Perceptual and memory biases for health-related information in hypochondriacal individuals

Too much focus on your health might be bad for your health: Reddit user's communication style predicts their Long COVID likelihood

Long Covid is a chronic disease that affects more than 65 million people worldwide, characterized by a wide range of persistent symptoms following a Covid-19 infection. Previous studies have investigated potential risk factors contributing to elevated vulnerability to Long Covid. However, research on the social traits associated with affected patients is scarce. This study introduces an innovative methodological approach that allows us to extract valuable insights directly from patients' voices. By analyzing written texts shared on social media platforms, we aim to collect information on the psychological aspects of people who report experiencing Long Covid. In particular, we collect texts of patients they wrote BEFORE they were afflicted with Long Covid. We examined the differences in communication style, sentiment, language complexity, and psychological factors of natural language use among the profiles of 6.107 Reddit users, distinguishing between those who claim they have never contracted Covid -19, those who claim to have had it, and those who claim to have experienced Long Covid symptoms. Our findings reveal that people in the Long Covid group frequently discussed health-related topics before the pandemic, indicating a greater focus on health-related concerns. Furthermore, they exhibited a more limited network of connections, lower linguistic complexity, and a greater propensity to employ emotionally charged expressions than the other groups. Using social media data, we can provide a unique opportunity to explore potential risk factors associated with Long Covid, starting from the patient's perspective.

Influence of vegetation pattern and aridity on soil properties related soil available water in the Mediterranean regions

Grassland ecology is deteriorating along with a fall in biodiversity and ecosystem services as a result of climate change in the Mediterranean regions. Understanding the mechanism of feedback between soil properties related to available water and increasing aridity is a key component of preserving grassland ecosystems. Structural equation modelling was used to explore a deep understanding of the underlying mechanisms of the feedback between soil properties related to available water and increasing aridity. In most cases, vegetation patches had significantly higher soil properties related to available water than inter-patches. Compared to inter-patches, the fine fractions of silt and clay content, soil organic carbon, saturated hydraulic conductivity, and available water under vegetation patches increased by 3.79%-7.64%, 31.08%-37.64%, 96.65%-141.14%, and 2.63%-9.21%, respectively, under limestone and mica schist lithologies. The fine fractions of silt and clay content, soil organic carbon, and available water were more responsive to the aridity index than the vegetation patch, while saturated hydraulic conductivity was more responsive to the vegetation patch than the aridity index. These complex relationships demonstrated that the available water was significantly positively affected by the vegetation pattern (0.09) and the aridity index (0.21-0.38). Soil texture had a significantly direct effect (0.43-0.53) on available water. Increasing aridity would strengthen the contrast in soil water availability while weakening the contrast in saturated hydraulic conductivity between vegetation patches and inter-patches. Available water was controlled by many aspects except vegetation pattern and aridity index. Understanding these relationships helped in predicting and mitigating the impacts of climate change on soil properties related to available water. The study offered fresh perspectives on the mechanism of vegetation pattern and aridity index on the various soil properties related to available water in arid and semiarid grasslands ecosystems under climate change.

Social inequalities in health anxiety: A systematic review and meta-analysis

OBJECTIVE

The association between a low socioeconomic status and poor health, also known as social inequalities in health, has been shown in numerous studies. This also applies to most mental illnesses, such as somatization or anxiety disorders. It is unclear, however, whether social inequalities are evident in health anxiety as well. Therefore, this review and meta-analysis systematically examines social inequalities in health anxiety.

METHODS

A systematic literature search was conducted covering all studies published until August 2021. The databases PubMED, Web of Science, PsycINFO, and PSYNDEX were screened to identify quantitative studies using validated tools to measure health anxiety and examining the association with socioeconomic status. Meta-analytic methods were applied by using random-effect models. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool.

RESULTS

Overall, 37 studies were eligible for meta-analysis. Effect sizes of 27 studies using screening scales and 10 studies using diagnostic interviews to measure health anxiety were calculated separately. Meta-analyses revealed a significant association between socioeconomic status and health anxiety (r - 0.14, 95%-CI -0.18 to -0.09 (screening scales) and OR 0.63, 95%-CI 0.43 to 0.92 (diagnostic interviews)), indicating a lower risk for health anxiety in people with higher socioeconomic status.

CONCLUSION

Findings suggest that the health-related disadvantage of socially deprived people is also evident regarding health anxiety. This should be considered in programs to reduce social inequalities in health. PROSPERO registration number CRD42021237550.

