Health anxiety, hypochondriasis, and the anxiety disorders

How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety?

Intolerance of uncertainty (IU)--a multidimensional cognitive vulnerability factor--is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.

Linking Illness in Parents to Health Anxiety in Offspring: Do Beliefs about Health Play a Role?

BACKGROUND

The cognitive behavioural (CB) model of health anxiety proposes parental illness leads to elevated health anxiety in offspring by promoting the acquisition of specific health beliefs (e.g. overestimation of the likelihood of illness).

AIMS

Our study tested this central tenet of the CB model.

METHOD

Participants were 444 emerging adults (18-25-years-old) who completed online measures and were categorized into those with healthy parents (n = 328) or seriously ill parents (n = 116).

RESULTS

Small (d = .21), but significant, elevations in health anxiety, and small to medium (d = .40) elevations in beliefs about the likelihood of illness were found among those with ill vs. healthy parents. Mediation analyses indicated the relationship between parental illness and health anxiety was mediated by beliefs regarding the likelihood of future illness.

CONCLUSIONS

Our study incrementally advances knowledge by testing and supporting a central proposition of the CB model. The findings add further specificity to the CB model by highlighting the importance of a specific health belief as a central contributor to health anxiety among offspring with a history of serious parental illness.

Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators

The present investigation employed meta-analysis to examine the efficacy of cognitive-behavioral therapy (CBT) for hypochondriasis/health anxiety as well as potential moderators that may be associated with outcome. A literature search revealed 15 comparisons among 13 randomized-controlled trials (RCTs) with a total sample size of 1081 participants that met inclusion criteria. Results indicated that CBT outperformed control conditions on primary outcome measures at post-treatment (Hedges's g = 0.95) and at follow-up (Hedges's g = 0.34). CBT also outperformed control conditions on measures of depression at post-treatment (Hedges's g = 0.64) and at follow-up (Hedges's g = 0.35). Moderator analyses revealed that higher pre-treatment severity of hypochondriasis/health anxiety was associated with greater effect sizes at follow-up visits and depression symptom severity was significantly associated with a lower in effect sizes at post-treatment. Although effect size did not vary as a function of blind assessment, smaller effect sizes were observed for CBT vs. treatment as usual control conditions than for CBT vs. waitlist control. A dose response relationship was also observed, such that a greater number of CBT sessions was associated with larger effect sizes at post-treatment. This review indicates that CBT is efficacious in the treatment of hypochondriasis/health anxiety and identifies potential moderators that are associated with outcome. The implications of these findings for further delineating prognostic and prescriptive indicators of CBT for hypochondriasis/health anxiety are discussed.

Panic Disorder and Agoraphobia in OCD patients: clinical profile and possible treatment implications

OBJECTIVE

Panic Disorder (PD) and agoraphobia (AG) are frequently comorbid with obsessive-compulsive disorder (OCD), but the correlates of these comorbidities in OCD are fairly unknown. The study aims were to: 1) estimate the prevalence of PD with or without AG (PD), AG without panic (AG) and PD and/or AG (PD/AG) in a large clinical sample of OCD patients and 2) compare the characteristics of individuals with and without these comorbid conditions.

METHOD

A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Bivariate analyses were followed by logistic regression models.

RESULTS

The lifetime prevalence of PD was 15.3% (N=153), of AG 4.9% (N=49), and of PD/AG 20.2% (N=202). After logistic regression, hypochondriasis and specific phobia were common correlates of the three study groups. PD comorbidity was also associated with higher levels of anxiety, having children, major depression, bipolar I, generalized anxiety and posttraumatic stress disorders. Other independent correlates of AG were: dysthymia, bipolar II disorder, social phobia, impulsive-compulsive internet use, bulimia nervosa and binge eating disorder. Patients with PD/AG were also more likely to be married and to present high anxiety, separation anxiety disorder, major depression, impulsive-compulsive internet use, generalized anxiety, posttraumatic stress and binge eating disorders.

CONCLUSIONS

Some distinct correlates were obtained for PD and AG in OCD patients, indicating the need for more specific and tailored treatment strategies for individuals with each of these clinical profiles.

