Hypochondriasis and fear of death

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

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

Death Anxiety in Obsessive-Compulsive Disorders

Objective: Death anxiety has long been attributed a role as a psychopathologically decisive factor in the development of mental illnesses such as obsessive-compulsive disorder (OCD). For example, patients with washing compulsions associate their behavior with a fear of life-threatening diseases or patients with control compulsions report that the constant checking is driven by the fear of fatal or deadly consequences for the occupants.Method: The Bochum Questionnaire to Assess Death Anxiety and Attitudes Towards Death (BOFRETTA) was administered to 31 patients with OCD and 31 healthy volunteers within a semi-structured interview using broad psychometry.Results: OCD patients showed increased death anxiety and negative attitute to death in comparison to healthy volunteers. A significant correlation was found between BOFRETTA-anxiety and the currently present religious obsessive thoughts.Conclusions: Our investigation provides further findings on the role of death anxiety and the problematic attitude towards death in OCD patients.

Death anxiety and mental health: Requiem for a dreamer

Recently, there has been an increased interest in the role of death anxiety in a broad range of mental health disorders. It has been argued that the fear of death may be a transdiagnostic variable contributing to the development and maintenance of many chronic mental health problems. Further, it has been suggested that death anxiety may be responsible for relapse and the emergence of new disorders in patients that have received successful treatment for earlier conditions in their lives. Given this, the purpose of the present selective review is to: (1) explore contemporary theoretical accounts of the role of death anxiety in a broad range of human behaviours; (2) examine evidence for death anxiety as a key variable in mental health disorders; (3) examine evidence on the treatment of death anxiety in both non-clinical and clinical populations; (4) describe the limitations of the current literature, and; (5) provide a detailed description of the critical future directions for this field.

A systematic review of the relationship between death anxiety, capability for suicide, and suicidality

This systematic review aimed to examine the relationship between death anxiety and suicidality in adults, and the impact of death anxiety interventions on the capability for suicide and suicidality. MEDLINE, PsycINFO, PubMed, and Web of Science were extensively searched using purpose-related keywords from the earliest to July 29th, 2022. A total of 376 participants were included across four studies which met inclusion. Death anxiety was found to relate significantly and positively with rescue potential, and although weak, negatively with suicide intent, circumstances of attempt, and a wish to die. There was no relationship between death anxiety and lethality or risk of lethality. Further, no studies examined the effects of death anxiety interventions on the capability for suicide and suicidality. It is imperative that future research implements a more rigorous methodology to establish the relationship between death anxiety and suicidality and establish the impacts of death anxiety interventions on the capability for suicide and suicidality.

Validity and utility of Hierarchical Taxonomy of Psychopathology (HiTOP): III. Emotional dysfunction superspectrum

The Hierarchical Taxonomy of Psychopathology (HiTOP) is a quantitative nosological system that addresses shortcomings of traditional mental disorder diagnoses, including arbitrary boundaries between psychopathology and normality, frequent disorder co-occurrence, substantial heterogeneity within disorders, and diagnostic unreliability over time and across clinicians. This paper reviews evidence on the validity and utility of the internalizing and somatoform spectra of HiTOP, which together provide support for an emotional dysfunction superspectrum. These spectra are composed of homogeneous symptom and maladaptive trait dimensions currently subsumed within multiple diagnostic classes, including depressive, anxiety, trauma-related, eating, bipolar, and somatic symptom disorders, as well as sexual dysfunction and aspects of personality disorders. Dimensions falling within the emotional dysfunction superspectrum are broadly linked to individual differences in negative affect/neuroticism. Extensive evidence establishes that dimensions falling within the superspectrum share genetic diatheses, environmental risk factors, cognitive and affective difficulties, neural substrates and biomarkers, childhood temperamental antecedents, and treatment response. The structure of these validators mirrors the quantitative structure of the superspectrum, with some correlates more specific to internalizing or somatoform conditions, and others common to both, thereby underlining the hierarchical structure of the domain. Compared to traditional diagnoses, the internalizing and somatoform spectra demonstrated substantially improved utility: greater reliability, larger explanatory and predictive power, and greater clinical applicability. Validated measures are currently available to implement the HiTOP system in practice, which can make diagnostic classification more useful, both in research and in the clinic.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