Encoding and retrieval biases for health-related scenes in patients with severe health anxiety

Severe health anxiety is a disorder characterised by excessive worries about harbouring or having a serious illness. The present study examines cognitive biases in evaluation and memory for health-related scenes in severe health anxiety in order to provide insights into the effect of these biases and the formation of illness intrusions in severe health anxiety. Twenty patients with severe health anxiety and 20 healthy participants completed a computerised task consisting of encoding, involuntary retrieval, voluntary retrieval and recognition of health-related, negative and neutral scenes. The results demonstrated that patients with severe health anxiety reported more negative emotional valence and greater physiological arousal to health-related scenes, both during encoding (ps < .031, ηp2  > .09) and retrieval (ps < .044, ds > 0.18). Furthermore, in contrast to the comparison group, patients with severe health anxiety did not show shorter retrieval time for health-related scenes during involuntary compared with voluntary retrieval (p = .789, d = 0.08), possibly due to greater demands on emotion regulation during involuntary retrieval. The results suggest an important role for negative emotional valence and physiological arousal to health-related stimuli in severe health anxiety, and highlight how cognitive biases in evaluation and memory might be at play in this disorder.

Altered functional connectivity of interoception in illness anxiety disorder

Interoception collects all information coming from the body and is sustained by several brain areas such as insula and cingulate cortex. Here, we used resting-state functional magnetic resonance imaging to investigate functional connectivity (FC) of networks implied in interoception in patients with Illness anxiety disorders (IADs). We observed significantly reduced FC between the left extrastriate body area (EBA) and the paracentral lobule compared to healthy controls. Moreover, the correlation analysis between behavioural questionnaires and ROI to ROI FC showed that higher levels of illness anxiety were related to hyper-connectivity between EBA and amygdala and hippocampus. Scores on a questionnaire for interoceptive awareness were significantly correlated with higher FC between right hippocampus and nucleus accumbens bilaterally, and with higher connectivity between left anterior cingulate cortex (ACC) and left orbitofrontal cortex (OFC). Last, patients showed increased interoceptive awareness, measured by Self-Awareness Questionnaire (SAQ), and reduced capability in recognizing emotions, indicating inverse correlation between interoception and emotional awareness. Taken together our results suggested that, in absence of structural and micro-structural changes, patients with IADs show functional alteration in the neural network involved in the self-body representation; such functional alteration might be the target of possible treatments.

Changes in negative implicit evaluations in patients of hypochondriasis after treatment with cognitive therapy or exposure therapy

BACKGROUND AND OBJECTIVES

Previous studies using modified versions of the Affect Misattribution Procedure (AMP; Payne, Cheng, Govorun, & Stewart, 2005) have revealed that there is an implicit negative evaluation bias of illness-related information in patients with hypochondriasis (HYP), which might be a maintaining feature of HYP. However, there is no evidence on whether this bias might be targeted successfully by effective treatments, such as exposure therapy (ET) or cognitive therapy (CT). This is the first study to examine the change in negative implicit evaluations in a randomized controlled trial, including individual CT and ET, compared to a wait-list control group for HYP.

METHODS

An AMP with illness, symptom and neutral primes was used in 70 patients with HYP before and after treatment (wait-list respectively).

RESULTS

There was no significant change in negative implicit affective evaluations in both CT and ET, compared to wait-list. However, comparisons between the two active treatments revealed an interaction effect, that only for CT were the affective reactions on illness-as well as symptom-related prime trials (but not neutral primes) significantly more positive at post-compared to pre-treatment. In CT but not in ET, the reduction of implicit negative evaluation bias regarding symptom-related primes was significantly related to the reduction of self-reported health anxiety.

LIMITATIONS

The small subsample sizes for CT and ET, in comparison to wait-list, prohibit the detection of smaller effects.

CONCLUSIONS

Formal cognitive restructuring is necessary for reducing implicit negative evaluation bias in HYP, but the latter is not a prerequisite for reducing health anxiety. Thus, the importance of the negative implicit evaluation bias for the maintenance of HYP remains questionable.