A community-based epidemiological study of health anxiety and generalized anxiety disorder

This community-based study examined the frequency of worry about personal health in respondents with and without generalized anxiety disorder (GAD), and the impact of health anxiety on the disorder. A random community-based telephone survey of 5118 Chinese respondents aged 18-64 was conducted. A fully structured questionnaire covered the DSM-IV-TR criteria of GAD, major depressive episode (MDE), eight domains of worry, the seven-item Whiteley Index (WI-7), health service use, and socio-demographic information. Worry about personal health ranked fifth (75.6%) among eight domains of worries examined. GAD respondents with high level of health anxiety were significantly older, less educated, and had lower family income. High health anxiety significantly increased the occurrence of one-year MDE, previous persistent worry, previous persistent low mood, number of domains of worries, number of non-core DSM-IV-TR GAD symptoms, health service use, and mistrust of doctors. Health anxiety is common in GAD and may signify greater severity of the disorder.

Adverse childhood experiences and health anxiety in adulthood

Childhood experiences are thought to predispose a person to the development of health anxiety later in life. However, there is a lack of research investigating the influence of specific adverse experiences (e.g., childhood abuse, household dysfunction) on this condition. The current study examined the cumulative influence of multiple types of childhood adversities on health anxiety in adulthood. Adults 18-59 years of age (N=264) completed a battery of measures to assess adverse childhood experiences, health anxiety, and associated constructs (i.e., negative affect and trait anxiety). Significant associations were observed between adverse childhood experiences, health anxiety, and associated constructs. Hierarchical multiple regression analysis indicted that adverse childhood experiences were predictive of health anxiety in adulthood; however, the unique contribution of these experience were no longer significant following the inclusion of the other variables of interest. Subsequently, mediation analyses indicated that both negative affect and trait anxiety independently mediated the relationship between adverse childhood experiences and health anxiety in adulthood. Increased exposure to adverse childhood experiences is associated with higher levels of health anxiety in adulthood; this relationship is mediated through negative affect and trait anxiety. Findings support the long-term negative impact of cumulative adverse childhood experiences and emphasize the importance of addressing negative affect and trait anxiety in efforts to prevent and treat health anxiety.

A behavioral test of contamination fear in excessive health anxiety

BACKGROUND AND OBJECTIVES

Health anxiety is characterized by a preoccupation with the possibility of having a serious health condition or disease. Contemporary conceptualizations of health anxiety have improved in recent years to incorporate a fear of acquiring an illness; however, there is limited experimental data demonstrating the presence of fear of contamination among health anxious individuals.

METHOD

The present study utilized behavior approach tasks (BATs) to examine the degree to which contamination fear is present in elevated health anxiety. Participants were 60 undergraduate students who reported elevated health anxiety, contamination fear, or no anxiety about either health or contamination. Participants completed four BATS from which avoidance, anxiety, and disgust ratings were derived.

RESULTS

Health anxious and contamination fearful individuals exhibited a similar degree of avoidance during the BATs. Contamination fearful participants reported significantly more anxiety and disgust relative to the non-anxious controls, but not the health anxious participants. Health anxious participants did not report more anxiety or disgust than the non-anxious participants.

LIMITATIONS

The use of an analogue sample may limit the extension of these findings to clinical populations. Additionally, the role of general negative affect could not be reliably determined in the absence of an anxious control group.

CONCLUSIONS

These findings suggest that contamination fear may be a source of conceptual overlap between health anxiety and other disorders characterized by contamination fear. This highlights the importance of considering contamination fear in excessive health anxiety.

Family background of modern health worries, somatosensory amplification, and health anxiety: A questionnaire study

In the development of somatosensory amplification, health anxiety, and modern health worries, environmental factors seem more important than genetic background. Parental attitudes might represent a major source of learning. In total, 186 adolescents and their parents completed a questionnaire assessing modern health worries, somatosensory amplification, health anxiety, and somatic symptoms. Adolescents’ modern health worries, somatosensory amplification, and health anxiety were positively related to respective parental characteristics in regression analyses even after controlling for sociodemographic variables and somatic symptoms. Parental beliefs may play a role in the development of these characteristics.

Construct validity and temporal stability of the abridged 31-item Illness Behaviour Questionnaire

OBJECTIVE

Key psychometric information was sought for three newly derived dimensions from an abridged Illness Behaviour Questionnaire (IBQ-31): Affirmation of Illness (AI), Concern for Health (CH) and General Affective State (GAS). The construct validity of these scales was examined along with their test-retest reliability and long-term stability.

