Correlates of hypochondriasis in a nonclinical population

Examining associations between early adverse life events and health anxiety using the DanFund study

Childhood adverse life events, in particular illness-related events, have been proposed as a risk factor for development of health anxiety.

OBJECTIVE

To examine: 1) The association between accumulated early adverse life events and health anxiety in adulthood and 2) The influence of specific types of life events, i.e., illness, injury, loss, and the impact of their exposure time on health anxiety in adulthood.

METHOD

A population-based, cross-sectional study including 7454 participants from the Danish study of Functional Disorders (DanFunD). Health anxiety was assessed with Whiteley-6-R and early adverse life events with the Cumulative Lifetime Adversity Measure. Caseness was defined as a Whiteley-6-R score ≥ 90%ile. Generalised linear models were used to estimate the association with relative risk (RRa, adjusted for sociodemographics).

RESULTS

A cumulative effect was found for each additional adverse life event with 8.03% increased risk of health anxiety. Two categories were associated with a higher risk: violence (RRa = 1.65, 95% CI: 1.37-1.99, P < 0.001) and relationship stress (RRa = 1.34; 95% CI: 1.15-1.57, P < 0.001). Respondents with self-reported childhood illness were also more likely to report health anxiety (RRa = 1.52, 95% CI 1.11-2.09, P = 0.009). Timewise, health anxiety seemed associated with illness during school age and injury during adolescence.

CONCLUSIONS

Accumulated adverse life events, early exposure to specific categories and specific health-related life events were associated with self-reported health anxiety in adulthood. Our findings provide new knowledge on the potential role of early life events in health anxiety which could inform early intervention.

Ethnic and migration-related inequalities in health anxiety: A systematic review and meta-analysis

Background

Health anxiety exists on a continuum ranging from the absence of health awareness to the obsessive fear of having a serious illness despite reassurance. Its pathological manifestation can be diagnosed as hypochondriacal or illness anxiety or somatic symptom disorder. Health anxiety is associated with psychological distress and adverse life events, among others, and leads to considerable economic burden. Compared to the majority population, migrants, and ethnic minorities often face major health inequalities. Several mental illnesses and psychosomatic complaints are more common among these groups. To date, potential ethnic and migration-related inequalities in health anxiety have not been clearly described. However, they are of high relevance for the provision of adequate health care of this diverse and potentially vulnerable group. Thus, we conducted a systematic review and meta-analysis of health anxiety in migrants and ethnic minorities.

Methods

A systematic literature search of PubMED, Web of Science, PsycINFO, and PSYNDEX was conducted, covering all studies published until 1st of December 2021. Studies were selected if they employed validated measurement tools of health anxiety and examined migrants and/or ethnic minorities in comparison with the majority population. Meta-analytic methods were applied by using a random-effect model. The study quality was assessed with the Effective Public Health Practice Project Quality Assessment Tool (EPHPP).

Results

We identified 18 studies from 445 studies initially screened. Of these, 14 studies conducted in North America with a total number of 5,082 study participants were included in the meta-analysis. The pooled effect size indicated a higher risk of health anxiety in migrants and ethnic minorities compared to the majority population (OR 1.39, 95%-CI 1.01-1.92). The results proved not to be robust according to publication bias (adjusted OR 1.18, 95%-CI 0.83-1.69) and fail-safe N (2/3 < benchmark N = 75) and are limited due to heterogeneity (I 2 = 57%), small sample sizes and an overall low quality of included studies.

Conclusion

To address the diversity of migrants and ethnic minorities, inter-sectional approaches across different countries are needed in research to shed further light on social inequalities in health anxiety linked to migration.

Systematic review registration

PROSPERO, registration number CRD42022298458.

Health anxiety During COVID-19: Predictive Roles of Health Promoting Behaviors and Sensory Processing Sensitivity

OBJECTIVE

The emergence of the COVID-19 pandemic resulted in major changes in daily life and economic conditions while heightening physical and mental health problems, including health anxiety. Health authorities and elected officials have encouraged individuals to engage in health behaviors. Perceptions of and reactions to these changes could be subject to individual differences. In this line, the current study investigated the predictive roles of health promoting behaviors, sensory processing sensitivity, and their interactions with health anxiety.Design and measures: In this cross-sectional study, 355 participants (73% female, 25.9% male) whose ages range from 19 to 72 (M = 25.91, SD = 9.80) filled out self-reported measures on health promoting behaviors, sensory processing sensitivity, and health anxiety via an online platform between April and May 2020.

