Running head: DIFFERENCES IN SOCIAL AND EMOTIONAL REACTIONS BASE ON STIGMA
Differences in Social and Emotional Reactions
Based on Perceptions of Gender and Illness Characters
Sean R. Glynn
Elon University
Abstract
Objective: To examine differences in participants’ emotional reactions and social rejection due to a targeted individual’s gender and gender oriented illness characteristics. Setting: Classroom at Elon University. Participants: 65 undergraduate students from Elon University. Measures: Participants rated a manipulated vignette with a seven-point scale questionnaire. Results: Participants socially rejected gender consistent individuals just as much as gender inconsistent individuals. Women received higher rates of pity and empathy than men did. Conclusions: Target women were empathized with more while the target men who were received greater pity. Gender consistent targets received greater concern from participants than gender inconsistent targets.
Differences in Social and Emotional Reactions
Based on Perceptions of Gender and Illness
Over the years, the attachment of stigma to diseases has resulted in social rejection and a range of emotional reactions. Stigmas are labels placed on an individual do to their deviation from the norm. Stigmas are a representation of negative and unwanted characteristics of a society. Social rejection and emotional reactions result from a stigma’s negative label. Stigmatization has been categorized into two classes of physical and mental stigma. The study found that the emotional reactions of these two categories of stigma depended on the participants’ perceived attributional characteristics of responsibility and reversibility of the stigma. Based on the participant’s perception of these characteristics, resulted in differences in emotional reaction pity and anger. Individuals with physical stigmas tended to be perceived as un-responsible for the onset while higher perceptions of controllability and responsibility were associated with individuals with mental stigmas. Individuals who were held responsible for their stigma received little pity and great anger while un-responsible individuals received inverse results (Weiner, Perry, & Magnuson, 1988).
Research has shown our perception of an illness is based on stigma that results in different attitudes towards others as seen in the Weiner’s attribution-emotional model where pity, anger, and anxiety changes depending on seriousness of disease, valence of behavioral cause, and personal responsibility (Dijker & Koomen, 2003). Further research has shown that emotions can depend on the gender individual interacting with the stigmatized individual.
There has been previous research that studied the differences in perceptions of smoking characteristics such as “manly,” “relaxed,” and “unladylike” based on the target’s genders. Prior research has shown that women tended to have more positive attitudes than men, e.g., Bos et al., 2007; Herek & Capitanio 1993; Olkin and Howson 1994; as cited in Mosher & Danoff-Burg, 2008.
Data showed that women expressed greater pity and willingness to help the target person, relative to men. Participants saw male targets as having a greater control over illness onset relative to female targets. Data partially supported the researchers’ hypothesis that participants exposed to nonsmoking target persons perceived less controllability of the illness relative to the other target conditions. Nonsmoking and unspecified smoking statuses showed no difference in anger generated by participants. Anger did not mediate the relation of willingness to help. However, illness controllability was positively associated with anger and negatively associated with willingness to help the target (Mosher & Danoof-Burg, 2008).
When women participants judged illness controllability, they perceived women targets with greater illness controllability than men targets. The data contradicts prior research that found no interaction effect of participant and target’s gender, on perceptions of disease controllability when manipulating target behaviors that increase HIV risk (Borchert and Rickabaugh 1995; Schulte 2002 as cited in Mosher & Danoff-Burg, 2008). The researchers felt the implications of this data could go into future research in defining the factors for greater same gender responsibility. The results of the study suggest that cancer-related stigma is a complex phenomenon. Future application of this data can be useful in showing the importance of considering gender when developing interventions to reduce or prevent illness-related stigma. Illnesses caused by negligence can result in the individual looked down upon with anger or pity but whether the disability is visible can affect the willingness to help.
A study showed that a woman with an above the knee amputation received more people willing to help her than when the same woman who hid her disability from people. Data was also collected on the comfort of people helping the women by estimating the distance people stood from the women in a way to quantify comfort. Lastly, the study looked at the differences in willingness to help between men and women. The researchers concluded that participants probably felt that it was not socially acceptable to ignore the examiner (Cacciapaglia, Beauchamp, & Howells, 2004).