DESIGN

A longitudinal, observational study was conducted with 675 participants (general community members and those with either asthma, diabetes and chronic pain or chronic fatigue syndrome) providing self-report questionnaire data at baseline, with additional information sought at three (n = 483; 71.6%) and 12 months (n = 517, 76.6%).

MAIN OUTCOME MEASURES

Construct validity of the IBQ-31 was explored using well-validated psychological measures of Symptom Attributions and Symptom Experience, Cognitive Distortion of Somatic Information and Illness Likelihood.

RESULTS

In general, AI, CH and GAS shared predictable empirical overlap with related psychological indices across the five samples. Adequate three-month test-retest reliability was evident, with greater score variability over 12 months.

CONCLUSION

The IBQ-31 comprises three theoretically relevant dimensions which demonstrate relative short- and long-term stability for individuals with diverse illness experiences. Future investigations should explore the predictive validity of AI, CH and GAS, along with the potential value of 'cut-off' scores for clinical use.

Reliability and Validity of the Turkish Version of the Health Anxiety Inventory

INTRODUCTION

Health anxiety is seen in the clinical presentation of both somatoform disorders, especially hypochondriasis and anxiety disorders. In this study, we aimed to perform the reliability and validity analyses of the Turkish version of the Health Anxiety Inventory which is used in the assessment of health anxiety.

METHOD

Translation and back-translation of the Health Anxiety Inventory was done. Study groups consisted of in- or out-patients with somatoform disorder (n=65), panic disorder (n=55), major depressive disorder (n=22), and healthy volunteers (n=114). In the assessment, beside the Health Anxiety Inventory, the Hamilton Rating Scale for Depression, Somatosensory Amplification Scale and the Trait Anxiety Inventory were used.

RESULTS

In reliability analyses, Cronbach's alpha internal consistency coefficient was 0.918 and item-total score correlation coefficients were between 0.405 and 0.769. Test-retest correlation coefficient was r=0.572. In construct validity, two factors that representing 54.5 percent of the total variance were obtained and they represented sensitivity to somatic symptoms and anxiety towards organic diseases. In concurrent validity, it had moderate to good correlation with the other study scales. In the comparison of study groups, the groups of somatoform disorder and anxiety disorder had significantly higher level of health anxiety than the groups with major depressive disorder and of healthy controls.

CONCLUSION

The Turkish version of the Health Anxiety Inventory can be reliably and validly used both in clinical practice and in research.

Mediators in internet-based cognitive behavior therapy for severe health anxiety

According to the cognitive behavioral model of severe health anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe health anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. health anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in health anxiety. The study supports the validity of the cognitive behavioral model of health anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for health anxiety.

Short Health Anxiety Inventory: Factor structure and psychometric properties in Spanish adolescents

The Short Health Anxiety Inventory is a common screening tool for assessing health anxiety among adolescents; however, its psychometric properties and internal structure have not been evaluated within a Spanish-speaking population. The goodness of fit of four models of the latent structure of the Short Health Anxiety Inventory was tested by using confirmatory factor analysis in a sample of 832 Spanish secondary school adolescents. Based on these results, the reliability of the original two-factor model was tested. Differences in health anxiety by gender and age were also examined. The results support use of the Spanish version of the Short Health Anxiety Inventory by researchers and clinicians among Spanish adolescents.

Perceptions of health and somatic sensations in women reporting premenstrual syndrome and premenstrual dysphoric disorder

Focus on bodily sensations may be involved in the etiology of premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). This study investigated the relationship between two types of somatic self-focus (i.e., health anxiety and anxiety sensitivity) and health-related quality of life (QOL) in women with provision diagnoses of PMS and PMDD. On the basis of responses to a screening measure, 731 college women were divided into three groups: PMDD, Moderate/Severe PMS, and Mild/No PMS. Measures included health-related QOL, health anxiety, anxiety sensitivity, and trait anxiety. Women with provisional diagnoses of PMDD and moderate/severe PMS reported higher levels of health anxiety and anxiety sensitivity. These relationships were not accounted for by trait anxiety. Furthermore, women in the PMDD and Moderate/Severe PMS groups reported lower health-related QOL. There is a significant health-related QOL burden for college women with PMDD and PMS. Health anxiety and anxiety sensitivity may contribute to the etiology of premenstrual disorders.

