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

Personality Pathology and Functional Impairment in Patients With Hypochondriasis

BACKGROUND

Research indicates substantial co-occurance of personality pathology and hypochondriasis, which both involve significant psychosocial impairment.

OBJECTIVE

This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity.

METHODS

Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instruments for personality pathology, health anxiety severity, and functional impairment (general, social, and physical): The Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Short Health Anxiety Inventory (SHAI), the 36-item Short Form health survey (SF-36), and the Global Assessment of Functioning (GAF). Hierarchical regression analyses were performed with boot-strapping (1000 samples).

RESULTS

Findings overall showed that personality pathology incrementally explained functional impairment over the influence of health anxiety severity. More specifically, findings revealed that the incremental effect of PID-5 trait dimensions was substantially larger than the SCID-II personality disorder criterion-count. Functional impairment was specifically associated with SCID-II symptoms of Avoidant Personality disorder and dependent personality disorder as well as PID-5 trait domains of negative affectivity, detachment, and psychoticism.

CONCLUSIONS

The findings highlight the potential significance of personality pathology for understanding and clinical management of functional impairment in patients with hypochondriasis. The personality features that best explained functional impairment were avoidant personality disorder and dependent personality disorder and, in particular, DSM-5 and the International Classification of Diseases, 11th revision personality trait domains of negative affectivity, detachment, and psychoticism.

The role of individual factors on corona-induced hypochondriasis and job stress: A case study in workplace

Background: Given the importance of maintaining the mental health of workers, the present study was conducted to determine the effect of the individual factors on hypochondriasis and job stress under the corona epidemic condition in a company.

Methods: This cross-sectional study was performed on 275 workers in 2020 in one of the industries in southern Iran. To gather the data, demographic, researcher-made, standard hypochondria, and job stress questionnaires were sent electronically along with a guide and study objectives. The participants completed the questionnaires during 2 weeks and send them electronically to the research team. Finally, data were analyzed using tests of one-way ANOVA and linear regression in SPSS software version 22.

Results: The results showed that the mean score of hypochondriasis in different groups of variables, including age, work experience, use of personal protective equipment, corona experience, and attention to preventive measures was significantly different (p<0.05). Based on the results, the mean score of job stress significantly differed in different groups of variables of personal protective equipment use, corona experience, and awareness on corona (p<0.05). Moreover, based on the regression relationships, hypochondriasis could be predicted by variables of personal protective equipment, corona experience, awareness on corona, and attention to preventive measures; and job stress could be predicted by variables of awareness on corona and attention to preventive measures.

Conclusion: Regarding the importance of providing the physical and mental health of employees, the implementation of measures to reduce stress and hypochondriasis of employees, particularly in identified groups, is helpful.

DSM-5 Personality Disorders and Traits in Patients With Severe Health Anxiety

Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. In general populations, 12% have a personality disorder (PD). We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84) with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) axis II (SCID-II), Personality Inventory for DSM-5 (PID-5), Whiteley Index 7, and Short Health Anxiety Inventory, and the healthy controls (n = 84) with PID-5 only. There were 71.4% of the patients who met criteria for PDs: avoidant (22.6%), obsessive-compulsive (16.7%), depressive (16.7%), dependent (7.1%), paranoid (3.6%), borderline (2.4%), and not otherwise specified (32.1%). Severity of personality pathology was associated with severity of health anxiety. In group comparisons, PID-5 trait domains of negative affectivity, detachment, low antagonism, and low disinhibition, and facets of anxiousness, separation insecurity, and low attention seeking emerged as unique predictors of SHA. Personality pathology is common among individuals with SHA/HY. Further research is needed to understand the nature of the relationship between health anxiety and personality pathology and to determine whether treatments that target both SHA/HY and personality pathology will improve short- and long-term outcomes.