Stigmas gain their power from the fears that the masses have towards something that is abnormal to them. So people try to conceal their stigmas to prevent stigmatization but diminishes their self-esteem. Studies showed that individuals who do not conceal their stigmas, while surrounding themselves with similar others, resulted in the lowering of stigmatic attributes while increasing self-esteem. A study done on undergraduates from Harvard showed those individuals with concealable stigmas such as gays, the poor, and bulimics, where found to have a better self-perception of themselves when surround by similar individuals. Individuals were able to maintain a healthier mental state when surrounded by like individuals and the study proposes that it is likely that these similar groups lack the stigma found in general social groups (Frable, Platt, & Hoey, 1998).
Uncontrollability is the key defense against stigmatization for many people. Studies have shown that overweight women who have a belief that their weight is uncontrollable, attributed negative assessments to the experimenter’s prejudices but this fail improve the individual’s self-esteem. Due to the conditioning that their weight is uncontrollable it separates them from the overweight stigma due to the fact that stigma based on the social norm that people are in control of their weight. Once an individual is in the belief that they are not in control, they are no longer at fault for their weight so they feel that any stigmatization based on ignorance (Blaine & Williams, 2004).
Though an overweight woman who feels her weight is controllable are susceptible to negative social rejection and perceptions. The individuals who fear stigmatization or tend to suffer the negative attributes of social rejection try to avoid placing themselves within those social situations. Problems arise when individuals fear acquiring stigma resulting in their lower probability of screening for illnesses.
Of the patients who tested positive for cognitive impairment, nearly half refused to get a diagnostic evaluation (Boustani, et al., 2008). Participants feared the stigma that would arise if they received an evaluation. Researchers developed the Perceptions Regarding Investigational Screening for Memory in Primary Care (PRISM-PC), a questionnaire designed to evaluate the patient’s attitudes towards a dementia screening. The exploratory study found high rating for questions relating to stigma, such as, “If Alzheimer’s Disease, would feel humiliated by family members.” Stigmas like these limit individuals from obtaining quality healthcare due to fears of stigmatization.
Another screening study found that males were more likely than females to be suspected for gonorrhea in the past but females were more likely than males to have had a gonorrhea or HIV test in the past year. The data supported the hypothesis that stigma plays a role in affecting the likelihood of getting tested while controlling for sex, age and suspicion of gonorrhea. STD-related, shame, failed to support the hypothesis but the researchers say that though there isn’t an association but that shame is still an important factor to consider (Fortenberry, et al., 2002). Unlike these studies that look at the perception of screened stigmatized individuals, our study looks at the perception of outside individuals whose perceptions cause the stigmatization and social rejection.
Our study decided to take this problem of stigma and see how stigma perception depended on the gender of the stigmatized individuals. We wanted to research if stigmatization changed depending on the individual’s gender along with whether the individual exhibited gender consistent or gender inconsistent characteristics. This study defined gender characteristics by the fictional target’s body physique, emotion reactions, energy levels and sex drive.
I hypothesized a main effect in illness condition such that targets exhibiting gender consistent illness characteristics would receive less social rejection than gender inconsistent targets, especially gender inconsistent men. The gender of the target has no expected main effect. We hypothesized an interaction such that men are going to have an overall higher social rejection that exhibit gender inconsistent illness characteristics.
I also decided to study participants’ emotional reactions to the target individuals. We hypothesized a main effect in illness condition such that gender inconsistent individuals will receive higher negative rating gender inconsistent individuals. We predicted female would receive higher pity than men. We hypothesized that men are going to have an overall lower pity, concern and empathy that exhibit gender inconsistent illness characteristics. Targets exhibiting gender consistent illness characteristics will receive greater pity, concern, and empathy than gender inconsistent targets, especially gender inconsistent men.
Methods
Participants
Participants consisted of 67 undergraduate students from Elon University in North Carolina, USA. Participants were students from psychology classes that required students to participate in at least one psychological study for which they received extra credit. Of the 67 participants who volunteered, two answered incorrectly on the manipulation check questions, showing the participant’s lack of understanding of the assessment and resulting in the removal of their data from the group. The participant pool consisted of 30 freshmen, which represented 46.2% of the sample, 18 sophomores (27.7%), 11 juniors (16.9%), and 6 seniors (9.2%). Of the 65 participants, 10 were men while the remaining 55 were women. The age of participants ranged from 18 to 23 years of age with a mean age of 19.5.