The roles of emotional reactivity and tolerance in generalized, social, and health anxiety: a multimethod exploration

Emotion regulation difficulties have been implicated in the maintenance of many anxiety disorders. However, existing research has relied mostly on self-report measures of emotion regulation or one type of mood induction. The present study examined the relationships between anxiety symptoms and emotional reactivity and tolerance using multiple assessment methodologies. Participants (N=122) completed measures of generalized, social, and health anxiety symptoms and reported tolerance of and reactivity to negative emotions (sadness, fear, anger, disgust) elicited by 4 film clips. Participants also completed a mirror-tracing persistence task, a behavioral measure of distress tolerance. Social anxiety symptoms predicted unique variance in tolerance of film-elicited emotions, whereas generalized anxiety symptoms predicted unique variance in total peak reactivity to film-elicited emotions. Health anxiety was not related to tolerance or peak reactivity, but it was predictive of greater anxiety following the mirror-tracing task. The results of this study suggest heightened emotional reactivity is a salient feature of generalized anxiety symptoms, whereas emotional tolerance is more strongly related to social anxiety symptoms. The unique association between health anxiety and anxious response to the distress tolerance task represents a novel finding that warrants further investigation.

Anxiety-related constructs mediate the relation between age and health anxiety

OBJECTIVE

Few studies have examined health anxiety in older adults, and it is unknown which factors account for age-related differences in health anxiety. Given similarities between health anxiety and the anxiety disorders, anxiety-related constructs, including anxiety sensitivity, intolerance of uncertainty, emotion regulation, and anxiety control, were examined as mediators of the relation between age (older vs. young adults) and health anxiety.

METHODS

Eighty-six older adults aged 60 and older and 117 young adults aged 18 to 30 completed several self-report measures of health anxiety and anxiety-related constructs.

RESULTS

Young adults reported higher levels of health anxiety than older adults. Anxiety sensitivity and intolerance of uncertainty partially mediated the relation between age and health anxiety. Perceived anxiety control, reappraisal, and suppression did not mediate the relation between age and health anxiety.

CONCLUSIONS

Anxiety sensitivity and intolerance of uncertainty are predisposing characteristics that appear to partially explain age-related differences in health anxiety. These constructs may be necessary targets for assessment and interventions among older and young adults.

Exploration of health anxiety among individuals with diabetes: Prevalence and implications

Health anxiety has been infrequently examined in individuals with diabetes. In this study, individuals with Type 1 or 2 diabetes ( n = 414) completed questionnaires assessing health anxiety and related constructs. Elevated health anxiety was reported by 24.1 percent of the sample and was greater among younger individuals, females, unmarried participants, and those recently diagnosed with diabetes. The construct was related to trait anxiety, fear of diabetes complications, poorer adherence to dietary and exercise self-care activities as well as lower physical quality of life. The research improves our understanding of health anxiety among individuals with diabetes.

The Short Health Anxiety Inventory: a systematic review and meta-analysis

INTRODUCTION

The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts.

OBJECTIVE

To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs.

METHODS

Direct search of digital databases for papers that cited the original SHAI publication.

RESULTS

Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbach's alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry.

CONCLUSIONS

The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.

The restrictive concept of good health in patients with hypochondriasis

The restrictive concept of good health and the misinterpretation of bodily symptoms as a sign of illness are considered in the DSM and in well-established cognitive models as central characteristics of hypochondriasis. However, until now it has not been satisfactorily resolved whether this tendency is unique for hypochondriasis. In the current study a modified card sorting technique was used to investigate the extent to which bodily complaints were seen as compatible with a state of good health. We found that patients with hypochondriasis (n = 45) showed a more restrictive concept of good health than anxiety patients (n = 45) and healthy controls (n = 45). Those differences were only observable when a concrete evaluation of own bodily symptoms was carried out in comparison to a more general evaluation of symptoms. The misinterpretation of bodily symptoms demonstrates to be a highly specific characteristic of hypochondriasis.

