How to operationalize the “body-knowledge” construct so it can be analyzed and measured

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I started using the term “body-knowledge” a few years back as a way to label the extent to which people can accurately report symptoms or interior sensations. It is not as of 2010 a popular term. The earliest citation of the term I know of is from a clinical neurology paper by Sirigu, Grafman, Bressler, and Sunderland, (1991): Multiple representations contribute to body knowledge processing: Evidence from a case of autotopagnosia

“Body knowledge” does quite not have the same meaning as “embodied cognition”, “body image”,”body schema”, “interoception”, “visceral perception”, or even “body cognition”, though there is considerable overlap. I typically use the concept body-knowledge to emphasize the verbal reporting of internal states. My epistemology teacher years ago taught me a great idea:

To know something, you have to know that you know it, and to know that you know it, you have to be able to say it.

I wouldn’t defend that as the end-all be-all theory of knowledge, but it works as a heuristic at the least. For now, I use “body-knowledge” to refer to how well people can know and verbally report on what is happening to their physiological states.

To analytically probe this construct, I started looking very deeply at a particular domain: symptom reporting about cardiovascular processes. I have found some useful results from earlier studies that serve as a guide to help approximate how accurate people are when they feel and report palpitations: their heart is racing, they feel irregular beats, heart thumping or pounding, skipped beats, and so forth. Evidently a fair amount of the time people suffering from panic disorder or anxiety “cognize” otherwise benign sensations and report heart problems, and such false positives adds a great deal of expense to the healthcare system.

Symptom report accuracy is a largely unexplored area for the young field of neurophenomenology: how much of what is happening inside our bodies is accessible to our minds? Very little of the existing neurophenomenology literature deals with these issues.

How can the “body-knowledge accuracy” construct be operationalized, analyzed and measured? For the particular domain of palpitations reporting, here are some useful core metrics:

From ‘The Validity of Bodily Symptoms in Medical Outpatients,” (Barsky, 2000) Chapter 19 in The Science of Self Report (Stone, A, ed): -When patients complaining of palpitations undergo 24-hour, ambulatory, electrocardiographic monitoring, 39% to 85% manifest some rhythm disturbance; the vast majority of these arrhythmias are benign, clinically insignificant, and do not merit treatment). Although as many as 75% of these patients with arrhythmias report their presenting symptom during monitoring; in only about 15% of cases do these symptom reports coincide with their arrhythmias.

From Barsky, Ahern, Delamater, Clancy & Bailey (1997): -145 consecutive outpatients referred to an ambulatory electrocardiography (Holter) laboratory for evaluation of palpitations were accrued, along with a comparison sample of 70 nonpatient volunteers who had no cardiac symptoms and no history of cardiac disease. A symptom was considered accurate when it followed within 30 seconds after any demonstrated arrhythmia.

-average positive predictive value (PPV)… is equal to the number of reported symptoms that were preceded by an arrhythmia divided by the total number of symptoms reported (true positives / [true positives + false positives]).

-Ninety-nine palpitation patients (68%) reported at least one palpitation during monitoring. Among those patients who were symptomatic, the mean number of diary symptoms reported in 24 hours was 3.7. The mean PPV for all symptom reports among palpitation patients was 0.399, compared with a mean PPV = .118 for the nonpatient volunteer sample (p = .01).

-the palpitation descriptors most likely to be accompanied by electrocardiographic abnormalities are heart stopping, fluttering, and irregular heartbeat. The least predictive descriptive terms used by the patients were racing and pounding.

-34% of the symptomatic palpitation patients and 11% of the asymptomatic comparison subjects were classified as accurate reporters

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2 thoughts on “How to operationalize the “body-knowledge” construct so it can be analyzed and measured

  1. i hink you might help me with something. what can you tell me about body awareness? I know the concept has been mentioned in phenomenological litterature. drew leder sure did it, but i couldn’t find any operationalization of the concept, although i am sure there is at least one in the medical field. i’m thinking about some social science perspective, preferably. I;m trying to work on it for my phd thesis, but i lack a good social science library, and some specialized guidance. thank you

    1. Alex, some foundational and very influential work on body awareness was done by Merleau-Ponty. I am currently trying to operationalize the concept by using the Positive Predictive Value metric that comes from epidemiology and evidence based medicine. I will post on this soon, but for now see Arthur Barsky’s work on “The Validity of Bodily Symptoms in Medical Outpatients” in the comipilation The Science of Self Report: http://www.amazon.com/reader/0805829911?_encoding=UTF8&query=barsky#reader_0805829911

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