RESULTS

It was revealed that caring for a healthy diet, taking responsibility for health and sensory processing sensitivity, but not physical activity and stress management, were associated with health anxiety. Diagnoses and perceptions of physical and mental health problems also contributed to health anxiety during the COVID-19 pandemic.

CONCLUSION

Individuals with higher levels of sensory processing sensitivity and health responsibility were more likely to experience higher levels of health anxiety, while typical physical activities and stress management behaviors were less likely to have an impact during the COVID-19 pandemic. These results highlight the importance of having a healthy diet and the need for pandemic-specific interventions for stress management and sport activities.

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.

The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students

PURPOSE

In order to explain the potential mechanism that might motivate and maintain health anxiety (HA), researchers have developed several measures to assess the level of HA and to identify related cognitions and personality features. However, such instruments typically measure general metacognitions [e.g., the Metacognition Questionnaire-30 (MCQ-30)], thereby compromising the degree of sensitivity and specificity of measurement as applied to HA-related metacognitions. To address that issue, the Metacognitions about Health Questionnaire (MCQ-HA) was designed especially for measuring metacognitive beliefs specific to HA. Because a Chinese version of MCQ-HA may be helpful in improving our understanding of HA in a Chinese population, in the current study we sought to develop a Chinese version of the MCQ-HA (CMCQ-HA).

METHODS

We translated the MCQ-HA into Chinese with consideration of cultural diversity. For evaluation of its validity and stability, a sample of 1290 Chinese college students answered the CMCQ-HA, the Short Health Anxiety Inventory, the MCQ-30, and the Neuroticism scale of the Eysenck Personality Questionnaire. 292 students of them answered the CMCQ-HA twice.

RESULTS

Good internal consistency (α = 0.81) and test-retest reliability (ICC = 0.70) of the CMCQ-HA was presented. Exploratory and confirmatory factor analyses indicated a three-factor structure: beliefs about biased thinking, beliefs that thoughts can cause illness, and beliefs that thoughts are uncontrollable. Convergent validity, divergent validity, and incremental validity all were acceptable. Measurement invariance across gender was established.

CONCLUSIONS

The CMCQ-HA shows promise for the measurement of specific HA-related metacognitions in Chinese populations.

Somatic Symptoms Mediate the Relationship Between Health Anxiety and Health-Related Quality of Life over Eight Weeks

Previous research has indicated that at clinical levels, health anxiety is cross-sectionally correlated with both somatic symptoms and health-related quality of life (HRQOL). However, research has not tested mediational models of how health anxiety may lead to diminished HRQOL prospectively, and more broadly outside of clinical contexts. In the context of an eight-week prospective diary study of 118 subclinical adults, we examined whether somatic symptoms mediate the relationship between health anxiety and both same-week HRQOL and week-to-week change in HRQOL. Multilevel modelling indicated that somatic symptoms fully mediated the relationship between HA and HRQOL concurrently and over time. Even after accounting for depressive symptoms, individuals who were predisposed to experience illness preoccupation and oversensitivity to bodily sensations were at risk for higher somatic symptoms and thereby poorer levels of perceived health. Thus, both health anxiety and somatic symptoms may be an important target for interventions seeking to improve HRQOL in subclinical populations. Copyright © 2016 John Wiley & Sons, Ltd.

Food avoidance in an Australian adult population sample: the case of dairy products

OBJECTIVE

To assess the prevalence of and explanations for the avoidance of dairy foods, including symptoms attributed to their consumption, diagnoses and psychological predictors of avoidance. Also considered were comparisons with symptom-related avoidance of wheat in the same sample.

DESIGN

Cross-sectional population survey.

SETTING

The study was conducted in Australia using a national postal omnibus survey.

SUBJECTS

Adults aged 18 years and over (n 1184; 52·9 % female) selected at random from the Australian Electoral Roll.

RESULTS

Despite few claims of formally diagnosed allergy or intolerance, 11·8 % of the sample reported avoiding dairy products because of adverse physiological effects, which commonly included gastrointestinal symptoms. Unlike wheat (3·5 %) or wheat-and-dairy (3·6 %) avoidance, dairy avoidance (8·2 %) was predicted by age (negatively) and worry about illness (positively).