Influences of mood on information processing styles in high and low symptom reporters

<b>Background</b><br /> Negative mood, which has been strongly linked to the presence of medically unexplained symptoms (MUS), is also suggested to modulate the way information is processed (analytic vs. schematic processing style). The present study investigated whether negative mood influences the information processing style differentially in people reporting frequent MUS in daily life.<br /> <br /> <b>Participants and procedure</b><br /> Forty female participants (22 low, 18 high habitual symptom reporters) completed a semantic priming task, as an index of schematic processing, after positive and after negative mood induction in a counterbalanced order. The priming task consisted of neutral or unpleasant body-related and body-unrelated words to assess the specificity of processing style shifts.<br /> <br /> <b>Results</b><br /> The analyses indicated a non-significant tendency for negative mood to increase priming effects compared to positive mood for the high habitual symptom reporters, while the opposite pattern was found for the low symptom reporters. This differential effect of mood was only seen for neutral body-related words.<br /> <br /> <b>Conclusions</b><br /> The current findings suggest that negative mood can trigger schematic processes assumed to be crucial for the emergence of MUS, which may explain the profound link between unpleasantness and elevated symptom reporting in high symptom reporters.

Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure

Cognitive theories of hypochondriasis (HYP) suggest that catastrophic misinterpretations of benign body sensations are a core feature for the maintenance of the disorder. There is tentative support from an analog sample that the interpretation of illness-related information also involves an implicit affective component. This is the first study to examine this negative affective evaluation bias implicitly in patients with HYP. An adapted version of the Affect Misattribution Procedure (AMP) with illness, symptom and neutral primes was used in 80 patients with HYP, and compared to 83 patients with an anxiety disorder (AD), as well as 90 healthy controls (CG). The HYP group showed significantly more negative affective reactions in illness prime trials, compared to both control groups, as well as more negative implicit evaluations on symptom prime trials, compared to the CG. Significant inverse relationships were observed only between the implicit evaluations of illness words and health anxiety questionnaires. Thus, an implicit negative affective evaluation bias of serious illnesses rather than symptoms is a unique feature of HYP.

Health anxiety and attentional bias: the time course of vigilance and avoidance in light of pictorial illness information

Cognitive-behavioral models of health anxiety stress the importance of selective attention not only towards internal but also towards external health threat related stimuli. Yet, little is known about the time course of this attentional bias. The current study investigates threat related attentional bias in participants with varying degrees of health anxiety. Attentional bias was assessed using a visual dot-probe task with health-threat and neutral pictures at two exposure durations, 175ms and 500ms. A baseline condition was added to the dot-probe task to dissociate indices of vigilance towards threat and difficulties to disengage from threat. Substantial positive correlations of health anxiety, anxiety sensitivity, and absorption with difficulties to disengage from threat were detected at 500ms exposure time. At an early stage (i.e., at 175ms exposure time), we found significant positive correlations of health anxiety and absorption with orientation towards threat. Results suggest a vigilance avoidance pattern of selective attention associated with pictorial illness related stimuli in health anxiety.

Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts

Previous findings suggested that hypochondriacal attitudes could originate from a pessimistic trait independent of illness-related thoughts. We hypothesised that hypochondriacal attitudes correlated with a general cognitive tendency towards negative interpretations and reduced familiarisation. Healthy non-patients were invited to participate. The sum score from the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales assessed hypochondriacal attitudes. Participants without any knowledge of the Chinese language were asked to guess whether or not each of eight Chinese characters had a positive meaning and whether the characters appeared familiar. Stimuli without semantic content avoided a reference to illness in order to assess a general cognitive bias. Participants with high hypochondriasis scores rated apparently familiar stimuli as being less positive in comparison to low hypochondriacal participants, F(1,78) = 9.2, p = 0.003, η² = 0.10; correlation of hypochondriasis scores to the differences between ratings of familiar and unfamiliar characters: ρ = 0.345, p = 0.002. Positivity and familiarity ratings did not correlate with hypochondriacal attitudes independent of each other. A less positive appraisal of familiar experiences, which is unrelated to illness-related thoughts, may maintain hypochondriacal concerns. A general distrustful attitude towards familiar procedures should be considered in hypochondriasis.

The role of health anxiety in online health information search

This article is one of the first to empirically explore the relationship between health anxiety and online health information search. Two studies investigate how health anxiety influences the use of the Internet for health information and how health anxious individuals respond to online health information. An exploratory survey study with 104 Dutch participants indicates that health anxiety is related to an increase in online health information search. Moreover, results suggest that health anxious individuals experience more negative consequences from online health information search. Findings from an experimental study (n=120) indicate that online health information results in greater worries among health anxious individuals compared to nonhealth anxious individuals only if the information stems from a trustworthy governmental Web site. Information from a less trustworthy online forum does not lead to greater worries among health anxious individuals. In sum, the Internet appears to play a pivotal role in the lives of health anxious individuals.

