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Illness representations are patients' beliefs and expectations
about an illness or somatic symptom. Illness representations
are central to Leventhal's Self-Regulation Theory
(Leventhal,
1970
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Leventhal, H. (1970). Findings and theory in the study of
fear communications. Advances in Experimental Social Psychology,
5, 119-186. ; Leventhal,
Meyer, & Nerenz, 1980
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Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common
sense representation of illness danger. In S. Rachman (Ed.),
Medical psychology (Vol II, pp.7-30), New York: Pergamon
Press. ). Self-regulation theory postulates that illness
representations determine a person's appraisal of an illness
situation and health behavior. The self-regulation framework
is conceptualized as a parallel processing framework.
One processing arm is dedicated to the cognitive processing
of an internal or external stimulus and the second, parallel
processing arm is dedicated to the processing of the emotional
aspects of that stimulus. One implication of this parallel
processing is that health behaviors can be triggered as a
result of cognitive as well as emotional processes (Leventhal,
Diefenbach & Leventhal, 1992
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Leventhal, H., Diefenbach, M.A., Leventhal, E. A. (1992).
Illness Cognition: Using common sense to understand treatment
adherence and affect cognition interactions. Cognitive
Therapy and Research, 16, 143-163. ).
More concretely, research has identified six attributes or components of illness representations:
- Identity, the name or label of a threat (e.g., sore throat, arthritis)
- Timeline, the threat's believed time trajectory (e.g., acute, chronic, cyclical)
- Consequences, the believed consequence of a threat (minor or major)
- Cause, the threat's causal mechanism (e.g., hereditary, external, internal)
- Control/cure (Lau
& Hartmann, 1983
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Lau, R.R., & Hartman, K.A. (1983). Common sense representations
of common illnesses. Health Psychology, 2, 185-197.
), whether something can be done to control the threat
- Illness coherence (Weinman
& Petrie, 1986
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Weinman, J., Petrie, K., Moss-Morris, R, & Horne, R. (1996).
The Illness Perception Questionnaire: A new method for assessing
the cognitive representation of illness. Psychology
and Health, 11 431-445. ), whether a person
thinks about the threat in a coherent way.
Two examples help to explain how attributes construct an illness representation. The first example starts with a sore throat. An
individual might identify the sore throat as the beginning symptoms of a cold (label). The initial cold label determines that it is an
acute condition (timeline), with minor consequences, potentially caused by a number of factors. It can usually be cured
(control/cure). Taken together, these attributes of the illness representation making up the "cold profile" will lead the individual
to engage in common-sense health behaviors, such as drinking lots of fluid, getting some rest, and combating the cold
symptoms with over-the-counter remedies. The emotional reactions during these cognitive processes, as conceptualized in the parallel
processing model, are likely to be muted, maybe ranging from annoyance about the potential impact on work to worrying that the cold
is a precursor to something more serious (illness coherence).
Another example illustrates the use of illness representations in the cancer area. A woman detects an unusual lump in her breast.
For a lot of women, the first thought that comes to mind is "cancer" (identity). The cancer label will trigger thoughts about suffering
and potentially life-threatening consequences, prolonged treatment (cure) and probably uncertain cause beliefs. Simultaneously, an intense
emotional reaction of anxiety and fear is triggered. This is the reason cancer is often times called a "hot cognition," where illness
representations and their affective reactions are fused together.
Illness representations are shaped by two types of memories. The first type represents memories that are conceptual or
propositional, in other words, knowledge that is based on the individual's abstractions of illness experiences. This is in contrast
to schematic memories, the second type of memory, which represent the memory of prior illness episodes and its emotional
associations (i.e., experiences of what the health threat felt like).
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