Journal of Behavioral Medicine

, Volume 25, Issue 4, pp 373–394 | Cite as

Illness Causal Attributions: An Exploratory Study of Their Structure and Associations with Other Illness Cognitions and Perceptions of Control

  • Shoshana Shiloh
  • Dana Rashuk-Rosenthal
  • Yael Benyamini


Two studies were conducted to investigate the cognitive organization and psychological meaning of illness causes. Using a direct similarity judgment method (Study 1), illness causes were found cognitively organized in a hierarchical configuration that could meaningfully be represented as a tree with three main branches—environmental, behavioral, and hidden causes—that further divided into subcategories. This classification of illness causes was associated with other components of the illness schema, namely, the consequences and control/cure dimensions, but not with timeline perceptions (Study 2). Perceptions of control were significantly associated with the cognitive organization of illness causal attributions. Personal relevancy was found as a moderator of illness causal attributions, influencing the relationships between attributions and other illness cognitions.

illness cognitions causal attributions control 


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  1. Abramson, L.Y., Seligman, M. E. P., and Teasdale, J.D. (1978). Learned helplessness in humans: Critique and reformulation. J. Ab. Psychol. 87: 49–74.Google Scholar
  2. Affleck, G., Pfeiffer, C., Tennen, H., and Fifield, J. (1987a). Appraisals of control and predictability in adapting to chronic disease. J. Per. Soc. Psychol. 53: 273–279.Google Scholar
  3. Affleck, G., Tennen, H., Croog, S., and Levine, S. (1987b). Causal attribution, perceived control, and recovery from a heart attack. J. Soc. Clin. Psychol. 5: 339–355.Google Scholar
  4. Affleck, G., Tennen, H., Urrows, S., and Higgins, P. (1992). Neuroticism and the pain–mood relation in rheumatoid arthritis: Insights from a prospective daily study. J. Consul. Clin. Psychol. 60: 119–126.Google Scholar
  5. Agrawal, M., and Dalal, A. K. (1993). Beliefs about the world and recovery from myocardial-Infarction. J. Soc. Psychol. 133: 385–394.Google Scholar
  6. Alagna, S. W., Morokoff, P. J., Bevett, J. M., and Reddy, D. M. (1987). Performance of breast self-examination by women at high risk for breast cancer. Women Health 12: 29–46.Google Scholar
  7. Anderson, C. A., and Riger, A. L. (1991). A controllability attributional model of problems in living—Dimensional and situational interactions in the prediction of depression and loneliness. Soc. Cogn. 9: 149–181.Google Scholar
  8. Bar-On, D., Gilutz, H., Maymon, T., Zilberman, E., and Cristal, N. (1994). Long-term prognosis of low-risk, post-MI patients—The importance of subjective perceptions of disease. Euro. Heart J. 15: 1611–1615.Google Scholar
  9. Batson, C. D., Duncan, B. D., Ackerman, P., Buckley, T., and Birch, K. (1981). Is empathic motivation a source of altruistic motivation? J. Pers. Soc. Psychol. 40: 290–302.Google Scholar
  10. Benyamini, Y., Leventhal, E. A., and Leventhal, H. (1997). Attributions and health. In Baum, A., Newman, S., Weinman, J., West, R., and McManus, C. (Eds.), Cambridge Handbook of Psychology, Health and Medicine, Cambridge University Press, Cambridge, UK, pp. 72–77.Google Scholar
  11. Billings, E., Bar-On, D., and Rehnquist, N. (1997). Causal attribution by patients, their spouses and the physicians in relation to patient outcome after a first myocardial infarction—Subjective and objective outcome. Cardiology 88: 367–372.Google Scholar
  12. Bishop, G.D. (1987). Lay conceptions of physical symptoms. J. Appl. Soc. Psychol. 17: 127–146.Google Scholar
  13. Bishop, G. D. (1991). Lay disease representations and responses to victims of disease. Basic Appl. Soc. Psychol. 12: 115–132.Google Scholar
  14. Bradley, C., Brewin, C. R., Gamsu, D. S., and Moses, J. L. (1984). Development of scales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. Diabetic Med. 1: 213–218.Google Scholar
  15. Brown, J. D., and Siegel, J. M. (1988). Attributions for negative life events and depression: The role of perceived control. J. Per. Soc. Psychol. 54: 316–322.Google Scholar
