Fear of Death in Hypochondriasis: Bodily Threat and Its Treatment Implications

Development and validation of Believers' Death Anxiety Scale: integrating religious dimensions into death anxiety assessment

BACKGROUND AND OBJECTIVES

Death anxiety has traditionally been measured without considering religious beliefs related to death, such as afterlife, the grave, and punishment. The present study was aimed at developing and validating a new scale to address this limitation.

METHODS

The study was carried out in four phases and recruited a total of 2250 conveniently selected participants aged 18-59. Believers' Death Anxiety Scale (BDAS) was developed and validated according to the reputed standards for scale development and validation. Exploratory and confirmatory factor analyses were performed. The convergent validity was established by correlating BDAS with the Depression, Anxiety, and Stress Scale. Discriminant validity was established by correlating BDAS with the Satisfaction with Life Scale. Internal consistency and reliability were assessed through Cronbach's alpha, item-total, and item-scale correlations.

RESULTS

The BDAS consists of fifteen items distributed across five subscales: worry, terror, despair, avoidance, and thoughts. The BDAS exhibited a strong factor structure, with five distinct factors consistently exceeding acceptable factor loadings. Convergent validity was confirmed through positive correlations with depression, anxiety, and stress, while discriminant validity was demonstrated through a significant inverse correlation with life satisfaction. The scale demonstrated excellent internal consistency and reliability across all phases of testing.

CONCLUSION

The BDAS emerges as a valuable and innovative instrument for researchers and practitioners seeking to comprehensively assess death anxiety, considering the often-overlooked role of religious dimensions.

The Predictive Role of Personality Disorders and Personality Traits in Death Anxiety

The current study investigates the interplay between personality traits, personality disorders, and death anxiety in a sample of 2331 participants (49% males; 51% females) across two phases. The Death Anxiety Scale, the Psychosocial Personality Inventory, and the Personality Diagnostic Questionnaire were utilized. The findings revealed significant predictive relationships between personality disorders and death anxiety. Positive correlations were observed between death anxiety and nine personality disorders, including avoidant (r = .227), borderline (r = .123), dependent (r = .157), depressive (r = .098), histrionic (r = .074), narcissistic (r = .111), negativistic (r = .103), obsessive-compulsive (r = .126), and schizotypal (r = .078) personality disorders (p < .001). Death anxiety had significant inverse correlations with leadership (r = -.101) and spirituality (r = -.099) traits (p < .005). Avoidant personality disorder projected the highest prediction for death anxiety (β = .227; p = .000). Leadership as a personality trait demonstrated an outstanding ability to prevent death anxiety (β = -.101; p = .013). These findings make a unique contribution to the literature of death anxiety, personality disorders, and personality traits.

The Psychopathological Predictors and Effects of Death Anxiety

Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.

The Mediating Role of Death Obsessions in the Relationship Between Caregiver Burden and Somatic Symptoms: A Study on the Informal Dementia Caregivers in India

This study aimed to analyze the relationship between the caregiver burden, death obsessions, and somatic symptoms; and whether the death obsessions are playing a mediating role in the relationship between the caregiver burden and somatic symptoms. The study was done on the informal dementia caregivers residing in India. Three questionnaires in a google form were circulated. The correlational and mediation analysis revealed that there was a significant and positive correlation between the caregiver burden, death obsessions, and somatic symptoms. Further, the death obsessions significantly mediated the relationship between caregiver burden and somatic symptoms.

Research on the death psychology among Chinese during and after the COVID-19 pandemic

Under the threat of the novel coronavirus, people are compelled to contemplate some ultimate existential questions, such as life and death. This study collected texts related to the death psychology from Sina Weibo, and after data cleaning, a total of 3868 Weibo texts were included. Study 1 employed grounded theory from qualitative research to explore the core categories and evolutionary mechanisms of people's psychology when facing death threats in the context of the pandemic. Study 2 utilized big data mining techniques such as topic mining and semantic network analysis to validate the effectiveness of the death psychology theory developed in qualitative research. The findings demonstrate that within the "Emotion-Cognition-Behavior-Value" framework, the implications of death threats manifest in four aspects: death anxiety, death cognition, coping efficacy, and sense of meaning. As time progresses, the study of death psychology can be segmented into four distinct phases: the tranquil phase prior to lifting pandemic restrictions, the threat phase at lifting pandemic restrictions onset, the coping phase mid-lifting pandemic restrictions, and the reformative phase post-lifting pandemic restrictions. The calculated outcomes of topic mining and semantic network analysis corroborate the coding results and theories derived from the grounded theory. This reaffirms that data mining technology can be a potent tool for validating grounded theory.