Materials
The purpose of the creation of the four vignettes was to capture participant’s attitudes. Two vignettes depicted a male either exhibiting gender consistent characteristics or gender inconsistent characteristics to with his illness. Two other vignettes depicted a female either exhibiting gender consistent or gender inconsistent characteristics. The vignettes were kept the same expect for the changes in certain variables such as name, sex, body physique, and emotions. Each vignette was paired with an official looking doctor’s evaluation stating observational facts about the target in the vignette while the vignettes themselves were opinion based. For vignettes and doctor evaluations, see Appendix B.
Manipulation checks implemented at the beginning of the questionnaire prevented the study against confounding participants. The manipulation checks asked, “What was the name of the illness described in the patient’s report?” “How would you describe the patient? What gender is patient?” and “What symptoms is the patient experiencing?” (Appendix C).
The questionnaire was designed to capture a participant’s perception of social rejection, emotion reaction to the target, perception of the target’s illness, and stigmatization the participant would have against the other participants. Five-part questionnaire gathered demographic information of the participants such as age and gender, see Appendix C for more questions. Using Likert-scale for each question, the scale was able to capture an individual’s attitude. Sample Liker-scale questions were as follows; “I would be willing to do a favor for this person: Strong Disagree to Strongly Agree, using a 7 point scale.” “When you read about the patient with generalized endrocrine syndrome, how did you feel about the patient? Pity or No Pity, using a 7-point scale.” For the rest of the questions see Appendix C.
Both scales went through a reliability test. Individually questions were analyzed due to the scale for emotion reaction failed to be reliable. The social rejection scale received a Cronbach’s alpha of .89 making the 25-question scale reliable.
Procedure
The all participants volunteer to sign up for different group times to participate in the study. Individual completed the questionnaires within a small group setting requiring approximately 30 minutes to complete the study. Participants received a manipulated physician’s report describing symptoms of the target with the illness. Participants also received a vignette describing the illness from the target’s perspective of the illness. Four vignettes consisting of the same information expect for the manipulation of certain words to manipulate variables such as gender and illness. Distributed of vignette were given out using a stratified random sampling in order to get a representative sample for each vignette.
After reading the reports, the participants were required to complete a questionnaire to evaluate the illness and the target based on social rejection, stigmatization and emotional reaction. Questionnaire consisted of short answer questions to double check the validity of the participant and rating questions. Participants filled out an answer five questions on demographic information such as age, gender, and ethnicity. After the completion of the questionnaire, the participants received a debriefing on the true nature of the study.
Results
Out of the range symptoms that the targets presented, 49.2% of participants perceived being emotional as the worse symptom. The participants’ perception of severity of the disease was 5.5 out of a 9-point scale. The social rejection scale showed internal consistency between participants with a Cronbach index of .89. Analysis of the data failed to produce any statistically significant differences in results on social rejection.
An univariate ANOVA test of the data showed that participants significantly pitied target men than women, F(1, 61) = 7.36, p < .01. Men reported a mean of 4.73 with a standard deviation of 1.52 while women had a mean of 5.66 with a standard deviation of 1.13. Illness condition depicts a marginal trend of gender consistent targets receiving greater pity from the participants than gender inconsistent targets with an F(1, 61) = 1.79 and p < .19.
Participants empathy towards targets depicts an almost marginal significance that more empathy was given towards women than men, with illness condition failing to confound the data, F(1, 61) = 1.69, p < .2. Men received a mean of 5.33 while women received 5.75 on the participants of empathy.
The analysis of the question on concern shows that gender consistent targets received marginally higher concern ratings than gender inconsistent targets based on a univariate ANOVA test, F(1, 61) = 1.81, p = .18. Gender consistent targets average mean of 5.52 with a standard deviation of 1.12 in contrast to gender inconsistent, who received a mean of 5.06 with a standard deviation of 1.47.
Discussion
Participants’ answers show no difference in their social rejection of the target individuals. Participants socially rejected targets equally independent of the target’s gender or illness condition. Data collect in previous studies (Cacciapaglia, Beauchamp, & Howells, 2004) showed participants exhibiting greater willingness to help an individual with a physical deformity contradicted the findings of our data. Our findings show that participants equally reject targets with neither one being favored to help more than the others do. Reason for the difference may come from the fact that our study lacked physical interaction with the target individual, which may insight different reaction than reading a vignette. Another reason for this may be due to the target’s emotional characteristics resulting in greater rejection since the previous study only focused on physical where as this study focused on emotional and physical abnormalities.