CONCLUSIONS

The findings are further evidence of a widespread tendency for consumers to exercise control over their health by eliminating dietary factors considered suspect without medical evidence or oversight. Unanswered questions include the decision processes underlying dairy avoidance, whether symptoms are attributed correctly, the agents and physiological mechanism(s) involved, the relative contributions of symptom severity and vigilance to the association with illness worry, and the nutritional adequacy of dairy avoiders' diets. Irrespective of the accuracy of self-diagnoses, if the elimination of suspect foods is an end in itself the paradoxical possibility for nutritional imbalances may have significant public health implications.

The Relationship of Hypochondriasis to Anxiety, Depressive, and Somatoform Disorders

BACKGROUND

Though the phenotype of anxiety about medical illness has long been recognized, there continues to be debate as to whether it is a distinct psychiatric disorder and, if so, to which diagnostic category it belongs.

OBJECTIVE

Our objective was to investigate the pattern of psychiatric comorbidity in hypochondriasis (HC) and to assess the relationship of health anxiety to anxiety, depressive, and somatoform disorders.

METHODS

Data were collected as part of a clinical trial on treatment methods for HC. In all, 194 participants meeting criteria for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) HC were assessed by sociodemographic variables, results of structured diagnostic interviews, and validated instruments for assessing various symptom dimensions of psychopathology.

RESULTS

Most of the individuals with HC had comorbid psychiatric illness; the mean number of comorbid diagnoses was 1.4, and 35.1% had HC as their only diagnosis. Participants were more likely to have only comorbid anxiety disorders than only comorbid depressive or somatoform disorders. Multiple regression analysis of continuous measures of symptoms revealed the strongest correlation of health anxiety with anxiety symptoms, and a weaker correlation with somatoform symptoms; in multiple regression analysis, there was no correlation between health anxiety and depressive symptoms.

CONCLUSION

Our findings suggest that the entity of health anxiety (HC in DSM-IV and illness anxiety disorder in DSM-5) is a clinical syndrome distinct from other psychiatric disorders. Analysis of comorbidity patterns and continuous measures of symptoms suggest that its appropriate classification is with anxiety rather than somatoform or mood disorders.

The reliability and validity of a Chinese-version Short Health Anxiety Inventory: an investigation of university students

BACKGROUND

The Short Health Anxiety Inventory (SHAI) is widely used in English-speaking populations, with good reliability and validity. For further research needs in the Chinese population, it was translated into a Chinese version (CSHAI). Furthermore, the reliability, validity, and cutoff score were examined in a nonclinical population in the People's Republic of China.

METHODS

Three hundred and sixteen undergraduates were evaluated by a set of questionnaires including CSHAI, Zung Self-Rating Anxiety Scale (SAS), Zung Self-Rating Depression Scale (SDS), and the State-Trait Anxiety Inventory (STAI). Fifty-eight students completed CSHAI again after 30 days.

RESULTS

The two-factor model had satisfactory fit indices. The correlation coefficients between each item with the CSHAI total and each subscale were between 0.386 and 0.779. The Cronbach's alpha coefficients of CSHAI total and its subscales were 0.742, 0.743, and 0.788, respectively, and the split-half coefficients were 0.757, 0.788, and 0.912. The test-retest correlation coefficients were, respectively, 0.598 (P<0.001), 0.539 (P<0.001), and 0.691 (P<0.001). Convergent validities were respectively 0.389-0.453, 0.389-0.410, and 0.250-0.401, and discriminant validities were -5.689 (P<0.001), -5.614 (P<0.001), and -3.709 (P<0.001). The cutoff score was 15.

CONCLUSION

CSHAI showed good factor structure, reliability, convergent validity, and discriminant validity, and 15 was determined to be the appropriate cutoff score for screening health anxiety.

The development and validation of a Chinese version of the Illness Attitude Scales: an investigation of university students

BACKGROUND

The Illness Attitude Scales (IAS) are considered as one of the most suitable instruments to screen hypochondriasis.

PURPOSE

Whether it has cross-cultural validity in China remains to be determined.

