Chicken or egg? Attribution hypothesis and nocebo hypothesis to explain somatization associated to perceived RF-EMF exposure

Introduction: The aim of this study is to understand the temporal relationship between the somatization usually attributed to RF-EMFs, and to evaluate the attribution hypothesis and the nocebo hypothesis in this context. Method: In this longitudinal study, data from the Dutch Occupational and Environmental Health Cohort Study (AMIGO) was analyzed, consisting of a baseline questionnaire collected in 2011 (14,829 participants) and a follow-up questionnaire collected in 2015 (7,904 participants). Participants completed a questionnaire providing information on their health status, perceived environmental exposures, and demographics. Two sets of multiple regressions were conducted to evaluate the two hypotheses. Results: Results show that the attribution hypothesis overall explained symptom reporting in association to perceived RF-EMF base station exposure and perceived electricity exposure more frequently than the nocebo hypothesis. Discussion: This finding stands out from most of the existing literature, which primarily points to the nocebo effect as the main explanation for somatization in response to RF-EMF exposure. While this does not exclude, in absolute terms, the existence of a nocebo effect, potentially at other time scales, this finding has relevant consequences at the policy making level. The emerging relevance of the attribution hypothesis moves the focus on the discomfort of people with unexplained symptoms and their need to find a plausible explanation for their discomfort.