We were unable to analysis the dependent variable, emotional, due to the lack of reliability in the scale. We felt that the lack of reliability in the scale probably comes from the facts participants failed to have similar answers. Instead of studying emotional reactions as a complete unit, we analyzed specific attributes of emotional reaction such as pity, empathy, and concern. Though our data had multiple results with marginal significance, only one had a result that was significantly significant. We feel that these marginal results would become statistically significant if we had a larger sample size to analysis.
One of questions at the beginning of questionnaire was just an exploratory question, seeking to find what was participant’s perception of the worst symptom the target individual had after reading the vignettes (Appendix C). The results show that out of all the symptoms, the ratings of emotion were the highest. This shows that participants might have a possible stigma about emotional changes in an individual. Another possible reason for emotion being concerned the worst symptom may stem from the fact that individuals may believe emotions make up their personality, and a change in emotion is a change in who they are as an individual.
Results showed greater empathy towards women than men. Though this supports our hypothesis, the results contain confounding factors such as 55 of the 65 participants were women. The fact that 85 percent of participants in the study were female might have resulted in a limitation in our data due the fact that we are lacking an equal representation of men and women. The results that empathy was greater towards women may result from women participants being able to related better to targets of the same sex. In addition, the high rates of women participant may have affected emotion rating since data collected by Mosher and Danoff-Burg (2008) has shown that women pity target individuals more than they pity men. Our rating of pity may have been higher if the gender sample size was equal.
Though the data shows that target women were empathized with more, it was the target men who were received greater pity. A possible reason for this may come from the cultural perception that men are supposed to be tough and even if they are exhibiting gender consistent characteristics, they are still exposing their feelings. Due to the failure of the man being able to control his symptoms as expected by society, the pity for men might come from that lack of strength. These finding support the prior research that women perceive greater controllability of illness on their own sex done by Mosher and Danoff-Burg (2008). Due to the possibility that this study, which is comprised of mostly women, may have perceived women as having greater control of their illness condition result in less pity since they were perceiving their own sex. The data contributes to the work on overweight stigma on women (Boustani, et al., 2008), in that not only are women are more likely suffer stigmatized based on cultural expectancies but also there is less pity among women for each other.
Contrary to our predictions, results indicated that gender consistent targets received greater concern from participants than gender inconsistent targets. Since the gender inconsistent individuals were exhibiting characteristics that are not generally associated with that gender, the prediction was gender inconsistent individuals would receive greater concern due to their lack of connection to gender inconsistent.
The lack of related ability to the gender inconsistent targets could instead be the reason for the lack of concern could be the fact that gender inconsistent symptoms were not relatable to participants. Though the data show that participants equally empathized with both gender illness conditions, meaning the participants understood the emotions that both conditions were going through but still showed greater concern for gender consistent targets.
A possible explanation may come from participants’ perceptions that it is not as big of a problem for man to cry but that being angry is very dangerous. This may come from prior perceptions of abusive males. Since women generally are not associated with this perception of being abusive, participants may have felt less concern for them becoming abusive.
Participant’s perception of the severity of the illness could be an alternative explain for my there were such a lack of emotional interaction. Severity of the disease had a rating of 5.5 out of a 9-point scale, making the participants’ perception of the disease barely over a neutral standpoint. The disease may not have seemed severe enough to arouse strong enough emotions.
Since the perception of social rejection was equal for both gender illnesses and greater pity towards male, future research would benefit from studying the participant’s willingness to interaction. In this study, similar to the amputated leg study done by Cacciapalia, Beauchamp, and Howells (2004), their interaction with a staged individual who presents the same symptoms as the vignettes in this study based on participants’ ratings. The study would look at the gender of the participant and rate them on how close they get to the individual, length of conversation and attempts at helping. According to our study, participants show equally reject the targets but our study also shows that men received greater amounts of pitied, possibly resulting in closer interaction with males than females. This study provides a stronger representation of real world experience since some participants are not always as truthful in questionnaires.
Future studies could look at the perceptions of stigmatized participants against those who are stigmatizing them. Most articles discuss the perception of the ones not stigmatized so research targeted directly towards the perception of the stigmatized could give insight into a different sample of the data.