METHODS

In Chinese university students (141 women and 141 men), we have administered the IAS, the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), and the Plutchik-van Praag Depression Inventory (PVP).

RESULTS

For the first time in Chinese culture, we have identified a four-factor structure of the IAS: patho-thanatophobia, symptom effect, treatment seeking, and hypochondriacal belief. Women scored significantly higher on IAS patho-thanatophobia and treatment seeking, on ZKPQ neuroticism-anxiety and activity, and on PVP than men did. The neuroticism-anxiety was significantly correlated with patho-thanatophobia and symptom effect, and PVP was positively correlated with symptom effect in women. Neuroticism-anxiety was significantly correlated with patho-thanatophobia, and impulsive sensation seeking and activity were significantly correlated with symptom effect in men.

CONCLUSION

In Chinese students, we have found a stable four-factor IAS structure.

Health anxiety--an indicator of higher interoceptive sensitivity?

BACKGROUND AND OBJECTIVES

According to cognitive-behavioral models, health anxiety arises from the misattribution of normal bodily sensations as signs of a severe illness. Consequently, higher levels of interoceptive accuracy might be critically involved in the development of health anxiety.

METHODS

To test this central assumption of cognitive behavioral models of health anxiety, we assessed interoceptive accuracy in a sample of college students (N = 100). Two interoceptive tasks (detection of one's own heartbeat using the Schandry paradigm and detection of nonspecific skin conductance fluctuations, NSCFs) were used.

RESULTS

We found no indication for a positive association between facets of health anxiety and a higher interoceptive accuracy in the two tasks. In fact, worse heartbeat perception was associated with higher health anxiety as measured by two questionnaires whereas perception of NSCFs was not significantly related to any facet of health anxiety. In addition, we found a bias to overestimate NSCFs in people with heightened health anxiety.

LIMITATIONS

Because a sample of college students served as participants, the generalization of the findings is limited and further studies in patients with the diagnosis of hypochondriasis are necessary.

CONCLUSIONS

The findings of both interoceptive paradigms suggest that health anxiety is not associated with better but rather with less accurate and biased interoceptive sensitivity. Probably, not a heightened interoceptive sensitivity but rather the bias in overestimating harmless somatic cues is more relevant for the maintenance of health anxiety. Our results are in line with recent research in other somatoform disorders.

Personality predicts time to remission and clinical status in hypochondriasis during a 6-year follow-up

We aimed to investigate whether personality characteristics predict time to remission and psychiatric status. The follow-up was at most 6 years and was performed within the scope of a randomized controlled trial that investigated the efficacy of cognitive behavioral therapy, paroxetine, and placebo in hypochondriasis. The Life Chart Interview was administered to investigate for each year if remission had occurred. Personality was assessed at pretest by the Abbreviated Dutch Temperament and Character Inventory. Cox's regression models for recurrent events were compared with logistic regression models. Sixteen (36.4%) of 44 patients achieved remission during the follow-up period. Cox's regression yielded approximately the same results as the logistic regression. Being less harm avoidant and more cooperative were associated with a shorter time to remission and a remitted state after the follow-up period. Personality variables seem to be relevant for describing patients with a more chronic course of hypochondriacal complaints.

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.

Personality is of central concern to understand health: towards a theoretical model for health psychology

This paper sets out the case that personality traits are central to health psychology. To achieve this, three aims need to be addressed. First, it is necessary to show that personality influences a broad range of health outcomes and mechanisms. Second, the simple descriptive account of Aim 1 is not sufficient, and a theoretical specification needs to be developed to explain the personality-health link and allow for future hypothesis generation. Third, once Aims 1 and 2 are met, it is necessary to demonstrate the clinical utility of personality. In this review I make the case that all three Aims are met. I develop a theoretical framework to understand the links between personality and health drawing on current theorising in the biology, evolution, and neuroscience of personality. I identify traits (i.e., alexithymia, Type D, hypochondriasis, and empathy) that are of particular concern to health psychology and set these within evolutionary cost-benefit analysis. The literature is reviewed within a three-level hierarchical model (individual, group, and organisational) and it is argued that health psychology needs to move from its traditional focus on the individual level to engage group and organisational levels.

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.