Entwicklung und Validierung eines Fragebogens zur Erfassung von hypochondrischem Sicherheitsverhalten

Theoretischer Hintergrund: Sicherheitsverhalten wird für die Aufrechterhaltung von hypochondrischen Ängsten ein wichtiger Stellenwert beigemessen. Fragestellung: In der vorliegenden Untersuchung soll die Güte eines Fragebogens zur Erfassung von Sicherheitsverhalten bei vorliegender Hypochondrie (FSVH) überprüft werden. Methode: Zur Validierung wurden eine Patientenstichprobe (N = 108) und eine Online-Stichprobe (N = 503) herangezogen. Ergebnisse: Mittels explorativer und konfirmatorischer Faktorenanalysen ließen sich die Faktoren Rückversicherungs- und Vermeidungsverhalten extrahieren. Es zeigten sich deutliche Hinweise für die konvergente und diskriminante Validität des FSVH. Für den FSVH fanden sich signifikant höhere Werte für Patienten mit Hypochondrie als für solche mit Angststörungen, somit war es möglich, mittels des FSVH zwischen diesen beiden Störungsgruppen mit hoher Genauigkeit zu diskriminieren. Schlussfolgerung: Der FSVH stellt eine geeignete Ergänzung zu etablierten Verfahren dar.

Declining health anxiety throughout medical studies: it is mainly about a more relaxed perception of the health-related concerns

BACKGROUND

Reports on effects of advancing medical education on health anxiety are scarce and contradictory.

AIM

To evaluate a hypothesis that its components could be differently affected.

METHOD

A cross-sectional study assessed the Health Anxiety Questionnaire (HAQ), Anxious Thoughts Inventory, and Somatosensory Amplification Scale scores in medical (n = 214) and law (controls, n = 821) students at different study years.

RESULTS

In the controls, all outcomes minimally differed across the study-year levels. Medical scores were similar to control scores at the lower and intermediate level and were significantly lower at higher study years. However, health worry, fear, and reassurance seeking only differed mildly between the medical study levels (adjusted effect sizes ≤ 0.23), whereas tendency toward amplification, meta-worry, social worry, and the HAQ interference with life score were significantly lower at higher than at the lower years (adjusted effect sizes 0.31-0.47). In the medical students, the HAQ interference with life score was affected mainly by the level of meta-worry, whereas in controls the major impact was that of health-related concerns.

CONCLUSIONS

Studying medicine does not seem to relevantly affect the level of health-related concerns, but the degree by which they are perceived as disruptive declines as a specific function of advancing stages of education. This is closely related to progressively declining tendency toward amplification and levels of meta-worry.

Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis

BACKGROUND

The cognitive model and empirical research underline the importance of dysfunctional beliefs about bodily symptoms and illness in health anxiety and hypochondriasis. However, specificity of such beliefs has not yet been adequately demonstrated for patients with hypochondriasis.

OBJECTIVE

This study examined whether dysfunctional beliefs about bodily symptoms and illness are elevated in comparison to patients with anxiety disorders and, therefore, specific for patients with hypochondriasis.

METHOD

Patients with hypochondriasis (n = 38), patients with anxiety disorders (n = 40), and healthy controls (n = 42) completed the Symptom and Outcomes Scale (SOS) measuring participants' estimation of the likelihood of various symptoms being indicative of a particular illness. Additionally, participants' general psychopathology (Brief Symptom Inventory), depressive (Beck Depression Inventory-II), and anxiety symptoms (Beck Anxiety Inventory) were evaluated.

RESULTS

In comparison to patients with anxiety disorders and healthy controls, patients with hypochondriasis estimated bodily symptoms to be more likely an indicator for a catastrophic illness. Patients with anxiety disorders took a middle position between patients with hypochondriasis and healthy controls. Regarding the estimation of the likelihood of symptoms indicating a minor illness, no differences were found between the three groups.

CONCLUSIONS

Dysfunctional beliefs about symptoms and illness are important and specific for patients with hypochondriasis, which is in line with the cognitive model. In order to reduce misinformation about serious illnesses in patients with hypochondriasis, more attention should be paid to psychoeducational strategies.

Personality disorders in hypochondriasis: prevalence and comparison with two anxiety disorders

OBJECTIVE

Symptoms of hypochondriasis are sometimes attributed to personality psychopathology by health care providers. The goals of this study were to assess the prevalence of personality disorder (PD) comorbidity in hypochondriasis (HYP) and to compare the PD comorbidity profile of patients with HYP with that found among patients with other disorders characterized by intrusive thoughts and fears.

METHODS

Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders (SCID-I and SCID-II) were administered to 179 individuals: 62 with HYP, 46 with obsessive-compulsive disorder (OCD), and 71 with social anxiety disorder (SAD). For group contrasts, the samples were "purified" of the comparison comorbid disorders. General linear models were used to test the combined effect of group (HYP, OCD, SAD), age, and gender on the PD outcome variables.