This data could be important because it could give insight into different variables affecting the severity of stigmatization. If the person is stigmatized will have a lower perception of the person causing the stigmatized, this may affect how much they either try to hide their stigma or how much they socially ostracize themselves.
The questionnaires for most of the articles looked at how participants perceived people with stigmas like physical changes, sexually transmitted infections or mental state. Though no previous study has selected people with the actually stigma and recorded their perception of others with the same illness. Even though previous studies may have had some participants with a stigma answering the questionnaire, that sample size is generally too small to get accurate representation in the data. It would be interesting to see if people with an illness would have the same emotions towards others with the same illness or do they exhibit different behaviors based on reasons why they did it. For example, a person with lung cancer from cigarettes could feel pity for a person because they understand what they are going through or could express anger since they know it was their own decision.
This study provides multiple areas for follow-up research. One interesting result of the data is the fact that emotion was consisted the worst symptom compared with other symptoms such as physical deformities. Another follow-up study could look to develop reasons why gender consistent individual received greater concern. Instead, participants cared more about gender consistent.
References
Blaine, B., & Williams, Z. (2004). Belief in the controllability of weight and attributions to prejudice among heavyweight women. Sex Roles, 51(1), 79-84.
Boustani, M., Perkins, A., Monahan, P., Fox, C., Watson, L., Hopkins, J., et al. (2008). Measuring primary care patients’ attitudes about dementia screening. International Journal of Geriatric Psychiatry, 23(8), 812-820.
Cacciapaglia, H., Beauchamp, K., & Howells, G. (2004). Visibility of disability: effect on willingness to interact. Rehabilitation Psychology, 49(2), 180-182.
Dijker, A., & Koomen, W. (2003). Extending Weiner’s attribution-emotion model of stigmatization of ill persons. Basic and Applied Social Psychology, 25(1), 51-68.
Mosher, C. E, and Danoof-Burg, S. (2008). An attribution analysis of gender and cancer-related stigma. Sex Roles, 59, 827-838.
Frable, D., Platt, L., & Hoey, S. (1998). Concealable stigmas and positive self-perceptions: Feeling better around similar others. Journal of Personality and Social Psychology, 74(4), 909-922.
Fortenberry, J., McFarlane, M., Bleakley, A., Bull, S., Fishbein, M., Grimley, D., et al. (2002, March). Relationships of stigma and shame to gonorrhea and HIV screening. American Journal of Public Health, 92(3), 378-381. Retrieved February 23, 2009, from PsycINFO database.
Appendix A
Greeting Statement
Thank you for participating, I am _______________ and this is _____________. We are conducting this study to fulfill a requirement for our Empirical Research class. In our study, we are examining factors that affect perception patients experiencing an illness. After you complete the informed consent and turn it in, you will receive a patient folder with two reports inside. There will be a summary of a doctor’s visit written by a physician and there will be a summary written by the patient. After you read these documents, you’ll be asked to complete surveys relating to your opinion of the patient and illness. The entire study will take approximately 30 minutes to complete.
When you are finished, please turn your papers face down on your desk and wait till all other participants are finished. When you are all done, we’ll share more information about the study and distribute extra credit sheets for your professors.
Before we begin, can you please sign the informed consent document?
Debriefing Statement
Thank you for your participation in this study. Our class project is investigating the factors that affect perceptions of men and women with illnesses. Some of you read about a female patient, whereas others read about a male patient. We also varied the symptoms of the illness to make it consistent with or inconsistent with traditional gender roles. So there were four versions of the patient descriptions that you read about. We will be looking at your responses as a group to determine if evaluations of the patients who had gender-consistent and gender- inconsistent illnesses differ. We also asked you to complete a measure of your own level of masculinity and femininity. We will be examining if there is a relationship between a masculinity and femininity and perceptions of patients.
If you have any questions about the study please contact Dr. Smith in the Psychology Department. She will have a summary of our findings at the end of the semester in case you would like to receive one.
Do you have any questions for us at this time?
