title: The symmetry rule: a seven-year study of symptoms and explanatory labels among Gulf War veterans.
abstract: Noticing medical symptoms can cause one to search for explanatory labels such as "ate bad food" or even "exposed to anthrax," and perhaps these labels may cause new symptom reports. The present study examined whether there is empirical support for this symptom-label "symmetry rule." We interviewed veterans (N= 362) from the Gulf War Registry in 1995 and 2002 about their medical symptoms and about their exposure to war-related hazards and stressors. Health symptom reports were strongly correlated between the two time periods and showed relatively stable mean levels, whereas recall of war-related exposures was notably unstable. Veterans starting with fewer medical symptoms recalled fewer war-related exposures seven years later. Initial recollection of chemical and biological warfare exposure (but not other exposures) longitudinally predicted novel medical symptoms. The findings generally support the symmetry rule hypotheses, although the evidence for the label to symptom link was less strong. The findings account for some variability in symptoms and exposure recall over time, but they do not, on their own, account for the Gulf War veterans' elevated number of unexplained medical symptoms.
authors.affiliation: Department of Health Behavior and Health Education, University of North Carolina School of Public Health, Chapel Hill, NC 27516, USA. ntb1@unc.edu
authors.forename: Noel T
authors.initials: NT
authors.lastname: Brewer
authors.forename: William K
authors.initials: WK
authors.lastname: Hallman
authors.forename: Howard M
authors.initials: HM
authors.lastname: Kipen
mesh_terms: D000328:Adult; D001694:Biological Warfare; D002618:Chemical Warfare; D003130:Combat Disorders / Q000150:complications / Q000175:diagnosis*; D005260:Female; D047830:Gulf War; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D018923:Persian Gulf Syndrome / Q000175:diagnosis* / Q000209:etiology; D012306:Risk; D018570:Risk Assessment; D014728:Veterans; D014857:Warfare
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