The Theory of Unpleasant Symptoms

The Theory of Unpleasant Symptoms

Seeking medical care is frequently prompted by a series of events that result in unpleasant feelings—the symptoms that a patient experiences. The theory of unpleasant symptoms was developed to understand unpleasant feelings better, what causes them, and how they affect performance. The theory is divided into three concepts: influencing factors, symptoms, and performance (Blakeman, 2019; Gomes et al., 2019).

Symptoms, the theory’s central focus, refers to the perceived indicators of change in normal functioning experienced by patients and have four characteristics: timing, intensity, distress, and quality (Blakeman, 2019; Gomes et al., 2019).

On the other hand, the influencing factors are physiologic, psychologic, or situational factors that determine how harrowing a symptom is, whereas performance is the consequence of the symptom experience (Blakeman, 2019; Gomes et al., 2019). When evaluating a patient, it is necessary to consider all three concepts the theory depicts. This paper aims to discuss the different dimensions of symptoms to look for when evaluating patients.

Assessment Tool for Patient Symptoms

            Symptoms serve as red flags of threat to health and prompt people to seek medical care. An individual may have only one symptom, but usually, multiple symptoms occur simultaneously.  For comprehensiveness, key dimensions to check and consider when assessing patients include intensity, timing, distress, and quality. The intensity of a symptom refers to its severity, and it is frequently subjectively reported.

For example, when assessing pain, patients are asked to rate the severity of their pain on a scale of 0 to 10, with 0 indicating no pain and 10 indicating severe pain (Dydyk & Grandhe, 2022). A patient with dyspnea may also be asked to rate the severity on a scale of 0 to 4, with 0 being no dyspnea and four being too breathless to leave the house or breathless when dressing or undressing (Hashmi et al., 2022). Variable time dimensions can also be used to describe symptoms.

The frequency with which an intermittent symptom occurs, the duration of a persistent symptom, or the timing of a symptom’s occurrence in relation to a specific activity are all examples of timing variation (Moore, 2022). A gallstone, for example, may cause right quadrant abdominal pain shortly after eating a fatty meal. A clinician would rely on the patient’s account of their illness to determine the timing of a symptom.

The level of distress is also an important factor in symptom assessment. The degree to which a person is bothered by a symptom is indicated by distress. A person may be incapacitated or less bothered by a symptom, and a clinician relies on the patient’s account of their illness to obtain this information. This dimension contributes to the quality of life by assisting in determining whether treatment or amelioration will be sought.

Quality is reflected by the vocabulary patients use to describe how they feel about the symptoms. For example, when using the International Prostate Symptom Score (IPSS) to assess patients with prostate tumors, the eighth question is, “if you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that?”  (Hopland-Nechita et al., 2022).

A patient’s response could be one of the following: delighted, pleased, mostly satisfied, mixed, mostly dissatisfied, unhappy, or terrible (Hopland-Nechita et al., 2022). Due to people’s varying abilities to perceive and report symptoms, determining the quality aspect of a symptom may be difficult.


            The theory of unpleasant symptoms holistically explores various aspects of symptom experience.  The gravity of a symptom may be determined by variable factors, which the theory term influencing factors. Furthermore, symptoms have an impact on a person’s performance, whether functional or cognitive.

Clinicians are thus tasked with conducting a thorough assessment of patients and initiating early measures to halt the progression and the resulting impact on life. While some dimensions of symptoms, such as timing, are easy to assess, others, such as quality, are difficult to assess because patients have varying abilities to discern symptoms.


Blakeman, J. R. (2019). An integrative review of the theory of unpleasant symptoms. Journal of Advanced Nursing75(5), 946–961.

Dydyk, A. M., & Grandhe, S. (2022). Pain Assessment. In StatPearls [Internet]. StatPearls Publishing.

Gomes, G. L. L., Oliveira, F. M. R. L. de, Barbosa, K. T. F., Medeiros, A. C. T. de, Fernandes, M. das G. M., & Nóbrega, M. M. L. da. (2019). Theory of Unpleasant Symptoms: Critical analysis. Texto & Contexto Enfermagem28(0).

Hashmi, M. F., Modi, P., Basit, H., & Sharma, S. (2022). Dyspnea. In StatPearls [Internet]. StatPearls Publishing.

Hopland-Nechita, F. V., Andersen, J. R., & Beisland, C. (2022). IPSS “bother question” score predicts health-related quality of life better than total IPSS score. World Journal of Urology40(3), 765–772.

Moore, A. K. (2022). The Holistic Theory of Unpleasant Symptoms. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association40(2), 193–202.