Attachment Relationships as Determinants of Physical Health

Childhood adversity alters the relational world of the child and inhibits the development of secure attachment bonds. The purpose of this article is to survey recent evidence that attachment insecurity has the potential to impair physical health throughout the lifespan. It is proposed that attachment insecurity contributes to disease risk through a range of mechanisms which include (1) disturbances in arousal and recovery within physiological systems that respond to stress; (2) physiological links between the mediators of social relationships, stress, and immunity; (3) links between relationship style and various health behaviors; and (4) disease risk factors that serve as external regulators of dysphoric affect, such as nicotine and alcohol. The evidence for these mechanisms, particularly the evidence that has accumulated since the model was first proposed in 2000, is presented and discussed.

Overcome Death Anxiety: The Development of an Online Cognitive Behaviour Therapy Programme for Fears of Death

Emerging research suggests that death anxiety is a transdiagnostic construct, which may underpin a number of mental illnesses. Although cognitive behaviour therapy (CBT) has been found to be the most effective treatment for death anxiety, no self-guided treatments for this construct exist at present. Furthermore, there is a growing need for accessible, scalable and cost-effective psychological treatments. To address these gaps, we created Overcome Death Anxiety (ODA), an online CBT-based programme which specifically targets fears of death. ODA was designed to be a fully automated, standalone, yet individualised online treatment. The present study outlines the development and structure of this programme using responses from four users to illustrate feasibility. Research is needed to examine the efficacy and usability of ODA with a larger clinical sample.

Death Anxiety and Related Factors in Schizophrenia Patients: Controlled Study

The aim of the study was to investigate the level of death anxiety and related sociodemographic and clinical variables in schizophrenia patients. One hundred and ninety schizophrenia patients and 110 healthy controls were included the study. Death anxiety measured with Templer Death Anxiety Scale (TDAS). The patients were also evaluated with scales in terms of depression, anxiety, obsessive-compulsive symptoms, and suicide. The death anxiety level in patients with schizophrenia was significantly higher than the healthy controls. The severity of depressive and psychotic symptoms were related to the level of death anxiety. Patients with schizophrenia may need more protection and psychosocial interventions about death related themes.

Preliminary evidence of the effectiveness of acceptance and commitment therapy for death anxiety in Iranian clients diagnosed with obsessive-compulsive disorder

The authors investigated the effectiveness of acceptance and commitment therapy (ACT) for the treatment of death anxiety and obsessive-compulsive disorder (OCD) with eight adult women in Iran. The ACT protocol was conducted in weekly solo sessions with each participant for 8 weeks (45 minutes each). The results were analyzed by visual analysis method and improvement percentage. ACT resulted in a 60%-80% decrease in death anxiety and a 51%-60% decrease in obsessive-compulsive symptoms, thereby indicating promise for ACT as a treatment for OCD and death anxiety.

Death anxiety and attitude to death in patients with schizophrenia and depression

Attitude to death and death anxiety in patients with severe psychiatric disorders have been studied rarely so far, although this is an existential perspective for each human being and clinically seems to be changed in patients with depression and schizophrenia. Patients with depression (mean age 46.30 ± 13.39; 12 women, 8 men) and schizophrenia (mean age 38.95 ± 1285; 9 women, 11 men), as well as healthy controls, were included in the study. Death anxiety and attitude to death were assessed using the newly developed and currently validated BOFRETTA scale. Attitude to death was significantly worse in the group of patients with schizophrenia, especially in those with prominent negative symptoms. Concerning death anxiety, patients with schizophrenia and also those with depression exhibited higher mean values compared with healthy controls in the same age range. These results suggest that there are specific similarities and differences concerning attitude to death and death anxiety in patients with psychotic and affective disorders. It can be concluded that existential aspects such as death and meaningful life should also be considered within the treatment of patients with severe mental disorders.