Memory performance related to organic and psychosocial illness attributions in somatoform pain disorder patients

OBJECTIVE

Somatoform disorders are characterized by patterns of persistent bodily complaints. Organic illness attributions are assumed to represent a central supporting factor in the development and maintenance of somatoform disorders. Using group control design, we aimed to investigate the processing of illness-belief-related word stimuli in somatoform pain disorder patients.

METHODS

Organic-related, psychosocial-related, and neutral word stimuli were presented to 14 somatoform pain patients with a predominantly organic illness attribution, 14 somatoform pain patients with a predominantly psychosocial illness attribution, and 14 control participants. Behavioral measures were taken during free recall and recognition tasks.

RESULTS

Our study revealed cognitive impairment in somatoform pain patients with an organic attribution of pain symptoms as compared to somatoform pain patients with a psychosocial attribution and healthy controls in both free recall test and recognition test. However, selective processing of word stimuli was not observed for patient groups.

CONCLUSION

We conclude that the observed impairment of memory performance in somatoform pain patients with an organic illness attribution may play an important role in the illness behavior of this patient group and ultimately result in the maintenance of symptoms and a more critical clinical outcome.

Stellen Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für Krankheitsängste dar?

Zusammenfassung. Theoretischer Hintergrund: Kognitive Modelle zu Hypochondrie und Krankheitsängsten beschreiben vergangene Erfahrungen mit Krankheiten als einen Risikofaktor für deren Entstehung. Diese Sichtweise wird durch mehrere empirische Untersuchungen gestützt, die jedoch nicht die allgemeine Ängstlichkeit der Personen hinreichend berücksichtigten. Fragestellung: Da Krankheitsängste hoch mit Ängstlichkeit assoziiert sind, stellt sich die Frage, ob frühere Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für die Entstehung von Krankheitsängsten darstellen oder lediglich die allgemeine Ängstlichkeit bedingen. Methode: 260 Personen der Allgemeinbevölkerung wurden mittels Fragebogen über ihre Erfahrungen mit Krankheiten befragt. Zudem wurden bei diesen Personen Krankheitsängste (IAS) und allgemeine Ängstlichkeit (STAI) erfasst. Ergebnisse: Zusammenhänge zwischen Erfahrungen mit Krankheiten und Krankheitsängsten bleiben auch nach Kontrolle der Ängstlichkeit bestehen. Bei der Vorhersage von Krankheitsängsten mittels multipler Regression kommt der Ängstlichkeit mit einer Varianzaufklärung von 18% das höchste Gewicht zu. Die Anzahl verstorbener Familienangehöriger trägt darüber hinaus zur Varianzaufklärung (4%) bei. Schlussfolgerung: Insgesamt deuten die Ergebnisse auf eine multifaktorielle Genese von Krankheitsängsten hin, Erfahrungen mit Krankheiten stellen hierbei einen spezifischen Risikofaktor dar. Eine Erweiterung des kognitiven Modells wird vorgeschlagen.

A taxometric analysis of health anxiety

BACKGROUND

A long-standing issue in the health anxiety literature is the extent to which health anxiety is a dimensional or a categorical construct. This study explores this question directly using taxometric procedures.

METHOD

Seven hundred and eleven working adults completed an index of health anxiety [the Whiteley Index (WI)] and indicated their current health status. Data from those who were currently healthy (n=501) and receiving no medical treatment were examined using three taxometric procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIGEN) and L-mode factor analysis (L-MODE).

RESULTS

Graphical representations (comparing actual to simulated data) and fit indices indicate that health anxiety is more accurately represented as a dimensional rather than a categorical construct.

CONCLUSIONS

Health anxiety is better represented as a dimensional construct. Implications for theory development and clinical practice are examined.

Memory bias for health-related information in somatoform disorders

OBJECTIVE

Cognitive processes are considered to be relevant to the etiology and maintenance of somatoform disorders (SFDs). The aim of this study was to assess explicit and implicit information-processing bias for disorder-congruent information in SFDs.

METHODS

A clinical sample of 33 patients suffering from multiple somatoform symptoms (SSI-3/5) and 25 healthy controls performed an encoding task with computer-presented word lists (illness related, negative, positive, neutral content), subsequently followed by explicit memory tests (free recall and recognition) and an implicit test (word-stem completion).