RESULTS

59.7% of HYP subjects had no Axis II comorbidity. The most common PDs in HYP were paranoid (19.4%), avoidant (17.7%), and obsessive-compulsive (14.5%). HYP significantly differed from SAD in the likelihood of a cluster C disorder, whereas no significant difference was noted for HYP vs. OCD. The proportion of subjects having at least two PDs was not significantly different for HYP vs. OCD or for HYP vs. SAD.

CONCLUSION

Although 40% of patients with hypochondriasis have PD comorbidity as assessed by the SCID-II, the amount of PD comorbidity is not significantly different than found among individuals with two comparison anxiety disorders. Therefore, health providers should be aware that PD may complicate the clinical profile of HYP, but they should avoid assuming that PD psychopathology is the primary source of hypochondriacal distress.

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n=30) or control condition (n=30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.

Validation of a classification system of obsessive-compulsive spectrum disorder symptoms in a non-clinical sample

Controversy surrounds the classification of obsessive-compulsive spectrum disorder (OCSD) symptoms. In this study, we tested whether a broad OCSD symptoms model consisting of obsessive-compulsive, body dysmorphic, health anxiety, trichotillomania, pathological skin picking, impulsivity, and anxiety symptoms displayed sufficient data fit. Alternatively, we tested whether a reduced OCSD symptoms model consisting of obsessive-compulsive, body dysmorphic, health anxiety, trichotillomania, and pathological skin picking symptoms demonstrated superior fit. The reduced OCSD symptoms model demonstrated good data fit. However, the broader OCSD symptoms model only displayed marginal data fit. In context with other findings, results of this study support an OCSD symptoms dimension that includes obsessive-compulsive, body dysmorphic, health anxiety, trichotillomania, and pathological skin picking symptoms. Implications of these findings are discussed as they relate to proposed changes in the forthcoming edition of the Diagnostic and Statistical Manual.

Health anxiety: comparison of the latent structure in medical and non-medical samples

The Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002) is a self-report measure designed to assess health anxiety in both medical and non-medical samples. The invariance of the factor structure across these samples has not been examined in the 14-item version of the SHAI. In the current study, the SHAI was completed by a community sample with no serious medical conditions (n=232) and a medical sample with multiple sclerosis (n=245). Factor analysis implied the same two-factor solution for both samples, with the two factors labelled: (1) Thought Intrusion, and (2) Fear of Illness. Item loadings were invariant across the medical and non-medical samples, but the two factors were more strongly correlated in the non-medical sample. Implications of the findings as well as directions for future research are discussed.

A community study of generalized anxiety disorder with vs. without health anxiety in Hong Kong

BACKGROUND

Although generalized anxiety disorder (GAD) is characterized by multiple worries, anxiety about one's health is absent in the DSM-IV description of the illness.

METHOD

A random community-based telephone survey (N = 2005) that covered DSM-IV symptoms of GAD, two core symptoms of major depression, Rome-III criteria of Irritable Bowel Syndrome (IBS), Sheehan Disability Scale (SDS), and help-seeking behavior was conducted.

RESULTS

The 1-year prevalence of 3-month GAD was 5.4%. Among affected individuals, 78.9% reported worry about personal health while 21.1% did not. The former subgroup was significantly older, had higher mean numbers of associated anxiety symptoms and worries, more likely to have worry about finances and sought professional help than the latter subgroup. The two subgroups had similar sex distribution, core depressive symptoms, IBS, distress and SDS impairment profiles.

CONCLUSION

Health anxiety is common in GAD. Some but not all illness severity indicators differed between GAD with and without health anxiety.

Treinamento físico intervalado como ferramenta na terapia cognitivo-comportamental do transtorno de pânico

Este trabalho consiste no relato da utilização de um programa de exercícios físicos aeró-bicos intervalados no contexto da terapia cognitivo-comportamental em um caso de transtorno de pânico e agorafobia. São descritos os procedimentos utilizados, bem como os resultados positivos obtidos na redução da ansiedade cardíaca e na ansiedade cotidiana em relação a situações que exigem esforço físico.

Health anxiety among older people: an exploratory study of health anxiety and safety behaviors in a cohort of older adults in New Zealand

BACKGROUND

Despite a stereotype that characterizes older people as excessively anxious about their health, there is little research into this phenomenon. The present exploratory study examined: (a) whether a cohort of older adults was unduly health anxious, (b) which demographic and health factors predicted health anxiety (HA), and (c) whether an aspect of the cognitive behavioral model of HA was applicable to older adults by investigating the relationship between HA and safety behaviors.