Death anxiety in the time of COVID-19: theoretical explanations and clinical implications

The recent COVID-19 pandemic has triggered a surge in anxiety across the globe. Much of the public's behavioural and emotional response to the virus can be understood through the framework of terror management theory, which proposes that fear of death drives much of human behaviour. In the context of the current pandemic, death anxiety, a recently proposed transdiagnostic construct, appears especially relevant. Fear of death has recently been shown to predict not only anxiety related to COVID-19, but also to play a causal role in various mental health conditions. Given this, it is argued that treatment programmes in mental health may need to broaden their focus to directly target the dread of death. Notably, cognitive behavioural therapy (CBT) has been shown to produce significant reductions in death anxiety. As such, it is possible that complementing current treatments with specific CBT techniques addressing fears of death may ensure enhanced long-term symptom reduction. Further research is essential in order to examine whether treating death anxiety will indeed improve long-term outcomes, and prevent the emergence of future disorders in vulnerable populations.

Key learning aims

(1)To understand terror management theory and its theoretical explanation of death anxiety in the context of COVID-19.(2)To understand the transdiagnostic role of death anxiety in mental health disorders.(3)To understand current treatment approaches for directly targeting death anxiety, and the importance of doing so to improve long-term treatment outcomes.

Religiosity and Death Anxiety: A Study of Muslim Dars Attendees

Dars is usually considered a religious lecture or activity where attendees spend much time in search of Islamic information, which often keeps the attendees away from negative thinking. Religious directions, belief salience, spiritual activities and practices are significant assets for dealing with difficult situations and odds of life. Death anxiety can increase the vulnerability of development of any psychological illness. Therefore, it is vital to study whether religiosity can serve as a buffering agent to death anxiety. The objective of our study was to examine the relationship between religiosity and death anxiety among Muslim dars attendees. We also aimed to investigate the gender-based differences in religiosity and death anxiety among Muslim dars attendees. A purposive sample of 200 adults (male n = 100 and female n = 100) with the age range of 20-60 years participated in the present study. The sample was collected from informal religious gatherings (dars) from Islamabad and Rawalpindi. The information was gathered through self-reporting questionnaires, death anxiety scale and index of religiosity. The questionnaires were in Urdu (native language) for ease and convenience of the respondents. Variable correlation analysis and t test was applied statistically through SPSS 21 version. The findings of the study indicate that there is a significant negative relationship between religiosity and death anxiety. Results also revealed that there is insignificant difference in religiosity between male and female Muslim adults. Results also specified that the level of death anxiety is higher in female than in male Muslim adults. Religiosity has a significant inverse relationship with death anxiety, and this can be helpful in reducing the anxiety-related features. Being a trans-diagnostic construct, measures can be taken to control death anxiety in order to enhance the mental well-being of masses. The present research also puts forward that the development of religious beliefs and interventions can help people to better adjust in life.

Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics

Psychedelic therapies can engender enduring improvements in psychological well-being. However, relatively little is known about the psychological mechanisms through which the salutary effects of psychedelics emerge. Through integrating extant research on psychedelics with contemporary existential psychology, we present a novel hypothesis that reduced death anxiety may be a key mechanism underpinning the therapeutic effects of psychedelics. In developing this hypothesis, we also provide a complementary review of mechanisms through which psychedelics may reduce death anxiety. We conclude that an awareness of the role of death anxiety in psychopathology has the potential to guide future research into psychedelic therapies.

A systematic review of the psychometric properties of death anxiety self-report measures

Recent research suggests that the transdiagnostic construct of death anxiety may be a basic fear underlying a range of anxiety disorders. Although the investigation of death anxiety in clinical populations is relatively recent, the death anxiety literature as a whole has a longer history evidenced by the number of instruments developed to measure this construct. This systematic review aimed to evaluate the evidence supporting the psychometric properties of self-report death anxiety measures. Relevant studies were identified via a systematic search of four electronic databases in addition to reference list searches. Two independent reviewers evaluated relevant studies using the established Terwee et al. quality appraisal tool. Of the 1831 studies identified, 89 met inclusion criteria. These studies investigated the psychometric properties of 21 self-report scales of death anxiety as well as six subscales. No measure was found to possess evidence of adequacy on all evaluated quality criteria. The Templer Death Anxiety Scale, Concerns about Dying Instrument and Death Concern Scale were found to possess the most evidence supporting their validity and reliability. Overall findings suggest that additional research is needed to establish the psychometric adequacy of death anxiety instruments, especially given increased utilization of these measures in both clinical and research settings.