Self-esteem and cyberchondria: The mediation effects of health anxiety and obsessive–compulsive symptoms in a community sample

Cyberchondria refers to the excessive and repeated searching for medical information on the Internet and may be considered as health-related problematic Internet use. Previous findings indicated that cyberchondria is positively associated with health anxiety and obsessive–compulsive symptoms. Also, research suggests that excessive or problematic Internet use as well as health worries and compulsive behaviors are present among individuals with low self-esteem. This study sought to examine: (1) the association between self-esteem and cyberchondria, and (2) the mediating role of health anxiety and obsessive–compulsive symptoms in the relationship between self-esteem and cyberchondria. Participants (N = 207) from a community sample completed self-report measures assessing global self-esteem, health anxiety, obsessive–compulsive symptoms, and cyberchondria. We found that self-esteem directly predicted cyberchondria and that health anxiety and obsessive–compulsive symptoms parallelly mediated the relationship between self-esteem and cyberchondria. These findings suggest that low self-esteem, health anxiety and obsessive–compulsive symptoms can be considered vulnerability factors for cyberchondria. In addition, the reverse mediation model indicated that cyberchondria potentially predicts self-esteem both directly and through health anxiety and obsessive–compulsive symptoms. The bidirectional relationship among the analyzed variables are discussed in the context of potential psychological predictors and consequences of cyberchondria and possible mechanisms explaining cyberchondria. The current study provides further insight into the conceptualization of cyberchondria and the feasibility of specific treatment directions.

Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders

BACKGROUND

Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states.

METHODS

We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states.

RESULTS

Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect.

CONCLUSIONS

Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.

Predictors and consequences of health anxiety symptoms: a novel twin modeling study

OBJECTIVE

The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population.

METHOD

Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates.

RESULTS

Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001).

CONCLUSION

Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.

Personality Disorders in Hypochondriasis: A Comparison to Panic Disorder and Healthy Controls

Previous studies found high prevalence rates of personality disorders (PDs) in patients with hypochondriasis; however, assessment was often based only on questionnaires. In the current study, a sample of 68 patients with hypochondriasis was compared to 31 patients with panic disorder and to 94 healthy controls. Participants were investigated with the Structured Clinical Interview for DSM-IV Personality Disorders questionnaire (SCID-II questionnaire) and the SCID-II interview. Based on the cut-off scores of the SCID-II questionnaire, we found a prevalence rate of 45.6% for PD in patients with hypochondriasis. In comparison to healthy controls, patients with hypochondriasis showed characteristics of paranoid, borderline, avoidant, and dependent PDs in the dimensional assessment significantly more often. However, no significant differences were found between the clinical samples. Based on the SCID-II interview, only 2.9% of the patients with hypochondriasis fulfilled the criteria for a PD. These results suggest that PDs are not a specific characteristic of hypochondriasis.

Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety

BACKGROUND

Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT).

AIMS

To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years.

METHOD

Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years.

RESULTS

In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder.

CONCLUSIONS

The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.

Patient Characteristics and Patient Behavior as Predictors of Outcome in Cognitive Therapy and Exposure Therapy for Hypochondriasis

OBJECTIVE

Psychotherapy for hypochondriasis has greatly improved over the last decades and cognitive-behavioral treatments are most promising. However, research on predictors of treatment outcome for hypochondriasis is rare. Possible predictors of treatment outcome in cognitive therapy (CT) and exposure therapy (ET) for hypochondriasis were investigated.

METHOD

Characteristics and behaviors of 75 patients were considered as possible predictors: sociodemographic variables (sex, age, and cohabitation); psychopathology (pretreatment hypochondriacal symptoms, comorbid mental disorders, and levels of depression, anxiety, and somatic symptoms); and patient in-session interpersonal behavior.

RESULTS

Severity of pretreatment hypochondriacal symptoms, comorbid mental disorders, and patient in-session interpersonal behavior were significant predictors in multiple hierarchical regression analyses. Interactions between the predictors and the treatment (CT or ET) were not found.

CONCLUSIONS

In-session interpersonal behavior is an important predictor of outcome. Furthermore, there are no specific contraindications to treating hypochondriasis with CT or ET.

Obsessive-compulsive personality disorder: a current review

This review provides a current overview on the diagnostics, epidemiology, co-occurrences, aetiology and treatment of obsessive-compulsive personality disorder (OCPD). The diagnostic criteria for OCPD according to the recently published Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) include an official set of criteria for clinical practice and a new, alternative set of criteria for research purposes. OCPD is a personality disorder prevalent in the general population (3-8 %) that is more common in older and less educated individuals. Findings on sex distribution and course of OCPD are inconsistent. OCPD is comorbid with several other medical and psychological conditions. As for causes of OCPD, most empirical evidence provides support for disturbed attachment as well as the heritability of OCPD. So far, cognitive (behavioural) therapy is the best validated treatment of OCPD. Self-esteem variability, stronger early alliances as well as the distress level seem to predict cognitive (behavioural) therapy outcome. Future research is needed to further advance knowledge in OCPD and to resolve inconsistencies.

