CARDIORESPIRATORY SYMPTOMS IN RESPONSE TO PHYSIOLOGICAL AROUSAL

Objective: To develop a laboratory paradigm for assessing the tendency to amplify somatic symptoms and report bodily distress. Method: Repor ts of four different cardiopulmonary symptoms were obtained during sta ndardized, treadmill exercise, while the physiological parameters whic h induce these symptoms were simultaneously measured. Two indices were developed to compare symptom reporting across patients: symptom sever ity after reaching 80% of predicted, maximal exercise capacity; and th e magnitude of physiological arousal necessary to induce an initial se nsation of discomfort. Results: Fifty-one medical outpatients with a c hief complaint of palpitations were studied. Symptom distress at 80% o f maximal exercise capacity was significantly associated with state an xiety and daily life stress. The complaint of ''heart racing'' first o ccurred at a significantly lower heart rate for patients who were olde r, more anxious, and reported more daily life stress. Measures of hypo chondriasis, somatization, bodily amplification, and bodily absorption were not significantly associated with either symptom measure. Conclu sions: Standardized exercise testing may provide a suitable paradigm w ith which to study the tendency to amplify symptoms and to somatize. T he distress reported by different subjects at 80% of maximal exercise capacity may be considered an index of the discomfort engendered by a standardized stimulus, whereas the point of onset of discomfort may be a measure of the patient's threshold for becoming symptomatic. These findings are not conclusive, but do suggest that patients who are more anxious and under more stress tend to report more intense cardiopulmo nary symptoms at comparable levels of physiological arousal, and to ha ve a lower threshold for experiencing discomfort.