Heldentum gegen Todesangst und Psychopathologie: “Selbstwert” als protektiver Faktor in der ambulanten Psychotherapie

<b><i>Hintergrund:</i></b> Die Befunde der bisherigen Untersuchungen legen nahe, dass die Angst vor dem Tod ein wichtiger Faktor bei der Entstehung psychischer Erkrankungen ist. Insbesondere die Terror-Management-Theorie geht davon aus, dass Menschen zwei verschiedene Strategien anwenden, um mit Todesangst umzugehen: (1) Sie versuchen, ihren Selbstwert zu steigern; (2) sie halten die Werte ihrer Kultur hoch. <b><i>Patienten und Methoden:</i></b> Im Rahmen einer prospektiven Studie wurden 56 ambulante Psychotherapie-Patienten (29 Frauen, Alter 42,8 Jahre, SD 13,8) vornehmlich mit depressiven Störungen mittels Interview/Fragebögen u.a. zu Angst vor dem Tod (BOFRETTA) sowie Religiosität untersucht. <b><i>Ergebnisse:</i></b> Die Angst vor dem Tod korrelierte signifikant mit der Schwere der psychischen Symptomatik (BDI), Neurotizismus (NEO-FFI) sowie dem Hochhalten kultureller Werte (LeBe). Erwartungsgemäß zeigte sich ein signifikanter negativer Zusammenhang von Selbstwert und Angst vor dem Tod. Dieser zeigte sich nicht bei Vergleichsvariablen wie Lebenssinn, Religiosität und Spiritualität. <b><i>Diskussion und Schlussfolgerungen:</i></b> Die Angst vor dem Tod spielt bei der Entstehung und Aufrechterhaltung psychischer Probleme eine wesentliche Rolle. Ein wichtiger protektiver Faktor gegen diese scheint das Selbstwertgefühl zu sein. Es lässt sich vermuten, dass das Hochhalten kultureller Werte zwar ein unbewusster Versuch ist, gegen die Angst vor dem Tod (und die psychische Symptomatik) vorzugehen, dieser allerdings nicht wirksam ist.

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

A Multifactorial Approach to Predicting Death Anxiety: Assessing the Role of Religiosity, Susceptibility to Mortality Cues, and Individual Differences

Death anxiety is not only experienced by individuals receiving end-of-life care, but also by family members, social workers, and other service providers who support these individuals. Thus, identifying predictors of individual differences in experienced death anxiety levels may have both theoretical and clinical ramifications. The present study assessed the relative influence of religiosity, susceptibility to mortality cues, state and trait anxiety, and demographic factors in the experience of death anxiety through an online survey distributed to members of two online communities related to end-of-life care. Results indicated that cognitive and emotional susceptibility to mortality cues, as well as gender, predicted differences in death anxiety. Conversely, religiosity and age did not increase the predictive power of the model. Thus, death anxiety may be a function of emotional, cognitive, and sociocultural factors that interact in complex, but predictable, ways to modulate the response to mortality cues that occur in one's life.

Death Anxiety, Perfectionism and Disordered Eating

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

The link between death anxiety and post-traumatic symptomatology during terror: Direct links and possible moderators

The current wave of terrorism which is taking place in Israel is characterized by increased arbitrary attacks by individual terrorists, acting independently, with reduced ability to anticipate when and where the next attack will take place. This situation creates an atmosphere of fear and insecurity in the lives of many citizens. Accordingly, the current study aims to establish a connection between death anxiety and PTSD symptom severity, as well as to examine whether major personality characteristics may moderate this connection. Using an online survey, 429 adult participants were recruited, and filled out death anxiety and PTSD symptomatology scales, as well as a short version of the Big Five personality scale. Findings revealed that death anxiety was a significant predictor of posttraumatic symptom severity, as were personality characteristics. Moreover, two personality traits, emotional stability and conscientiousness, moderated the association between death anxiety and PTSD symptomatology. The importance of death anxiety as a factor which is associated with PTSD symptomatology is discussed.

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

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

The prospective association between health anxiety and cancer detection: A cohort study linking the Hordaland Health Study (HUSK) with the Norwegian Cancer Registry

OBJECTIVE

Health anxiety is associated with distress and disability, and overutilization of health services, but it is not known whether high levels of health anxiety may lead to increased detection of severe diseases such as cancer. By linking a large population based health study with the national cancer registry, the aim of the study was to investigate a potential prospective association between health anxiety in men and women and later cancer detection and tumour metastasis at the time of diagnosis.