Appendix B
Male Exhibiting Male Characteristics
Patient Intake Report and Disease Assessment (Form-PR1)
Patient Name: Mark Adams Patient ID #: 18-23401
Date of symptom onset: 9/27/08 Date of assessment: 11/17/08
Sex: M / F Height: 5’10” Weight: 170 BP: 117/75 Temp: 98.5
Reason for visit: Sched Physical Diagnostic Diag/Follow-Up
Description of patient characteristics and diagnostic information (transcription of phys. notes):
Patient present to office in October with evidence of influenza symptomology: fever, head ache, slight impairment of kidney functioning. Intermittent raised rash on upper torso. CBC analyses suggested endocrine-hormone elevations. Diagnosed with generalized endocrine syndrome affecting pituitary functioning; scheduled for six week follow up. Presented today for follow up appointment and further blood tests. Patient advised on chronic and progressive nature of the condition.
Exam revealed increasing muscle mass in upper body leading to increasing size and strength in arms and abdomen.
Patient reports higher general activity level and sex drive. Patient advised these symptoms are consistent with disease symptomology.
Prognosis/further action:
Schedule session with health educator for guidance on handling emotional outbursts
Scheduled for 6 week for blood work up
Transcription of patient’s interview relating to onset of the illness and symptoms:
“My name is Mark. I was recently diagnosed with a chronic disorder that affects a wide variety of body systems. At first I thought I just had the flu, I felt like I had a fever and was sick at my stomach. Then I noticed a rash that comes and goes on my abdomen and back. When I went to the doctor he did some blood tests and diagnosed generalized endocrine syndrome, a condition that influences hormones in the body – resulting in changes in emotional states and in my physique.
In terms of symptoms, I’ve noticed some pretty troubling things so far.
I seem to be unable to control my emotions. I have had angry outbursts so bad that it has affected taking care of my kids.
My body seems to be changing in ways I hadn’t expected – my whole physique and body shape has altered!
My energy level is higher than normal for me and so is my sex drive.
The illness is not contagious but the rash and changes in my physique are very noticeable to others, so I am pretty embarrassed by the whole thing.
So far my wife is being supportive but I don’t know what to expect in the future as the illness progresses.”
Male with Female Characteristics
Patient Intake Report and Disease Assessment (Form-PR1)
Patient Name: Mark Adams Patient ID #: 18-23401
Date of symptom onset: 9/27/08 Date of assessment: 11/17/08
Sex: M / F Height: 5’10” Weight: 170 BP: 117/75 Temp: 98.5
Reason for visit: Sched Physical Diagnostic Diag/Follow-Up
Description of patient characteristics and diagnostic information (transcription of phys. notes):
Patient present to office in October with evidence of influenza symptomology: fever, head ache, slight impairment of kidney functioning. Intermittent raised rash on upper torso. CBC analyses suggested endocrine-hormone elevations. Diagnosed with generalized endocrine syndrome affecting pituitary functioning; scheduled for six week follow up. Presented today for follow up appointment and further blood tests. Patient advised on chronic and progressive nature of the condition.
Exam revealed decreasing muscle mass in upper body leading to decreasing size and strength in arms and abdomen.
Patient reports lower general activity level and sex drive. Patient advised these symptoms are consistent with disease symptomology.
Prognosis/further action:
Schedule session with health educator for guidance on handling emotional outbursts
Scheduled for 6 week for blood work up
Transcription of patient’s interview relating to onset of the illness and symptoms:
“My name is Mark. I was recently diagnosed with a chronic disorder that affects a wide variety of body systems. At first I thought I just had the flu, I felt like I had a fever and was sick at my stomach. Then I noticed a rash that comes and goes on my abdomen and back. When I went to the doctor he did some blood tests and diagnosed generalized endocrine syndrome, a condition that influences hormones in the body – resulting in changes in emotional states and in my physique.
In terms of symptoms, I’ve noticed some pretty troubling things so far.
I seem to be unable to control my emotions. I have had bouts of crying so bad that it has affected my ability to work.
My body seems to be changing in ways I hadn’t expected – my whole physique and body shape has altered!
My energy level is lower than normal for me and so is my sex drive.
The illness is not contagious but the rash and changes in my physique are very noticeable to others, so I am pretty embarrassed by the whole thing.
So far my wife is being supportive but I don’t know what to expect in the future as the illness progresses.”