  16. Chalder, T., Power, M. J., and Wessely, S. (1996). Chronic fatigue in the community: “A question of attribution.” Psychol. Med. 26: 791–800.Google Scholar
  17. Cope, H., David, A., and Mann, A. (1994). 'Maybe it's a virus?': Beliefs about viruses, symptom attributional style and psychological health. J. Psychosom. Res. 38: 89–98.Google Scholar
  18. De Jong, W. (1980). The stigma of obesity: The consequences of naive assumptions concerning the causes of physical deviance. J. Health Soc. Behav. 21: 75–87.Google Scholar
  19. Deuser, W. E., and Anderson, C. A. (1995). Controllability attributions and learned helplessness: Some methodological and conceptual problems. Basic Appl. Soc. Psychol. 16: 297–318.Google Scholar
  20. de Valle, M. N., and Norman, P. (1992). Causal attributions, health locus of control beliefs and lifestyle changes among pre-operative coronary patients. Psychol. Health 7: 201–211.Google Scholar
  21. Furnham, A. (1994a). Explaining health and illness: Lay perceptions on current and future health, the causes of illness, and the nature of recovery. Soc. Sci. Med. 39: 715–725.Google Scholar
  22. Furnham, A. (1994b). Explaining health and illness: Lay beliefs on the nature of health. Pers. Indiv. Diff. 17: 455–466.Google Scholar
  23. Fortune, D.G., Richards, H. L., Main, C. J., and Griffith, C. E. M. (2000). Pathological worrying, illness perceptions and disease severity in patients with psoriasis. Brit. J. Health Psychol. 5: 71–82. 392 Shiloh, Rashuk-Rosenthal, and BenyaminiGoogle Scholar
  24. Green, D. W., and McManus, I. C. (1995). Cognitive structural models: The perception of risk and prevention in coronary heart disease. Brit. J. Psychol. 86: 321–336.Google Scholar
  25. Heider, F. (1958). The Psychology of Interpersonal Relations, Wiley, New York.Google Scholar
  26. Heijmans, M., and de Ridder, D. (1998). Assessing illness representations of chronic illness: Explorations of their disease-specific nature. J. Behav. Med. 21: 485–503.Google Scholar
  27. Hunt, L. M., Jordan, B., and Irwin, S. (1989). Views of what's wrong: Diagnosis and patients' concepts of illness. Soc. Sci. Med. 28: 945–956.Google Scholar
  28. Kelley, H. H. (1967). Attribution theory in social psychology. In Levine, D. (Ed.), Nebraska Symposium on Motivation, University of Nebraska Press, Lincoln.Google Scholar
  29. King, J. (1983). Attribution theory and the Health Belief Model. In Hewstone, M. (Ed.), Attribution Theory: Social and Functional Extensions, Basil Blackwell, Oxford, pp. 170–186.Google Scholar
  30. Klonoff, E. A., and Landrine, H. (1994). Culture and gender diversity in commonsense beliefs about causes of six illnesses. J. Behav. Med. 17: 407–418.Google Scholar
  31. Ladany, N., Stern, M., and Inman, A.G. (1998). Medical students' perceptions of and willingness to treat patients who are HIV infected. J. Appl. Soc. Psychol. 28: 1031–1050.Google Scholar
  32. Lalljee, M., Lamb, R., and Carnibella, G. (1993). Lay prototypes of illness: Their content and use. Psychol. Health 8: 33–49.Google Scholar
  33. Landrine, H., and Klonoff, E. A. (1994). Cultural diversity in causal attributions for illness. J. Behav. Med. 17: 181–193.Google Scholar
  34. Lau, R. R., Bernard, T. M., and Hartman, K. A. (1989). Further explorations of common-sense representations of common illnesses. Health Psychol. 8: 195–219.Google Scholar
  35. Lau, R. R., and Hartman, K. A. (1983). Common-sense representations of common illnesses. Health Psychol. 2: 167–185.Google Scholar
  36. Lerman, C. (1997). Psychological aspects of genetic testing: Introduction to the special issue. Health Psychol. 16: 3–7.Google Scholar
  37. Lerman, C., Rimer, B., Trock, B., Balshem, A., and Engstrom, P. F. (1990). Factors associated with repeat adherence to breast cancer screening. Prev. Med. 19: 279–290.Google Scholar
  38. Leventhal, H., and Benyamini, Y. (1997). Lay beliefs about health and illness. In Baum, A., Newman, S., Weinman, J., West, R., and McManus, C. (Eds.), Cambridge Handbook of Psychology, Health and Medicine, Cambridge University Press, Cambridge, UK, pp. 131–135.Google Scholar