The role of health anxiety in the experience of perceived stress across the menstrual cycle

Background: Hormonal variation throughout the menstrual cycle influences physiological and psychological symptoms, although not for all women. Individual differences in health anxiety (HA) might help to explain the differences in physiological and psychological symptoms and perceived stress observed across women. Design: We examined the moderating role of HA in the relation between menstrual phase and premenstrual symptom severity and perceived stress. Methods: A total of 38 women completed visits in both late luteal and follicular phases, with visit order randomized. Menstrual phase was verified using day-count, a luteinizing hormone test, and progesterone assay. Results: Linear mixed models revealed that women experienced more premenstrual symptoms during the late luteal phase vs. the follicular phase; however, HA did not moderate this effect. There was a significant HA × menstrual cycle phase interaction for perceived stress. During the late luteal phase, women with higher HA reported greater perceived stress compared to women with lower HA. In the follicular phase, women with higher and lower HA reported similar levels of perceived stress. Conclusion: Higher levels of HA may play a role in the experience of perceived stress in specific phases of the menstrual cycle.

Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review

OBJECTIVE

To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically unexplained symptoms (MUS).

METHODS

A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed.

RESULTS

Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible.

CONCLUSION

All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.

Death Anxiety, Perfectionism and Disordered Eating

Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.

Fears, Coping Styles, and Health Behaviors: A Comparison of Patients With Hypochondriasis, Panic Disorder, and Depression

Research into correlates of illness anxiety disorder (formerly hypochondriasis) rarely applies comprehensive assessments of health behavior. Moreover, studies on phenomenological varieties of clinical health anxiety are scarce. We examined health behavior, fear, and acceptance of death and dying, and coping with a hypothetical bodily disease in patients with hypochondriasis, panic disorder, depression, and healthy controls (all groups n = 30) using self-rated questionnaires. ANOVA with Dunnett-T3 post hoc tests revealed no group differences in health behavior. The hypochondriasis and panic disorder groups showed more fear and less acceptance of death and dying than patients with depression and controls. Groups did not differ concerning coping strategies. Patients with hypochondriasis ruminated more when confronted with their most feared rather than another disease. Patients apparently overestimate the danger of a specific disease, but without underestimating their coping abilities. A therapeutic focus on fear of death and dying via cognitive interventions and exposure is recommended.

[Hypochondriasis between health and psychosis]

Considering the lack of clarity in the conceptualisation of hypochondriasis, it is not surprising that the concept is quite heterogeneous and that there are dilemmas in terms of what is encompassed by hypochondriasis and where its boundaries are. Therefore, the aim of this review paper was to contribute towards a more coherent view on hypochondriasis, which would also allow its more adequate classification. The essential features of hypochondriasis were identified as an overvalued idea about the presence of disease, fear that the person has already become seriously ill, reassurance-seeking and other forms of health checking, and disturbances in the perception of bodily sensations and symptoms. These four aspects of hypochondriasis can be assessed dimensionally to ascertain to what extent they characterise each patient. Suggestions have been made to delineate more precisely hypochondriasis from health anxiety, anxiety disorders, obsessive-compulsive disorder, other somatoform disorders, personality disorders, depression, and delusional disorder with disease-related delusions. In the absence of better alternatives, hypochondriasis should continue to be classified among the somatoform disorders. In order to improve communication between clinicians and reduce conceptual heterogeneity, the term "hypochondriasis" should be used to refer only to primary hypochondriasis. The pressure to abandon this term should be resisted until an adequate substitution for it has been found.