Female Exhibiting Female Characteristics
Patient Intake Report and Disease Assessment (Form-PR1)
Patient Name: Mary Adams Patient ID #: 18-23401
Date of symptom onset: 9/27/08 Date of assessment: 11/17/08
Sex: M / F Height: 5’5” Weight: 135 BP: 117/75 Temp: 98.5
Reason for visit: Sched Physical Diagnostic Diag/Follow-Up
Description of patient characteristics and diagnostic information (transcription of phys. notes):
Patient present to office in October with evidence of influenza symptomology: fever, head ache, slight impairment of kidney functioning. Intermittent raised rash on upper torso. CBC analyses suggested endocrine-hormone elevations. Diagnosed with generalized endocrine syndrome affecting pituitary functioning; scheduled for six week follow up. Presented today for follow up appointment and further blood tests. Patient advised on chronic and progressive nature of the condition.
Exam revealed decreasing muscle mass in upper body leading to decreasing size and strength in arms and abdomen.
Patient reports lower general activity level and sex drive. Patient advised these symptoms are consistent with disease symptomology.
Prognosis/further action:
Schedule session with health educator for guidance on handling emotional outbursts
Scheduled for 6 week for blood work up
Transcription of patient’s interview relating to onset of the illness and symptoms:
“My name is Martina. I was recently diagnosed with a chronic disorder that affects a wide variety of body systems. At first I thought I just had the flu, I felt like I had a fever and was sick at my stomach. Then I noticed a rash that comes and goes on my abdomen and back. When I went to the doctor he did some blood tests and diagnosed generalized endocrine syndrome, a condition that influences hormones in the body – resulting in changes in emotional states and in my physique.
In terms of symptoms, I’ve noticed some pretty troubling things so far.
I seem to be unable to control my emotions. I have had bouts of crying so bad that it has affected my ability to work.
My body seems to be changing in ways I hadn’t expected – my whole physique and body shape has altered!
My energy level is lower than normal for me and so is my sex drive.
The illness is not contagious but the rash and changes in my physique are very noticeable to others, so I am pretty embarrassed by the whole thing.
So far my husband is being supportive but I don’t know what to expect in the future as the illness progresses.”
Female Exhibiting Female Characteristics
Patient Intake Report and Disease Assessment (Form-PR1)
Patient Name: Mary Adams Patient ID #: 18-23401
Date of symptom onset: 9/27/08 Date of assessment: 11/17/08
Sex: M / F Height: 5’5” Weight: 135 BP: 117/75 Temp: 98.5
Reason for visit: Sched Physical Diagnostic Diag/Follow-Up
Description of patient characteristics and diagnostic information (transcription of phys. notes):
Patient present to office in October with evidence of influenza symptomology: fever, head ache, slight impairment of kidney functioning. Intermittent raised rash on upper torso. CBC analyses suggested endocrine-hormone elevations. Diagnosed with generalized endocrine syndrome affecting pituitary functioning; scheduled for six week follow up. Presented today for follow up appointment and further blood tests. Patient advised on chronic and progressive nature of the condition.
Exam revealed increasing muscle mass in upper body leading to increasing size and strength in arms and abdomen.
Patient reports higher general activity level and sex drive. Patient advised these symptoms are consistent with disease symptomology.
Prognosis/further action:
Schedule session with health educator for guidance on handling emotional outbursts
Scheduled for 6 week for blood work up
Transcription of patient’s interview relating to onset of the illness and symptoms:
“My name is Martina. I was recently diagnosed with a chronic disorder that affects a wide variety of body systems. At first I thought I just had the flu, I felt like I had a fever and was sick at my stomach. Then I noticed a rash that comes and goes on my abdomen and back. When I went to the doctor he did some blood tests and diagnosed generalized endocrine syndrome, a condition that influences hormones in the body – resulting in changes in emotional states and in my physique.
In terms of symptoms, I’ve noticed some pretty troubling things so far.
I seem to be unable to control my emotions. I have had angry outbursts so bad that it has affected taking care of my kids.
My body seems to be changing in ways I hadn’t expected – my whole physique and body shape has altered!
My energy level is higher than normal for me and so is my sex drive.
The illness is not contagious but the rash and changes in my physique are very noticeable to others, so I am pretty embarrassed by the whole thing.
So far my husband is being supportive but I don’t know what to expect in the future as the illness progresses.”
Appendix C
Questionnaire
Participant Number
PLEASE TAKE CARE IN READING ALL DIRECTIONS and in filling out the questionnaires appropriately and completely. Your efforts to give thoughtful and accurate information will contribute to the quality of the project using this information. Remember your responses are not associated with any identifying information and will remain anonymous. Please make sure to answer the questions on each page. You can look back at the printed copy of the email as needed.