METHOD

A longitudinal study with a 13.2 year follow-up linking the population-based Hordaland Health Study (HUSK) and the Cancer Registry of Norway (CRN) was conducted. Health anxiety was measured with the Whiteley Index. Associations were examined through gender stratified Cox regression analyses adjusted for relevant covariates.

RESULTS

No association was found between baseline health anxiety and cancer detection for women (adjusted HR: 1.21, 95% CI: 0.42-3.50), but a positive association was found between health anxiety at baseline and cancer detection for men (adjusted HR: 1.76, 95% CI: 1.06-2.91). No statistically significant association was demonstrated between health anxiety and cancer metastasis for either gender.

CONCLUSION

An increased level of health anxiety in men may be advantageous, as it may motivate to self-examination and healthcare seeking when disturbing symptoms arise. Research is needed to investigate whether health anxiety has a protective effect on cancer metastasis at the time of detection, or whether health anxiety increases the risk of over-diagnosis and overtreatment.

Zusammenhänge zwischen Ekelempfindlichkeit, Ekelsensitivität und hypochondrischen Merkmalen

Theoretischer Hintergrund: Es gibt Hinweise, dass Ekelempfindlichkeit (Neigung, mit Ekel zu reagieren) und Ekelsensitivität (Neigung, Ekelempfindungen negativ zu bewerten) eine Rolle bei der Entstehung und Aufrechterhaltung der Hypochondrie spielen. Fragestellung: Besteht ein Zusammenhang zwischen Ekelempfindlichkeit bzw. Ekelsensitivität und hypochondrischen Merkmalen? Bleiben diese Zusammenhänge bei statistischer Kontrolle anderer Persönlichkeitseigenschaften bestehen? Methodik: Sechsundvierzig Probandinnen bearbeiteten folgende Fragebögen: Whiteley-Index (hypochondrische Merkmale), Fragebogen zur Erfassung der Ekelempfindlichkeit, Skala zur Erfassung der Ekelsensitivität, Angst-Sensitivitäts-Index, State-Trait-Angst-Depressions-Inventar (Ängstlichkeit). Ergebnisse: Es zeigten sich jeweils positive Zusammenhänge zwischen Ekelempfindlichkeit bzw. Ekelsensitivität und Krankheitsängsten. Auch nach Kontrolle des Lebensalters, Angstsensitivität und Ängstlichkeit konnten beide Ekeldomänen zusätzlich 12 % der Varianz von Krankheitsängsten aufklären. Schlussfolgerung: Die Bedeutung von Ekel für hypochondrische Merkmale erscheint größer als bisher angenommen.

The Ultimate Resistance

Although resistance takes many forms, this article elucidates the primary source of resistance in psychotherapy as well as the fundamental resistance to leading a fulfilling life. The ultimate resistance to change, in both cases, originates in the anticipatory fear of arousing existential angst. To varying degrees, most individuals retreat from life and adopt defense mechanisms in an attempt to avoid reawakening suppressed feelings of terror and dread they experienced as children in early separation experiences, and, in particular, when they first learned about death. As clients dismantle their defenses during therapy and move toward increased individuation and self-fulfillment, these unconscious fears threaten to emerge into conscious awareness, and core resistances come into play. Certain events and circumstances, both positive and negative, arouse or intensify latent death anxiety, whereas other circumstances and defenses relieve it. There are numerous defenses that help ameliorate the core anxiety including the fantasy bond—an illusion of connection or fusion with another person, persons, groups, or causes—addictions, microsuicidal behavior, and literal and symbolic methods of denying one’s eventual demise. Although these defenses provide a measure of security and a sense of immortality, they adversely affect one’s psychological adjustment, emotional well-being, and interpersonal relationships.

