Unexplained versus explained symptoms: The difference is not in patients' language use. A quantitative analysis of linguistic markers

• Published in: Journal of psychosomatic research Vol. 152; p. 110667
• Main Authors: Stortenbeker, Inge, olde Hartman, Tim, Kwerreveld, Anita, Stommel, Wyke, van Dulmen, Sandra, Das, Enny
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.01.2022; Elsevier Science Ltd
• Subjects: Communication; Complaints; Content analysis; General practice; Idiopathic; Language; Linguistic analysis; Linguistics; Mental states; Observational coding; Patient communication; Psychiatric/Mental Health; Quantitative analysis; Stigma; Subjectivity; Talking; Unexplained symptoms; Utterances; General practice; Linguistic analysis; Unexplained symptoms; Observational coding
• ISSN: 0022-3999; 1879-1360; 1879-1360
• DOI: 10.1016/j.jpsychores.2021.110667

Patients with medically unexplained symptoms (MUS) are believed to have a deviant way of talking about complaints. This study systematically compared linguistic markers in symptom presentations of patients with MUS and medically explained symptoms (MES). This content analysis (cross-sectional study) conceptualized relevant linguistic markers based on previous research about MUS communication. Linguistic markers included negations (“not”), intensifiers (“very”), diminishers (“a little”), first or third person subject (“I” vs. “my body”), subjectivity markers (“I think”) and abstraction (“I'm gasping for breath” vs. “I'm short of breath”). We also coded valence, reference to physical or mental states, and consultation phase. We compared 41 MUS and 41 MES transcribed video-recorded general practice consultations. Data were analyzed with binary random intercepts models. We selected and coded 2752 relevant utterances. Patients with MUS used less diminishers compared to patients with MES, but this main effect disappeared when consultation phase was included as predictor. For all other linguistic variables, the analyses did not reveal any variation in language use based on whether patients had MUS or MES. Importantly, utterances' valence and reference to physical or mental state did predict the use of linguistic markers. We observed no systematic variations in linguistic markers for patients who suffered from MUS compared to MES. Patients varied their language use based on utterances' valence and reference to physical or mental states. Current ideas about deviant patient communication may be based on stigmatized perceptions of how patients with MUS communicate, rather than actual differences in their talk. •Patients with MUS are believed to have a deviant way of presenting symptoms.•We systematically compared language use of patients with MUS and MES.•Prejudices about communication of MUS patients cannot be detected in language use.•Negative stereotyping and labelling may trigger communication problems.