RESULTS

The somatoform group showed a memory bias for illness-related stimuli in the word-stem completion task, whereas the two groups did not differ in explicit memory tests. This effect could not be explained by comorbid depression.

CONCLUSION

These results provide some support for current theories on SFDs.

Explaining medically unexplained symptoms-models and mechanisms

We summarize the psychological mechanisms that have been linked to the development and maintenance of medically unexplained symptoms (MUS). Many models postulate that patients with MUS misinterpret physical sensations and show other cognitive abnormalities (e.g., an over-exclusive concept of health) that play a major role in symptom development. While there is strong evidence for the role of cognitive aspects, there is less evidence for their interaction with perceptual features (e.g., perceptual sensitivity, lowered perceptual threshold). Modern neuroimaging techniques show that the expectation of symptoms leads to the activation of brain areas corresponding to symptom perception, while distraction from symptoms reduces brain activity in perception areas. The frequently postulated monocausal organic attribution for physical sensations by patients with MUS needs to be modified, as many patients report multiple symptom attributions, including psychological. Symptom attributions and causal models depend on memorized concepts, and so memory processes need to be investigated in more detail. Aberrations in memory processes not only offer a link to understanding perceptual processes, but are also involved in doctor-patient interaction. This encounter is characterized by unsuccessful medical reassurance, which again involves memory processes. We conclude that psychological mechanisms such as expectation, distraction, and memory processes need to be integrated with biological models to aid understanding of MUS.

Memory bias in health anxiety is related to the emotional valence of health-related words

OBJECTIVES

A model based on the associative strength of object evaluations is tested to explain why those who score higher on health anxiety have a better memory for health-related words.

METHOD

Sixty participants observed health and nonhealth words. A recognition memory task followed a free recall task and finally subjects provided evaluations (emotionality, imageability, and frequency) for all the words. Hit rates for health words, d', c, and psychological response times (PRTs) for evaluations were examined using multi-level modelling (MLM) and regression.

RESULTS

Health words had a higher hit rate, which was greater for those with higher levels of health anxiety. The higher hit rate for health words is partly mediated by the extent to which health words are evaluated as emotionally unpleasant, and this was stronger for (moderated by) those with higher levels of health anxiety. Consistent with the associative strength model, those with higher levels of health anxiety demonstrated faster PRTs when making emotional evaluations of health words compared to nonhealth words, while those lower in health anxiety were slower to evaluate health words.

CONCLUSIONS

Emotional evaluations speed the recognition of health words for high health anxious individuals. These findings are discussed with respect to the wider literature on cognitive processes in health anxiety, automatic processing, implicit attitudes, and emotions in decision making.

Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review

This review examined (a) whether hypochondriacal/health-anxious individuals hold distinct assumptions about health and illness, (b) if triggering these assumptions leads to increased hypochondriacal concerns, and (c) whether these individuals perceive their bodily sensations differently from others (i.e., experience greater somatosensory amplification). There was clear evidence that health anxiety is related dysfunctional health-related beliefs. Few studies have examined how hypochondriacal concerns are triggered, and inconsistent results emerged from those that have. Health anxiety is also associated with self-reported higher levels of somatosensory amplification. However, there was little evidence that individuals high in health anxiety are actually more accurate perceivers of the their own autonomic processes. Although the results generally supported the central tenets of the cognitive-behavioral model of hypochondriasis and health anxiety, further research will be necessary to determine whether these beliefs are specific to hypochondriasis and to identify any cognitive processes that may be unique to hypochondriasis.

Why reassurance fails in patients with unexplained symptoms--an experimental investigation of remembered probabilities

BACKGROUND

Providing reassurance is one of physicians' most frequently used verbal interventions. However, medical reassurance can fail or even have negative effects. This is frequently the case in patients with medically unexplained symptoms. It is hypothesized that these patients are more likely than patients from other groups to incorrectly recall the likelihoods of medical explanations provided by doctors.

METHODS AND FINDINGS

Thirty-three patients with medically unexplained symptoms, 22 patients with major depression, and 30 healthy controls listened to an audiotaped medical report, as well as to two control reports. After listening to the reports, participants were asked to rate what the doctor thinks the likelihood is that the complaints are caused by a specific medical condition. Although the doctor rejected most of the medical explanations for the symptoms in his verbal report, the patients with medically unexplained complaints remembered a higher likelihood for medical explanations for their symptoms. No differences were found between patients in the other groups, and for the control conditions. When asked to imagine that the reports were applicable to themselves, patients with multiple medical complaints reported more concerns about their health state than individuals in the other groups.