  39. Leventhal, H., Benyamini, Y., Brownlee, S., Diefenbach, M., Leventhal, E. A., Patrick-Miller, L., and Robitaille, C. (1997). Illness representations: Theoretical foundations. In Petrie, K. J., and Weinman, J. A. (Eds.), Perceptions of Health and Illness, Harwood Academic Publishers, Amsterdam, pp. 19–45.Google Scholar
  40. Leventhal, H., and Diefenbach, M. (1991). The active side of illness cognition. In Skelton, J. A., and Croyle, R. T. (Eds.), Mental Representations in Health and Illness, Springer-Verlag, New York, pp. 247–272.Google Scholar
  41. Leventhal, H., Meyer, D., and Nerenz, D. (1980). The common-sense representations of illness danger. In Rachman, S. (Ed.), Medical Psychology, Vol. 2, Pergamon, New York, pp. 7–30.Google Scholar
  42. Leventhal, H., and Nerenz, D. (1982). Representations of threat and control of stress. In Meichebaum, D., and Jaremko, M. (Eds.), Stress Prevention and Management: A Cognitive Behavioral Approach, Plenum, New York.Google Scholar
  43. Leventhal, H., Nerenz, D., and Steele, D. (1984). Illness representations and coping with health threats. In Baum, A., and Singer, J. (Eds.), A Handbook of Psychology and Health, Vol. 4, Erlbaum, Hillsdale, NJ, pp. 219–252.Google Scholar
  44. Lowery, B. J., and Jacobsen, B. S. (1984). Attributional analysis of chronic illness outcomes. Nurs. Res. 33: 82–88.Google Scholar
  45. Marteau, T. M., and Riordan, D. C. (1992). Staff attitudes to patients: The influence of causal attributions for illness. Brit. J. Clin. Psychol. 31: 107–110.Google Scholar
  46. Marteau, T. M., and Senior, V. (1997). Illness representations after the Human Genome Project: The perceived role of genes in causing illness. In Petrie, K. J., and Weinman, J. A. (Eds.), Perceptions of Health and Illness, Harwood Academic Publishers, Amsterdam, pp. 241–266.Google Scholar
  47. McNeil, T. F., Sveger, T., and Thelin, T. (1988). Psychological effects of screening for somatic risk: The Swedish alpha1–antitrysin experience. Thorax 43: 505–507. Illness Attributions and Control 393Google Scholar
  48. Michela, J. L., and Wood, J.W. (1986). Causal attribution in health and illness. In Kendall, P. C. (Ed.), Advances in Cognitive–Behavioural Research and Therapy, Vol. 5, Academic Press, New york.Google Scholar
  49. Michie, S., McDonald, V., and Marteau, T. M. (1996). Understanding responses to predictive genetic testing: A grounded theory approach. Psychol. Health 11: 455–470.Google Scholar
  50. Mickelson, K. D., Wroble, M., and Helgeson, V. S. (1999). “Why my child?”: Parental attributions for children's special needs. J. Appl. Soc. Psychol. 29: 1263–1292.Google Scholar
  51. Moss-Moris, R., Petrie, K. J., and Weinman, J. (1996). Functioning in chronic fatigue syndrome: Do illness perceptions play a regulatory role? Brit. J. Health Psychol. 1: 15–25.Google Scholar
  52. Murray, M., and McMillan, C. L. (1993). Gender differences in perceptions of cancer. J. Canc. Edu. 8: 53–62.Google Scholar
  53. Nerenz, D. R., and Leventhal, H. (1983). Self-regulation theory in chronic illness. In Burish, B. G., and Bradley, I. A. (Eds.), CopingWith Chronic Disease, Academic Press, New York.Google Scholar
  54. Peters, L., Denboer, D. J., Kok, G., and Schaalma, H. P. (1994). Public reactions towards people with AIDS—An attributional analysis. Pat. Edu. Couns. 24: 323–335.Google Scholar
  55. Peterson, C. (1991). The meaning and measurement of explanatory style. Psychol. Inquiry 2: 1–10.Google Scholar
  56. Peterson, C., and Seligman, M. E. P. (1987). Explanatory style and illness. J. Pers. 55: 237–265.Google Scholar
  57. Peterson, C., Seligman, M. E. P., and Valliant, G. E. (1988). Pessimistic explanatory style: A risk factor for physical illness. J. Pers. Soc. Psychol. 55: 23–27.Google Scholar
  58. Rounds, J.B., and Zevon, M.A. (1993). Cancer stereotypes: A multidimensional scaling analysis. J. Behav. Med. 16: 485–496.Google Scholar
  59. Sattath, A., and Tversky, A. (1977). Additive similarity trees. Psychometrica 42: 319–345.Google Scholar
  60. Schiaffino, K. M., and Cea, C. D. (1995). Assessing chronic illness representations: The implicit models of illness questionnaire. J. Behav. Med. 18: 531–548.Google Scholar
  61. Schiaffino, K. M., and Revenson, T. A. (1992). The role of perceived self-efficacy, perceived control, and causal attributions in adaptation to rheumatoid arthritis: Distinguishing mediator from moderator effects. Pers. Soc. Psychol. Bull. 18: 709–718.Google Scholar
