Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany

OBJECTIVE

Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce.

METHODS

In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses.

RESULTS

Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety.

CONCLUSION

It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.

Somatic Symptom Perception and Interoception

Abstract. Models of chronic somatic symptoms assume that abnormalities in interoception are related to the development and maintenance of symptom distress. Different models, however, disagree on the exact nature of the assumed abnormality: cognitive-behavioral models stress a hypervigilant cognitive style (predicting higher interoceptive accuracy) whereas predictive processing models assume a less detailed sensory processing (predicting lower interoceptive accuracy). This study aimed at testing the relationship between interoception and symptom perception. Using structural equation modeling, associations between cardiac interoception and symptom perception were tested in a sample of students ( n = 316) and a second heterogeneous sample ( n = 340, including 63 patients with either pathological health anxiety or a somatoform disorder according to DSM-IV). Stronger sensory symptom perceptions in the cardiorespiratory system were associated with lower interoceptive accuracy in sample 2. The findings are more in line with the predictive processing approach, suggesting less detailed and more biased interoception being associated with chronic somatic symptom distress.