Health anxiety in Australia: prevalence, comorbidity, disability and service use

BACKGROUND

Health anxiety is associated with high distress, disability and increased health service utilisation. However, there are relatively few epidemiological studies examining the extent of health anxiety or the associated sociodemographic and health risk factors in the general population.

AIMS

To provide epidemiological data on health anxiety in the Australian population.

METHOD

Lifetime and current prevalence estimates, associations between comorbid disorders, psychological distress, impairment, disability and mental health service utilisation were generated using the Australian 2007 National Survey of Mental Health and Wellbeing.

RESULTS

Health anxiety affects approximately 5.7% of the Australian population across the lifespan and 3.4% met criteria for health anxiety at the time of the interview. Age, employment status, smoking status and comorbid physical conditions were significantly related to health anxiety symptoms. Health anxiety was associated with significantly more distress, impairment, disability and health service utilisation than that found in respondents without health anxiety.

CONCLUSIONS

Health anxiety is non-trivial; it affects a significant proportion of the population and further research and clinical investigation of health anxiety is required.

Predictors of health anxiety among older and young adults

BACKGROUND

Many older adults have at least one chronic disease and experience greater health problems than young adults. However, little is known about factors other than health that account for health anxiety (HA) among older adults. The overall objective of the present study was to develop a better understanding of HA among older and young adults.

METHODS

We examined how anxiety-related constructs (anxiety sensitivity, intolerance of uncertainty, anxiety control, and emotion regulation) predict two core components of HA described in the cognitive-behavioral model of HA (illness likelihood and negative consequences) in older and young adults. We also examined the extent to which the predictor variables differentially account for HA in both age groups. Older and young adult participants completed several self-report surveys.

RESULTS

Young adults reported higher levels of HA than older adults. Anxiety sensitivity and reappraisal predicted illness likelihood for older and young adults. Intolerance of uncertainty predicted negative consequences in both age groups. Anxiety sensitivity predicted negative consequences for older adults only. Anxiety control did not predict illness likelihood or negative consequences for either age group.

CONCLUSIONS

Results suggest that anxiety sensitivity and intolerance of uncertainty may predispose older and young adults to HA, which is influenced by reappraisal. Implications for the cognitive-behavioral model of HA in both age groups are discussed.

Hypochondriasis, somatoform disorders, and anxiety disorders: sociodemographic variables, general psychopathology, and naturalistic treatment effects

The question of whether hypochondriasis (HYP) should be considered a somatoform disorder (SFD) or classified as an anxiety disorder (ANX) has recently been raised. To empirically provide information on this issue, we compared patients with HYP (n = 65) with those with other SFDs (n = 94) and those with ANX (n = 224) regarding sociodemographic and biographical variables, general psychopathology, and naturalistic cognitive-behavioral therapy treatment effects. Compared with SFD, patients with HYP were younger and had fewer comorbid affective disorders and less impaired life domains, suggesting a closer connection between HYP and ANX. Regarding cognitive-behavioral therapy treatment effects, all diagnostic groups showed comparable significant improvement (d = 0.44-0.64). According to level of anxiety, the SFD sample had significantly lower pretreatment scores than did the ANX and the HYP samples. The results suggest that patients with HYP have an interim position between SFD and ANX, with slightly closer connections to ANX.

Hypochondrische Merkmale bei Patienten einer psychotherapeutischen Ambulanz

Zusammenfassung. Theoretischer Hintergrund: Während die Hypochondrie eine relativ niedrige Prävalenz aufweist, gibt es Hinweise, dass hypochondrische Merkmale unterhalb der diagnostischen Schwelle deutlich häufiger vorliegen. Fragestellung: Wie häufig bestehen bei ambulanten Psychotherapiepatienten ausgeprägte hypochondrische Merkmale? Kann die hypochondrische Symptomatik durch bestehende somatische Krankheiten erklärt werden? Welche Risikofaktoren könnten bedeutsam sein? Methode: 85 Patienten einer psychotherapeutischen Ambulanz wurden hinsichtlich des Vorliegens hypochondrischer Merkmale, Krankheitserfahrungen und traumatischer Erfahrungen in der Kindheit untersucht. Ergebnisse: Je nach Cut-off-Kriterium zeigten sich bei 24–34% der Patienten ausgeprägte krankheitsbezogene Befürchtungen, die in geringem Umfang (6–10%) durch einen schlechteren Gesundheitsstatus erklärt werden konnten. Potenziell relevant für hypochondrische Symptome zeigte sich zudem die Anzahl verstorbener Familienangehöriger. Schlussfolgerung: Hypochondrische Merkmale sollten in der ambulanten psychotherapeutischen Versorgung eine größere Beachtung finden, da sie von den Patienten häufig berichtet werden.