  62. Schmelkin, L. P., Wachtel, A. B., Schneiderman, B. E., and Hecht, D. (1988). The dimensional structure of medical students' perceptions of diseases. J. Behav. Med. 11: 171–183.Google Scholar
  63. Schober, R., and Lacroix J. M. (1991). Lay illness models in the enlightenment and the 20th century: Some historical lessons. In Skelton, J. A., and Croyle, R. T. (Eds.), Mental Representation in Health and Illness, Springer-Verlag, New York, pp. 10–31.Google Scholar
  64. Senior, V., Marteau, T. M., and Peters, T. J. (1999). Will genetic testing for predisposition for disease result in fatalism? A qualitative study of parents' responses to neonatal screening for familial hypercholesterolemia. Soc. Sci. Med. 48: 1857–1860.Google Scholar
  65. Senior, V., Marteau, T. M., and Weinman, J. (2000). Impact of genetic testing on causal models of heart disease and arthritis: An analogue study. Psychol. Health 14: 1077–1088.Google Scholar
  66. Sensky, T. (1997). Causal attributions in physical illness. J. Psychosom. Res. 43: 565–573.Google Scholar
  67. Skinner, E. A. (1996). A guide to constructs of control. J. Pers. Soc. Psychol. 71: 549–570.Google Scholar
  68. Smith, T. J. (1998). A comparison of three additive tree algorithms that rely on a least-squares loss criterion. Brit. J. Math. Stat. Psychol. 51: 269–288.Google Scholar
  69. Swartzman, L. C., and Lees, M. C. (1996). Causal dimensions of college students' perceptions of physical symptoms. J. Behav. Med. 19: 95–110.Google Scholar
  70. Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. Am. Psychologist 41: 1161–1172.Google Scholar
  71. Taylor, S. E., Lichtman, R. R., and Wood, J. V. (1984). Attributions, beliefs about control, and adjustment to breast cancer. J. Pers. Soc. Psychol. 46: 489–502.Google Scholar
  72. ten Kroode, H., Oosterwijk, M., and Steverink, N. (1989). Three conflicts as a result of causal attributions. Soc. Sci. Med. 28: 93–97.Google Scholar
  73. Tennen, H., Affleck, G., Allen, D., McGrade, B., and Ratzan, S. (1984). Causal attributions and coping with insulin-dependent diabetes. Basic Appl. Soc. Psychol. 5: 131–142.Google Scholar
  74. Thompson, S. C. (1991). The search for meaning following a stroke. Basic Appl. Soc. Psychol. 12: 81–96.Google Scholar
  75. Timko, C., and Janoff-Bulman, R. (1985). Attributions, vulnerability, and psychological adjustment: The case of breast cancer. Health Psychol. 4: 521–544. 394 Shiloh, Rashuk-Rosenthal, and BenyaminiGoogle Scholar
  76. Turner DePalma, D. M., Madey, S. F., Tillman, T. C., and Wheeler, J. (1999). Perceived patient responsibility and belief in a just world affect helping. Basic Appl. Soc. Psychol. 21: 131–137.Google Scholar
  77. Turnquist, D. C., Harvey, J. H., and Andersen, B. L. (1988). Attributions and adjustment to life-threatening illness. Brit. J. Clin. Psychol. 27: 55–65.Google Scholar
  78. Tversky, A., and Hutchinson, W. J. (1986). Nearest neighbor analysis of psychological spaces. Psychol. Rev. 93: 3–22.Google Scholar
  79. Wallston, K. A. (1992). Hocus-pocus, the focus isn't strictly on locus: Rotter's social learning theory modified for health. Cogn. Ther. Res. 16: 183–199.Google Scholar
  80. Weil, J. (1991). Mothers' postcounseling beliefs about the causes of their children's genetic disorders. Am. J. Hum. Gen. 48: 145–153.Google Scholar
  81. Weinman, J., Petrie, K. J., Moss-Moris, R., and Horne, R. (1996). The illness perception questionnaire: A new method for assessing the cognitive representation of illness. Psychol. Health 11: 431–445.Google Scholar
  82. Weinman, J., Petrie, K. J., Sharpe, N., and Walker, S. (2000). Causal attributions in patients and spouses following first-time myocardial infarction and subsequent lifestyle changes. Brit. J. Health Psychol. 5: 263–273.Google Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Shoshana Shiloh
    • 1
  • Dana Rashuk-Rosenthal
    • 1
  • Yael Benyamini
    • 2
  1. 1.Department of PsychologyTel Aviv UniversityTel AvivIsrael
  2. 2.Bob Shapell School of Social WorkTel Aviv UniversityTel AvivIsrael

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