Perceptual and Cognitive Factors

What we know and believe about bodily states is inextricably bound with our experience of physical sensations as well as our behavioral response to them. For example, some studies have suggested that the acquisition of maladaptive beliefs about health and illness may be related to the development of somatiza-tion. Thus, the somatizing individual may hold the mistaken belief that health is a state devoid of physical symptoms, and that symptoms necessarily imply the presence of disease. Recently, Arthur Barsky and colleagues argued that such beliefs lead the somatizing individual to develop a preoccupation with his or her bodily states and a tendency to misinterpret them as pathological. Once symptoms are attributed to illness, further attention may be directed toward the body, with subsequent physical events being perceived as evidence in support of a pathological interpretation. Evidence demonstrating that hypochondriasis is associated with body-focused attention provides support for this model, as do several studies indicating that self-

focused attention is positively related to somatic symptom reports in nonclinical populations. Clinical experience strongly suggests that body-focused attention is also a central aspect of somatoform illness.

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