Childhood fears, neurobehavioral functioning and behavior problems in school-age children

The objective is to examine underlying associations between childhood fears, behavior problems and neurobehavioral functioning (NBF) in school-age children. Healthy, regular school children (N = 135), from second, fourth and sixth grade classes were assessed. Data regarding children's fears and behavioral problems were obtained with the Revised Fear Survey Schedule for Children, the Child Behavior Checklist, and NBF was assessed using a computerized neurobehavioral evaluation system. Significant correlations between childhood fears and NBF measures and somatic complaints were found. Children who reported higher levels of fears demonstrated lower working memory span (r = 0.24, p < 0.05), lower motor speed (r = -0.23, p < 0.05), and had more somatic complaints (r = 0.20, p < 0.05). Furthermore, younger children reported less fears than older ones and girls reported more fears than boys. These results highlight significant association between childhood fears, NBF and behavior problems in a non-clinical group children. Lower working memory span is an important component of executive control that may be an underlying factor in fears and anxiety in children.

Die Bedeutung von Ekel- und Angstsensitivität bei Personen mit der Verdachtsdiagnose einer Hypochondrie

Zentrales Merkmal bei der hypochondrischen Störung ist die Befürchtung, an einer schweren Erkrankung zu leiden. Dies führt zur Fehlinterpretation normaler Körperfunktionen. Neben dysfunktionalen Angstzuständen ist auch stark ausgeprägte Angstsensitivität störungsrelevant. Das aktuelle Hypochondriekonzept ist vorwiegend angstfokussiert, während die Bedeutung anderer Emotionen wie zum Beispiel von Ekel bisher kaum untersucht wurde. Ziel dieser Untersuchung war es herauszufinden, ob die habituelle Ekelneigung einen zusätzlichen Prädiktor für die Vorhersage von Hypochondrie darstellt. Nach einem Screening mit einem standardisierten klinischen Interview wurden 27 Personen mit und 27 Personen ohne Verdachtsdiagnose Hypochondrie in die Studie eingeschlossen und getestet. Mittels Diskriminanzanalyse wurde überprüft, ob Ekelempfindlichkeit (Neigung einer Person, mit Ekel zu reagieren) und Ekelsensitivität (Neigung, Ekelempfindungen als bedrohlich zu bewerten) für die Gruppentrennung in Personen mit und ohne Verdachtsdiagnose Hypochondrie (Kriterium: Whitely Index) relevant sind. Es zeigte sich, dass habituelle Angst, Ekelsensitivität und spezifische Bereiche der Ekelempfindlichkeit (z. B. Abneigung vor mangelhafter Hygiene) zwischen den beiden Gruppen differenzierten. Domänenspezifische Beziehungen zwischen Ekelempfindlichkeit und Hypochondrie werden diskutiert.

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.

Incremental specificity of disgust propensity and sensitivity in the prediction of health anxiety dimensions

The present study sought to determine the incremental specificity of disgust propensity and sensitivity in the prediction of symptoms of health anxiety in a large nonclinical sample (N=498). Exploratory factor analysis identified Illness Likelihood, Illness Severity, and Body Vigilance as dimensions of health anxiety symptoms that significantly correlated with disgust propensity and sensitivity. Negative affect and the fear of contamination were also significantly correlated with the three health anxiety symptom dimensions. Regression analyses did show that disgust propensity and sensitivity predicted overall health anxiety symptoms independent of negative affect and fear of contamination. However, the unique association between disgust propensity and sensitivity and symptoms of health anxiety was specific to the Body Vigilance dimension. These findings suggest that disgust propensity and sensitivity may be a unique vulnerability for the vigilance for bodily sensations/changes aspect of health anxiety but not necessarily other (perceived probability/severity of having a serious illness) aspects of health anxiety. The clinical and research implications of these findings for conceptualizing disgust propensity and sensitivity as a vulnerability for excessive health anxiety are discussed.

[Anxiety disorders in dialysis patients]

INTRODUCTION

Anxiety, as a primary symptom, includes all conditions of indefinite fear and psychic disorders dominated by fear. All dialysis patients suffer from anxiety as an independent phenomenon, or as part of another disease.

MATERIAL AND METHODS

This study included 753 patients on chronic hemodialysis in Bosnia and Herzegovina (B&H) in the period 1999-2004. The patients were divided into two groups: the first group included 348 patients with Balkan Endemic Nephropathy (BEN), and the control group included 405 patients with other diagnoses causing renal insufficiency (N18). The study was designed as a comparative cross sectional study, and patients were tested using questionnaires assessing anxiety, depression and general mental health status. Statistical analysis was done using standard descriptive and analytical methods.