CONCLUSIONS

Physicians should be aware that patients with medically unexplained symptoms recall the likelihood of medical causes for their complaints incorrectly. Therefore, physicians should verify correct understanding by using check-back questions and asking for summaries, to improve the effect of reassurance.

Cognitive Processing of Emotional Information in Depression, Panic, and Somatoform Disorder

Emotional Stroop tasks (subliminal/supraliminal exposures), implicit memory tasks (tachistoscopic word identification), and explicit memory tasks (free recall after incidental learning) with 4 word types (physical threat, positive, negative, and neutral words) were administered to patients with major depressive disorder (n=30), panic disorder (n=33), somatoform disorder (n=25), and healthy control participants (n=33). On the Stroop task, panic patients showed subliminal interferences for physical threat and negative words, depressive patients showed supraliminal interferences for negative words, and somatoform patients showed supraliminal interferences for physical threat words. No patient groups demonstrated implicit memory biases. On the explicit memory task, depressive and panic patients showed memory biases for negative words; somatoform patients showed biases for physical threat words.

Optimal lipid modification: the rationale for combination therapy

BACKGROUND

An emphasis on more aggressive lipid-lowering, particularly of low-density lipoprotein cholesterol, to improve patient outcomes has led to an increased use of combination lipid-lowering drugs. This strategy, while potentially beneficial, has triggered concerns regarding fears of adverse effects, harmful drug interactions, and patient nonadherence.

OBJECTIVE

To present key data regarding combination lipid-altering therapy including use, rationale, major trials, benefits, potential adverse effects, compliance issues, and limitations.

METHOD

Literature was obtained from MEDLINE (1966 - June 2005) and references from selected articles.

RESULTS

A substantial body of evidence from epidemiological data and clinical trials indicates that aggressive lipid modification, especially low-density lipoprotein reduction, is associated with reduced cardiovascular events. Numerous studies utilizing various combinations of cholesterol-lowering agents including statin/fibrate, statin/niacin, statin/bile acid resin, and statin/ezetimibe have demonstrated significant changes in the lipid profile with acceptable safety. Long-term trials of combination therapy evaluating clinical outcomes or surrogate markers of cardiovascular disease, while limited, are promising.

CONCLUSION

Combining lipid-altering agents results in additional improvements in lipoproteins and has the potential to further reduce cardiovascular events beyond that of monotherapy.

Effekte von hypochondrischen Einstellungen auf Krankheitsverhalten und selektive Gedächtnisprozesse am Beispiel von Patienten mit funktionellen Herzbeschwerden

Zusammenfassung. Theoretischer Hintergrund: Das kognitiv-behaviorale Modell der Hypochondrie postuliert selektive Prozesse der Informationsverarbeitung, die wesentlich für die Entstehung und Aufrechterhaltung einer hypochondrischen Störung sind. Fragestellung: Unterscheiden sich hoch von niedrig hypochondrischen Patienten nach einer unauffälligen Angiographie hinsichtlich Krankheitsverlauf und selektiver Gedächtniseffekte für symptomspezifische Informationen? Methode: 20 Patienten mit ‘funktionellen Herzbeschwerden‘ und hohem Hypochondriescore und 23 Patienten mit ‘funktionellen Herzbeschwerden‘ und niedrigem Hypochondriescore wurden psychometrisch, katamnestisch und experimentell untersucht. Die ‘sofortige‘ und ‘verzögerte‘ Erinnerungsleistung für ‘Herzwörter‘ im Vergleich zu ‘Panikwörtern‘, ‘Positiven Wörtern‘ und ‘Neutralen Wörtern‘ wurde untersucht. Ergebnisse: Hypochondrische Patienten mit ‘funktionellen Herzbeschwerden‘ fühlen sich durch den unauffälligen Angiographiebefund weniger entlastet, und planen danach vermehrt weitere Untersuchungen als vergleichbare nicht hypochondrische Patienten. Selektive Gedächtniseffekte für symptomspezifisches Informationsmaterial zeigten sich aber nicht. Schlussfolgerung: Hypochondrische und nicht-hypochondrische Patienten mit ‘funktionellen Herzbeschwerden‘ unterscheiden sich eindeutig in Krankheitsbewertung und Krankheitsverhalten, nicht aber in symptomspezifischen Gedächtnisprozessen.