New diagnostic perspectives on obsessive-compulsive personality disorder and its links with other conditions

PURPOSE OF REVIEW

This review examines the conceptualization of obsessive-compulsive personality disorder (OCPD), its epidemiology and efforts to better understand the relationships between OCPD and other conditions.

RECENT FINDINGS

The alternative Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders conceptualization of OCPD is radically different in that it combines categorical and dimensional diagnostic approaches and introduces a hierarchy of diagnostic criteria. OCPD is one of the most common personality disorders in the general population. The relationship between OCPD and obsessive-compulsive disorder (OCD) is important, but to a large extent obfuscated by the overlap between their diagnostic criteria. Frequent changes in the OCPD diagnostic criteria make it difficult to ascertain the 'true' relationship between OCPD and OCD. It is not uncommon for OCPD to occur with anorexia nervosa, depression, hypochondriasis, certain other personality disorders and Parkinson's disease, but further research is necessary to understand the implications of these links.

SUMMARY

OCPD is yet to be conceptualized consistently and in the manner that would make a clear and well supported distinction between its core and peripheral features. Future studies need to separate a genuine from overlap-driven co-occurrence of OCPD and other conditions, as that would give a better insight into the way in which OCPD relates to other disorders.

Personality disorders and anxiety disorders: what is the relationship?

PURPOSE OF REVIEW

To systematically review the recent studies which examined the co-occurrence and relationships between anxiety disorders and personality disorders.

RECENT FINDINGS

The prevalence rates of personality disorders in patients with anxiety disorders are high, with 35% in posttraumatic stress disorder, 47% in panic disorder with agoraphobia and generalized anxiety disorder, 48% in social phobia, and 52% in obsessive-compulsive disorder. There is a high rate (39%) of the DSM cluster C personality disorders among individuals with anxiety disorders. Moreover, anxiety disorders are highly prevalent in samples of people with personality disorders, especially borderline personality disorder (80-84.8%). Personality disorders co-occurring with anxiety disorders have a number of clinical implications, including an increased risk of suicide, greater severity of anxiety disorders, and negative impact on the treatment outcome of anxiety disorders.

SUMMARY

It is important for the clinicians to look for possible personality disorders among patients with anxiety disorders. Further studies need to ascertain how best to treat individuals suffering from both anxiety disorders and personality disorders and focus on the issue of causality when these conditions co-occur.

Investigation of health anxiety and its related factors in nursing students

OBJECTIVE

To explore health anxiety in a sample of nursing students to determine the relationships between health anxiety and life satisfaction, personality, and alexithymia.

METHODS

Two thousand and eighty-six nursing students in junior college, which were divided into five groups, were evaluated by questionnaires, including the Life Satisfaction Scales Applicable to College Students, the Chinese version of the Short Health Anxiety Inventory, the Toronto Alexithymia Scale (TAS-20), and the Eysenck Personality Questionnaire.

RESULTS

The mean age, whether the individual was an only child, residence (urban or rural), and were significantly different between the groups. The self-assessment scores were also significantly different between the groups. The Short Health Anxiety Inventory total score and the factor of fearing the likelihood of becoming ill were significantly negatively correlated with the Life Satisfaction Scales Applicable to College Students total score and its two factors, but were significantly positively correlated with psychoticism, neuroticism, and TAS-20 total scores and its scores of the three TAS-20 factors. The negative consequence scale of Short Health Anxiety Inventory was not significantly correlated with externally oriented thinking, but was significantly negatively correlated with extraversion. A hierarchical multiple regression analysis indicted that objective satisfaction, subjective satisfaction, neuroticism, and the three factors of TAS-20 were predictors of health anxiety.

CONCLUSION

Health anxiety was correlated with life satisfaction, personality, and alexithymia in junior college nursing students. Subjective and objective satisfaction, neuroticism, and the identification and expression of emotions may be predictors of health anxiety in nursing students.