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Institute of Advanced Study

Choosing the Gold Standard: Subjective Report vs Physiological Measure

Abstract

This essay approaches the broad topic of whether to privilege subjectivity or objectivity in the measurement of physical experience. The topic is approached from a relatively narrow focus on the measurement of hot flashes during the menopausal transition. Hot flashes are experienced as sudden, generally unpleasant, sensations of heat by up to 75% of women in the US. They are caused by transient episodes of sweating and vasodilation. Numerous surveys have been carried out with standardized questionnaires to query hot-flash experience (presence/absence) and bothersomeness. Biometric measurement of skin temperature, pulse or sweating provides an alternative source of information about symptom experience. At times, women demonstrate hot flashes that are biometrically documented, but do not experience, identify or label the phenomenon to be a hot flash. This may be because self-reported hot-flash frequencies are influenced by personal perceptions and by the cultural significance applied to subjectively perceived phenomena. In contrast, objective measures of hot flashes are largely unbiased by cultural context. Which is the true measure of a hot flash – subjective report or a change in the level of sternal skin conductance? The literature of phenomenology is explored with an emphasis on the problem of hot-flash assessment. This interest in hot flashes can be applied to the measurement of other conditions that can be both subjectively experienced and objectively measured, such as pain, stress, memory and sleep quality.

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