An attribution problem.

I occur in our lives, we seek ways to understand them. Sometimes our explanations are evidence-based and valid. Sometimes they are superstitious or spiritual or just plain wrong. The model of cognitive therapy focuses on the meanings people apply to events and situations that lead to distress. Many of these meanings take the form of “attributions” or explanations. When a patient consults a doctor, he or she will invariably have an explanation for the symptoms presented. The patient will seek, then may or may not accept, the physician’s attribution for the problem. A young woman consulted me after presenting a variety of complaints to several primary care physicians. Ms. A was 28 years old, recently married to a man she had known for 5 years, and held a stable job in commercial real estate. Two years ago, she had a series of bladder infections and was treated with an antibiotic. She “reacted” to this drug with episodes of hot sweaty palms, diarrhea, and chest pains. These episodes were followed in 1 week by a “weird feeling” in her head. She returned to her physician, who acknowledged that this could have been drug-related, and the doctor discontinued the drug. The episodes went away. The symptoms returned 1 year ago, with diarrhea, dizziness, and a similar weird feeling, this time in the context of being a bridesmaid at a good friend’s wedding. She consulted a “Doc-in-the-box” who examined her, ordered laboratory tests, and found “nothing wrong.” In the past several weeks, the symptoms have returned. “I was hoping they would go away,” she told me, “but instead they seem more frequent now, and they are prohibiting my daily activities.” She found that she preferentially was staying at home and had recently refused to travel for her job.