RESULTS

Socio-demographic data showed highly significant differences between BEN and N18 in relation to place of residence (urban/rural) (chi2 = 23.970) p < 0.01: in the incidence of renal comorbidity (chi2 = 23.970) p < 0.01, familial renal comorbidity (chi2 = 23.970) p < 0.01 and mnigrations (chi2 = 4.874) p < 0.01. Beck Anxiety Inventory Scores were highly significantly different between the two groups p < 0.001, in regard to the incidence and variables. Hamilton Depression Rating Scale demonstrated a group significance p < 0.001, and variables pointed to somatization, general anxiety and depression. This was confirmed by mini-mental state examnination pointing to general mental weakness.

CONCLUSION

Anxiety appeared in all tested dialysis patients. It may be independent, somatized as part of another mental disorder or reinforced by a cognitive damage. Structured anxiety and depression result in pre-suicidal risk.

Fear of terrorism and preparedness in New York City 2 years after the attacks: implications for disaster planning and research

OBJECTIVES

To help improve disaster planning and research, we studied psychosocial predictors of terrorism fear and preparedness among New York City residents after the World Trade Center disaster (WTCD).

METHOD

We conducted a random cross-sectional survey of 1,681 adults interviewed 2 years after the WTCD. Participants were living in New York City at the time of the attack and exposed to ongoing terrorist threats.

RESULTS

We found 44.9 percent (95% confidence interval [CI] = 41.9-47.9) of residents were concerned about future attacks and 16.9 percent (95% CI = 14.7-19.3) reported a fear level of "10" on a 10-point analog scale. Furthermore, 14.8 percent (95% CI = 12.8-17.0) reported they had made some plans for a future attack, a significant increase from the previous year. In addition, although 42.6 percent (95% CI = 39.6-45.7) indicated that they would likely wait for evacuation instructions following a chemical, biological, or nuclear attack, 34.4 percent (95% CI = 31.5-37.3) reported they would evacuate immediately against official advice. Predictors of high terrorism fear in a multivariate model included Hispanic ethnicity (odds ratio [OR] = 2.0, P = .006), lower education (OR = 4.4, P < .001, and OR = 3.7, P < .001, respectively, for nonhigh school and high school graduates, compared with college graduates), being exposed to stressful life events (OR = 1.6, P = .048), having current posttraumatic stress disorder (3.1, P < .001), having a fear of death (OR = 2.5, P = .002), and reporting a likelihood of fleeing an attack against advice (OR = 1.5, P = .034). The best predictors of preparedness in a multivariate model was being between 30 to 64 years old (30-44 years old, OR = 2.6, P = .001; 45-64 years old, OR = 1.8, P = .03, respectively, compared with 18-29 years old), having higher exposure to the WTCD (moderate exposure, OR = 1.7, P = .05; high exposure, OR = 2.4, P = .002; very high exposure, OR = 4.1, P < .001), respectively, compared with no little WTCD exposure), and having greater exposure to other lifetime traumatic events (high traumatic event exposure, OR = 2.1, P = .005, compared with no exposure).

CONCLUSION

Our study suggests that among those exposed to ongoing terrorism threats, terrorism fear and preparedness were related to socioeconomic factors, mental health status, terrorism exposure levels, and exposure to stressful life events.

Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V

BACKGROUND

Adjustment disorders have been found to be the most frequent psychiatric diagnosis in the medically ill. Problems have been raised, however, as to their clinical value. The aim of the study was to characterize the psychosomatic features of adjustment disorders.

METHODS

One hundred patients with medical illness and a diagnosis of adjustment disorder according to DSM-IV criteria were interviewed according to the Diagnostic Criteria for Psychosomatic Research (DCPR) system, consisting of 12 clusters.

RESULTS

A considerable overlap was shown between adjustment disorders and DCPR clusters related to abnormal illness behavior (health anxiety, tanatophobia, nosophobia and illness denial) (54%), somatization (functional somatic symptoms secondary to a psychiatric disorder, persistent somatization, conversion symptoms and anniversary reaction) (37%) and demoralization (33%). Only 13 of the patients with adjustment disorders did not present any DCPR syndromes.