A taxometric study of hypochondriasis symptoms

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

Fixed belief in cognitive dysfunction despite normal neuropsychological scores: neurocognitive hypochondriasis?

A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of "neurocognitive hypochondriasis." Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome.

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.

Prevalence of exercise dependence and other behavioral addictions among clients of a Parisian fitness room

AIM OF THE STUDY

Exercise dependence is an inadequate pattern of exercise leading to clinically significant negative consequences. Subjects present loss of control of their physical activity, tolerance, and withdrawal symptoms when they do not practice sport. We studied the prevalence of exercise dependence among clients of a Parisian fitness room. We also assessed alcohol and nicotine use disorders, 2 other "socially tolerated" behavioral addictions (compulsive buying and Internet addiction), and 2 disorders related to anxiety focused on the body (bulimia and hypochondria).

METHOD

All clients of the fitness room 18 years and older were invited to participate in the study. Three hundred subjects were included; 125 (42%) presented diagnostic criteria of exercise dependence. Unsurprisingly, exercise dependents spent more hours each day in the fitness center practicing (2.1 vs 1.5 hours per day). They went to the fitness center more often each week (3.5 vs 2.9 days per week). Exercise addicts smoked less; alcohol consumption was equivalent in both groups. Compulsive buying was significantly more frequent in exercise dependents (63% vs 38%), which means they scored higher in the compulsive buying scale (5.4 vs 4.1). Prevalence of hypochondria was equivalent in both groups, but scores in the Whiteley Index of Hypochondria were higher (4.1 vs 3) in the exercise-dependent group. Bulimia was significantly more frequent among exercise dependents (70% vs 47%), who also presented a higher number of bulimic episodes each week (2.5 vs 1.3). Subjects with exercise dependence spent more time on their computer each day (3.9 vs 2.4 hours per day). We found no difference regarding time spent using Internet, the number of e-mails sent or received, and their time at speaking on a cellular phone.

CONCLUSION

Our results lead to systematically study the addictive relation to exercise among regular clients of the fitness rooms. Exercise addicts are exposed to negative consequences for their excess of physical activity. Exercise addiction is also associated to compulsive buying, bulimia, and, in a lesser extent, hypochondria.

Alexithymia, Fear of Bodily Sensations, and Somatosensory Amplification in Young Outpatients With Panic Disorder

To elucidate the relationships between alexithymia, fear of bodily sensations, and somatosensory amplification in young patients with panic disorder (PD), authors evaluated 84 patients. Measures were the Panic Attack and Anticipatory Anxiety Scale, the Toronto Alexithymia Scale (TAS-20), the Body Sensations Questionnaire (BSQ), the Somatosensory Amplification Scale, the Agoraphobic Cognitions Questionnaire (ACQ), and the Hamilton Rating Scale for Depression. Alexithymic patients showed higher scores on all rating scales. Higher BSQ and ACQ scores, together with the Difficulty in Identifying Feelings and Difficulty in Describing Feelings subscales of the TAS-20 were predictors of severity of PD. Results of the present study do not support a direct role of somatosensory amplification in PD. Authors discuss study limitations and future research needs.

Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature

A valid classification is important for further understanding of the somatoform disorders. The main disorders in this grouping - somatization disorder and hypochondriasis - have lengthy historical traditions and are defined in a contrasting manner. Various authors point to distinguishing demographic and clinical features, but there have been few direct comparisons of patients with these disorders. A review of the literature indicates those domains where differences are most likely to be found. Research assessing these may serve to refine and validate these key somatoform categories and/or dimensions.

Prevalence and Correlates of Illness Worry in the General Population

The prevalence and correlates of illness worry in the general population were investigated in a representative sample. The authors screened residents of the United States by telephone, and more detailed interviews were conducted with 123 respondents who reported at least 1 month of worry about serious illness in the past 12 months and an equal number of randomly selected persons without such worry. Data on demographic characteristics, medical and psychiatric conditions, functional impairment, and health care utilization were collected. At least 1 month of worry was endorsed by 13.1% of the screened population. Correlates of worry included a cluster of psychiatric conditions (major depressive episode, panic attacks, and generalized anxiety disorder) and three clusters of physical conditions (heart disease, cancer, and other diseases). Worry about serious illness was associated with functional impairment and health care utilization.