1) What was the name of the illness described in the patient’s report?
2) How would you describe the patient? What gender is patient?
3) What symptoms is the patient experiencing?
4) Consider the symptoms of generalized endocrine syndrome as described in the patient and physician reports. In your opinion, which is the worst symptom?
Having read the description of the illness…
…how would you perceive this illness condition?
1 2 3 4 5 6 7 8 9
Have a very Have a very
positive perception negative perception
…in general, how would you be likely to perceive people who have been diagnosed with this illness condition?
1 2 3 4 5 6 7 8 9
Have a very Have a very
positive perception negative perception
…how serious or severe do you consider this illness to be?
1 2 3 4 5 6 7 8 9
Not at all Extremely
Serious Serious
…how much will the symptoms interfere with the patient’s life overall?
1 2 3 4 5 6 7 8 9
Not interfere Interfere
at all greatly
When you read about the patient with generalized endrocrine syndrome, how did you feel about the patient?
Not irritated at all 1 2 3 4 5 6 7 Irritated
Not embarrassed 1 2 3 4 5 6 7 Embarrassed
Not disgusted 1 2 3 4 5 6 7 Disgusted
No admiration 1 2 3 4 5 6 7 Admiration
Not anxious 1 2 3 4 5 6 7 Anxious
No empathy 1 2 3 4 5 6 7 Empathy
Not concerned 1 2 3 4 5 6 7 Concerned
No pity 1 2 3 4 5 6 7 Pity
Person Perceptions:
Please answer the following questions concerning how interested you would be in having contact with the patient you just read about. Base your decisions on the information presented in the patient and physician reports and your own assessment of that information.
Please rate your agreement with each seven items below using the following scale:
1 2 3 4 5 6 7
Strongly Strongly
Disagree Agree
I would be embarrassed if this person were a close friend
I would feel uncomfortable while in the same room as this person
I wouldn’t mind spending time with this person on a regular basis
I would feel comfortable working with this person in a small group setting
If this person needed me, I would want to comfort them
I would be willing to do a favor for this person
I would ignore this person if I saw them in public
I would want to carry on a conversation with this person
I think I would feel physically attracted to this person
I feel emotionally indifferent toward this person
I would consider being friends with this person
If this person invited me to a social event, I would decline to attend
I would invite this person to attend a social event I was hosting
I would feel comfortable attending a social event that this person would be present at
I believe this person has the capacity to persevere through adversity
I think this person could accomplish great things
I would be willing to give money to support research on this illness
This person is someone who deserves help and assistance
I wish I could be more like this person in character
This person is the kind of person that I tend to avoid
I would not want people to know I associated with this person
I would feel uncomfortable if this person touched me (shook my hand, pat on the back, etc.)
I would feel alright being seen in public with this person by people in my social circle
I would introduce my friends or those I interact with socially to this person
I would not trust this person with an important task
Please consider the overall personality of the patient on each of the following dimensions.
In your opinion, this person is:
Admirable 1 2 3 4 5 6 7 Shameful
Irresponsible 1 2 3 4 5 6 7 Responsible
Mature 1 2 3 4 5 6 7 Immature
Unintelligent 1 2 3 4 5 6 7 Intelligent
Attractive 1 2 3 4 5 6 7 Unattractive
Educated 1 2 3 4 5 6 7 Uneducated
Respectful 1 2 3 4 5 6 7 Disrespectful
Immoral 1 2 3 4 5 6 7 Moral
Likable 1 2 3 4 5 6 7 Unlikable
Unhealthy 1 2 3 4 5 6 7 Healthy
Careful 1 2 3 4 5 6 7 Reckless
Distant 1 2 3 4 5 6 7 Friendly
Kind 1 2 3 4 5 6 7 Unkind
Demographic Information:
(1) Please indicate your gender (check one): Male Female
(2) What is your age? years.
(3) Your year in college (please check appropriate response).
Freshman Junior
Sophomore Senior
(4) Do you know anyone personally who has experienced an illness similar to the one you read about?
a) No
b) Yes
(5) Have you heard of generalized endocrine syndrome prior to reading about this patient?
a) No
b) Yes
Thank you for participating in the study.
Please turn your questionnaire over and wait until the experimenter collects all materials.
After the experimenter collects all materials, he/she will give you more information about the study and sign your participation forms.