METHOD

Participants were a convenience sample of adults aged over 65 and living independently in Auckland, New Zealand. Participants (104 women and 41 men) completed an anonymous self-report questionnaire measuring demographic factors, physical health and function, health anxiety, safety behaviors, and medical utilization.

RESULTS

This cohort of adults over 65 were not unduly health anxious. Occurrence of severe HA was similar to that found in younger populations. Decreased physical function and lower education predicted scores on the HA measure. Consistent with the cognitive behavioral model, HA was a unique significant predictor of safety behaviors. HA and decreased physical function predicted medical utilization.

CONCLUSIONS

Generally low levels of HA among this cohort of older individuals challenged the pervasive stereotype of the "hypochondriacal" older person. Factors contributing to HA were similar to those reported in studies with younger cohorts. Findings provided preliminary support for the applicability of the cognitive behavioral model of HA to adults over 65. Implications of the findings and directions for future research were discussed.

Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V?

The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.

What impact does pregnancy have on anxiety about health?

BACKGROUND

A previous study suggests that health anxiety, or preoccupation and fears about ill health, is elevated during pregnancy. However, replication of this result is needed given several methodological weaknesses of the previous research. The current study refined earlier work by assessing health anxiety using two distinct measures and comparing scores to a control group and to established norms for healthy controls. The relationship of health anxiety to background variables such as parity and pregnancy complications was also explored.

METHODS

A total of 252 women in the third trimester of pregnancy and 45 similarly aged non-pregnant women completed the Illness Attitudes Scale (IAS) and the newly developed Short Health Anxiety Inventory (SHAI).

RESULTS

Compared to the non-pregnant sample and established scores for healthy controls, health anxiety was not elevated during pregnancy. Health anxiety was higher in women who experienced complications during pregnancy but was unrelated to other background variables. The IAS identified more individuals as health anxious than the SHAI.

CONCLUSIONS

Contrary to previous research, health anxiety was not elevated during pregnancy. The IAS appeared to be susceptible to identifying women as health anxious due to greater health care utilization by pregnant women rather than higher health anxiety. Clinical recommendations and future directions for the assessment of health anxiety are outlined.

Reexamining the domain of hypochondriasis: comparing the Illness Attitudes Scale to other approaches

The present study examined utility of the Illness Attitudes Scale (IAS; [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers]) in a non-clinical college sample (N=235). Relationships among five recently identified IAS dimensions (fear of illness and pain, symptom effects, treatment experience, disease conviction, and health habits) and self-report measures of several anxiety-related constructs (health anxiety, body vigilance, intolerance of uncertainty, anxiety sensitivity, and non-specific anxiety symptoms) were examined. In addition, this study investigated the incremental validity of the IAS dimensions in predicting medical utilization. The fear of illness and pain dimension and the symptom effects dimension consistently shared stronger relations with the anxiety-related constructs compared to the other three IAS dimensions. The symptom effects dimension, the disease conviction dimension, and the health habits dimension showed incremental validity over the anxiety-related constructs in predicting medical utilization. Implications for the IAS and future conceptualizations of HC are discussed.

Incremental specificity of disgust propensity and sensitivity in the prediction of health anxiety dimensions

The present study sought to determine the incremental specificity of disgust propensity and sensitivity in the prediction of symptoms of health anxiety in a large nonclinical sample (N=498). Exploratory factor analysis identified Illness Likelihood, Illness Severity, and Body Vigilance as dimensions of health anxiety symptoms that significantly correlated with disgust propensity and sensitivity. Negative affect and the fear of contamination were also significantly correlated with the three health anxiety symptom dimensions. Regression analyses did show that disgust propensity and sensitivity predicted overall health anxiety symptoms independent of negative affect and fear of contamination. However, the unique association between disgust propensity and sensitivity and symptoms of health anxiety was specific to the Body Vigilance dimension. These findings suggest that disgust propensity and sensitivity may be a unique vulnerability for the vigilance for bodily sensations/changes aspect of health anxiety but not necessarily other (perceived probability/severity of having a serious illness) aspects of health anxiety. The clinical and research implications of these findings for conceptualizing disgust propensity and sensitivity as a vulnerability for excessive health anxiety are discussed.