LIMITATIONS

The study is cross-sectional and does not allow to determine the prognostic features of DCPR categorization.

CONCLUSION

The clinical information which derives from the concomitant application of the DCPR might improve and make more specific the treatment of patients with adjustment disorders.

Using controlled comparisons in disgust psychopathology research: the case of disgust, hypochondriasis and health anxiety

The present paper describes the results of a study investigating the relationship between measures of disgust and measures of hypochondriasis and health anxiety. The results indicated that (1) there were highly significant correlations between measures of trait disgust and disgust sensitivity and measures of hypochondriasis and health anxiety, (2) the relationship between disgust sensitivity measures and hypochondriasis and health anxiety were still significant even when levels of trait anxiety were controlled for, but (3) controlled comparisons revealed that the measures of disgust also predicted scores on measures of disgust-irrelevant control psychopathologies (claustrophobia and height phobia)--even after trait anxiety had been partialled out. In addition, the series of multiple regressions carried out clearly indicated that trait anxiety and disgust sensitivity appear to be independent constructs each of which have relationships with anxious psychopathologies over and above the effect of the other. The discussion explores the nature of the possible relationships between disgust, hypochondriasis and health anxiety, and also looks at the implications for disgust psychopathology research of using controlled comparisons which indicate the existence of significant relationships between measures of disgust and anxious psychopathologies that, a priori, would be considered to be disgust irrelevant.

Tanatophobia in the patients on dialysis

Background/Aim. Thanatophobia is an exaggerated, specific, structured fear of death. It appears in childhood and continues to grow over the years, and in the old age it is accompanied with nosophobia and other mental disorders. The aim of this study was to analyze thanatophobia in dialysed patients which was in the direct connection with a basic disorder, and the influence of this disorder on functioning and the quality of life of the patients on dialysis. Methods. In the study we examined 753 patients from the chronic program of haemodialysis in a period from 1999 to 2004. The patients were classified in two groups: 348 randomized patients with Balkan Endemic Nephropathy (BEN), and the control group (N18) of patients with terminal renal insufficiency, and other diagnoses (n = 405). Since the study was a comparative, cross-sectional one, the patients were tested by the appropriate questionnaires for anxiety, depression and general mental functioning. Statistical analysis was done by the standard descriptive and analytic statistic methods. Results. Based on socio-demographics data we revealed a highly significant difference regarding the place of living between the groups BEN and N18 (?2 = 23.970; p < 0.01), the frequency of occurrence of renal comorbidity (?2 = 23.970; p < 0.01), the frequency of family renal comorbidity in siblings (?2 = 23.970; p < 0.01), and the frequency of migrationes (?2 = 4.874; p < 0.01). According to psychiatry scales, the patients from the BEN group were significantly more anxious and depressive than those from the control group. Conclusion. The signs of thanatophobia were revealed in both examined groups, but significantly more in the patients with BEN than in those with other nephrologic diseases. Thanatophobia starts before dialysis, and dialysis structures it into fear of death which is in a direct connection with the basic disorder. This intensive fear may be connected with dementia and depression, but also with other mental disorders.

INTERPERSONAL RELATEDNESS AND SELF-DEFINITION IN LATE ADULTHOOD DEPRESSION: PERSONALITY PREDISPOSITIONS, AND PROTECTIVE FACTORS

This study addresses depression in late adulthood within the context of Blatt's (1974; 1991) theory of development and vulnerabilities to depression. Participants were a sample of 237 Israeli community-dwelling old adults (age 65–75) in good health and functioning well. The authors assumed that in this developmental period, normally beset with questions about self-identity and interpersonal relatedness, the associations among Self-criticism, the Neediness component of dependency, and depressive symptomatology are moderated by participants' perceived social support as well as by their fear of death. As expected, the correlational results confirmed that depression in late adulthood is associated with Self-criticism, Neediness, fear of death, and low perceived social support. Additional results illustrated the protective role of Efficacy and Connectedness, as well as the buffering roles of social support and low fear of death in the relation between vulnerabilities to depression and depressive symptoms in late adulthood. The overall findings highlight the relevance of personality vulnerability factors in depression in late adulthood and the need to consider a range of moderating factors that may serve to protectively buffer or exacerbate the impact of personality vulnerability factors.