Illness and symptom perception: a theoretical approach towards an integrative measurement model

Several models have been proposed to conceptualize psychological representations of health, illness, and bodily sensations. These models differ as to the cognitive and affective components they include, whether they study the interaction of these components, and whether associations between psychological representations of bodily states and affective and behavioral reactions to these representations are considered conditional. These different conceptualizations and corresponding measurement approaches exist in parallel without resulting in synergistic effects or theoretical advancements within the field. In this paper, we review theoretical models on perception and attitudes and construct an integrative theoretical framework on psychological representation of bodily symptoms as well as more abstract representations of health and disease. The aim of this combination of approaches is to unify the strengths of different research domains in the conceptualization and measurement of mental representations of bodily states. Furthermore, the aim is to specify new, testable predictions and implications about the (conditional) relationship of these mental representations and affective and behavioral consequences. A core element in this integrative model is comparison. We review how comparison processes can change the cognitive and affective reference frame for illness and symptom perception and in turn affective and behavioral reactions. We discuss implications for measurement of illness and symptom representations as well as implications for clinical practice. Finally, we make suggestions for a research agenda to validate the proposed model as well as to address new questions derived from it.