Last updated: Tue, Aug 13, 2024
Who among us can honestly say that they've tried as hard as they could? Probably only team athletes?
People with chronic pain typically attempt to base their decisions about the amount of physical activity or the work that they perform on the level of pain that they experience or anticipate. Interestingly, we (Turk et al. 1996) found that patients in whom fibromyalgia syndrome was diagnosed tended to overestimate the extent of their physical limitations.
Overestimation may lead to a self-fulfilling prophecy and inhibit activities because patients view themselves as being more disabled than they actually are, which eventually prevents them from making an effort to undertake physical activities that they believe are beyond their capacity.1
The theory extends this starting point into a downward spiral in which the patient's tendency to “overestimate the extent of their physical limitations” leads to increasing disability.
This theory has two particularly thorny features to it. First, it puts the caregiver in the position of knowing things about the patient's condition that the patient doesn't know. Second, it casts the patient as the cause of the condition. Although I can imagine a case in which these two things might be true, I can much more easily imagine cases in which this would inflict much suffering on the patient. Aspects of this theory are addressed in In a Complex Body.