Perceived vulnerability to illness in individuals with irritable bowel syndrome

OBJECTIVE

To determine whether individuals with irritable bowel syndrome (IBS) differ from other individuals in their perceived lifetime risk of an unrelated medical condition.

METHOD

A questionnaire was used to assess worry about deep vein thrombosis (DVT) and perceived future risk of developing the condition in individuals with IBS and controls following a media scare concerning DVT.

RESULTS

Individuals with IBS reported higher perceived lifetime risk of DVT than did healthy controls or individuals with asthma. Current physical symptoms, exposure to information about DVT and the illness attitudes measured could not entirely account for the higher perceived health risk among individuals with IBS.

CONCLUSIONS

A perception of enhanced personal vulnerability to illness appears to be present in individuals with IBS, although it is possible that this perception is related to higher levels of negative affect amongst this group. Whilst a perception of enhanced vulnerability to illness is likely to contribute to IBS-related illness behaviour, it does not appear to be specific to reasoning about IBS and is also apparent when individuals consider an unrelated health issue.

Entwicklungspsychopathologie rekurrierender Bauchschmerzen und somatoformer Störungen

Zusammenfassung. Der Beitrag untersucht aus einer entwicklungspsychopathologischen Perspektive die störungs- und entwicklungsbezogenen Assoziationen zwischen rekurrierendem Bauchschmerz und somatoformer Störung sowie komorbiden Angststörungen bzw. Depression. Dazu werden eingangs Pfade des Übergangs von Störungsbildern der Eltern auf das Kind (Transmission) sowie die Stabilität bzw. Variabilität rekurrierender Bauchschmerzen und somatoformer Störungen vom Kindesalter zum Erwachsenenalter untersucht. Ein entwicklungspsychopathologisches Phasenmodell zeigt eine Sequenz von vier Etappen der Störungsentwicklung auf. Als Mediatoren eines ungünstigen Verlaufs werden Lernprozesse, Faktoren der kognitiv-behavioralen Schmerz- und Beschwerdeverarbeitung, beschwerdebezogene Copingstrategien sowie dysfunktionale Interaktionsmuster innerhalb der Familie sowie in der Arzt-Patient-Beziehung analysiert. Entwickelt sich eine Komorbidität mit einer Angststörung oder Depression, so zeigen diese Patienten störungsbedingt ein zusätzlich erhöhtes Risiko der verzerrten Verarbeitung abdomineller Beschwerden und Schmerzen.

Somatosensory amplification and its relationship to heartbeat detection ability

OBJECTIVE

Somatosensory amplification has been defined as the tendency to experience normal bodily sensations as intense, noxious, and disturbing. The present experiment investigated whether this tendency is due to heightened physiological sensitivity to bodily sensations.

METHODS

The relationship between Somatosensory Amplification Scale (SSAS) scores and objective measures of the ability to detect bodily (ie, heartbeat) sensations derived from the Method of Constant Stimuli procedure was assessed. Although somatosensory amplification characterizes hypochondriacs, the relationship between somatosensory amplification and sensitivity to bodily sensations was examined in nonhypochondriacal, nonpatient participants in an effort to dissociate somatosensory amplification from other variables associated with hypochondriasis and/or patient status.

RESULTS

Heartbeat detectors were found to exhibit significantly lower SSAS scores than nondetectors.

CONCLUSION

This finding suggests that somatosensory amplification is not due to heightened sensitivity to bodily sensations.

Memory bias in patients with hypochondriasis and somatoform pain disorder

OBJECTIVE

A memory bias enhances memory for disorder congruent information. The experimental evaluation of such biases in somatoform disorders may improve our understanding of these disorders.

METHOD

Immediate and delayed free recall as well as recognition for positive, negative, pain, and neutral word stimuli were studied in 28 patients with somatoform disorders (hypochondriasis and/or pain disorder patients) and 14 patients without somatoform disorders.

RESULTS

Somatoform patients recalled fewer positive words and their criteria for recognition of negative and pain words were less conservative than in patients without somatoform disorders. In addition, patients with comorbid hypochondriasis and somatoform pain disorder showed an enhanced immediate recall of pain words.

CONCLUSION

The memory biases found in this study support cognitive theories of somatoform disorders. They may contribute to the development and maintenance of somatoform disorders.