore, this study only shows one thing: people with GWI have more severe and disabling symptoms than those who don't have GWI.

And that's kind of... obvious. But not for the reasons they posit.

Wouldn't it just make more sense that people without a diagnosis don't have very severe symptoms (because diagnosis requires a threshold of impact before it's given)?
 
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The illnesses that counted as MUS in this study were: Chronic Fatigue Syndrome, Irritable Bowel Syndrome, Gulf War Illness, Fibromyalgia, and/or Chronic Multisymptom Illness. So the veterans were asked if they attributed their symptoms to one of those illnesses.

This study obviously has so many limitations that it's virtually useless. You could interpret the data any number of ways, and there's little reason to choose the explanation this study is going for. The basic question this study is getting at is, as it says at the end of the dicussion, whether people should be diagnosed with such conditions or whether there should just be "focusing on symptom perceptions without a diagnosis of MUS".

In the discussion they dismiss the possiblity of symptoms being attributed to MUS being rated worse because they actually are worse by saying that they controlled for that with symptom specific analyses (eg. comparing back pain to back pain). Which is like saying if you compare stomach ache symptoms between people with stomach cancer and people who ate too much chocolate, because you did a symptom specific analysis, that rules out the possiblity that symptoms attributed to stomach cancer are rated worse because they actually are worse. It makes no sense and it's a sign of the muddled thinking in this domain of research.

(If they meant their method rules out the possiblity that the certain categories of symptoms themselves more likely to be associated with MUS are worse, then their explanation makes sense. But that means they never acknowledge the extremely obvious possiblity that the symptoms of people who attribute them to MUS actually do have more severe symptoms. So either they made a massive omission, or they used absolutely terrible reasoning)

This research is bad. But you just know that there will be doctors who have no understanding of research methodology or science who will use research like this to justify not diagnosing people with ME/CFS.
 
Abstract said:
Military combat veterans (n = 243) answered postal-mail questions about their physical symptoms, severity of experienced symptoms, and attributions of these symptoms to MUS (e.g. Gulf War Illness) versus non-MUS conditions.
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Given the study population is military veterans, there could well be benefits to governments in avoiding labels like GWI. Without an appropriate label, people have a harder time advocating for useful research and support, and perhaps at some point, attributing responsibility for the illness onset.

petrichor said:
Which is like saying if you compare stomach ache symptoms between people with stomach cancer and people who ate too much chocolate, because you did a symptom specific analysis, that rules out the possiblity that symptoms attributed to stomach cancer are rated worse because they actually are worse. It makes no sense and it's a sign of the muddled thinking in this domain of research.
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Yes, I think we've seen this approach quite a bit - where people have wanted to minimise the impact of people's symptoms. It's happened with labels of 'fatigue' too - the muddling of people who just need to go to bed a bit earlier with those with fatiguability and fatigue that doesn't go away, even with perfect sleep hygiene.

edit to clarify
 
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