Relationship between hypochondriacal concerns and personality dimensions and traits in a military population

Our aim was to examine the relationship between personality dimensions and hypochondriacal concerns and somatic symptoms in a military population. The Schedule of Nonadaptive and Adaptive Personality along with measures of hypochondriacal concerns and somatic symptoms were administered to 602 military veterans who had been on active duty during the 1991 Gulf War. Factor analyses identified six separable dimensions-two of hypochondriacal concerns, two of somatic symptoms, and two of possible mechanisms of symptom generation-for study. Multiple regression models determined the proportion of variation in these measures of somatic distress explained by personality scales. Personality measures explained between 26% and 38% of the variance in hypochondriacal concerns and somatic symptoms, and Negative Temperament accounted for most of this. Moderately strong positive correlations were observed between trait scales Mistrust, Low Self-Esteem, and Eccentric Perceptions and the various measures of somatic distress. Thus, when Negative Temperament was taken into account, few significant correlations between personality measures and hypochondriacal concerns or somatic symptoms remained. Negative temperament or neuroticism is strongly associated with hypochondriacal concerns. Important features of hypochondriasis and somatic distress appear to lie within the domain of personality. It remains for future research to show whether negative temperament is a vulnerability factor for hypochondriasis or hypochondriasis is itself a personality disorder.

Risk factors for hypochondriacal concerns in a sample of military veterans

OBJECTIVE

The aim was to examine the influence of combat exposure and other risk factors on the development of hypochondriacal concerns among veterans of the Gulf War and to learn whether these concerns might be a source of increased symptom reporting among them.

METHOD

Six hundred two veterans who were deployed to the Gulf or elsewhere during the 1991 war took part in a two-phase study of symptoms and illnesses occurring among these veterans. Hypochondriacal beliefs and attitudes were assessed by the Whiteley Index and somatic symptoms by a factor-analytically derived measure. Multiple regression models were developed for these outcomes.

RESULTS

Hypochondriacal concerns were significantly associated with level of education, personal history of depression, number of prewar physical conditions, family history of functional syndromes, negative and positive temperament and disinhibition, military combat, level of military preparedness, social support, and perceived life stress. Somatic symptoms were associated with these same variables, as well as branch of service, family history of physical conditions, combat, and level of combat exposure. A regression model for hypochondriacal concerns included the number of prewar physical conditions, negative temperament, lack of social support, and perceived life stress.

CONCLUSIONS

Hypochondriacal concerns were not strongly related to combat exposure. Consequently, it is not likely that such concerns account for increased symptom reporting among the veterans studied. Hypochondriacal concerns appeared to arise in response to threats posed by physical illness. Vulnerability to such threats appeared to center on the personality dimension of negative temperament. This model may serve as a guide to future investigations.

A systematic review of the epidemiology of somatisation disorder and hypochondriasis

BACKGROUND

This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples.

METHOD

A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings.

RESULTS

In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders.

CONCLUSIONS

On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.

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.

Identifying somatization disorder in a population-based health examination survey: psychosocial burden and gender differences

Despite its enormous medical burden, little is known about the epidemiology of somatization in the community. The present study screened a representative population-based survey of 7,466 subjects in the age range of 25 to 69 years for the occurrence of somatization. A total of 137 (1.84%) individuals experienced six or more symptoms from at least two different body sites without an identifiable organic cause. These patients exhibited a lower quality of life (P < or = 0.0001) and suffered from higher levels of emotional stress (P < or = 0.0001) than their counterparts in the healthy subsample (n=906). Somatization was not associated with a medical diagnosis, but disability days, the use of medical services, and the level of medication was higher in the somatization disorder group (P < or = 0.004). The somatization risk was only 1.6-fold higher for women in comparison to men but escalated for women rapidly to an approximately 4-fold risk when being female was combined with low social class and high emotional distress. Against expectation, the somatization risk for men also mounted 3-fold under the identical risk constellation.