Aus vier mach zwei

Background

The diagnostic and statistical manual of mental disorders 5 (DSM-5) includes a revision of the DSM-IV criteria for somatoform disorders. The aim of the current work was to investigate whether (a) patients with DSM-IV diagnoses of somatization disorder, pain disorder and hypochondriasis and (b) whether patients categorized as having the DSM-5 somatic symptom disorder and illness anxiety disorder differ with respect to illness anxiety and cognition regarding somatic symptoms.

Material and methods

The data from 269 inpatients from the psychosomatic clinic Schön Klinik Bad Bramstedt were used. Somatoform disorders were diagnosed using the German version of the structured clinical interview for DSM-IV (SCID).

Results

Patients with a DSM-IV diagnosis of hypochondriasis differed in illness anxiety and catastrophizing interpretation of somatic symptoms compared to patients with other somatoform disorders. Patients with illness anxiety disorder differed in the catastrophizing interpretation of physical symptoms, autonomic sensations, bodily weakness and intolerance of physical complaints compared to patients with somatic symptom disorder.

Conclusion

The present results indicate that illness anxiety and a catastrophizing interpretation of somatic symptoms play a fundamental role in patients with somatoform disorders. Therefore, psychotherapy should address illness anxiety and health-related concerns in all patients with somatoform disorders.     

The role of disgust in patients with hypochondriasis

Theoretically, disgust sensitivity and disgust proneness could play an important role in hypochondriasis, since disgust is a defensive emotion widely believed to protect the organism from illness. However, empirical evidence to support this hypothesis has so far been based only on nonclinical samples, so that the importance and specificity of disgust for hypochondriasis remains unclear. In the current study, 36 patients with hypochondriasis, 27 with an anxiety disorder, and 29 healthy controls completed several measures which included the assessment of disgust sensitivity (Scale for the Assessment of Disgust Sensitivity) and disgust proneness (Questionnaire for the Assessment of Disgust Proneness). We found that patients with hypochondriasis and those with an anxiety disorder had higher scores than those of the healthy controls for several measures of disgust proneness. Moreover, measures of hypochondriacal characteristics were associated with those of disgust proneness and disgust sensitivity. However, no differences were found between patients with hypochondriasis and those with anxiety disorders, with respect to disgust proneness and disgust sensitivity. Therefore, it can be assumed that disgust proneness and disgust sensitivity seem to be less specific than previously suggested for the development and maintenance of hypochondriasis.     

Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles

Increased understanding of the nature and role of intrusive imagery has contributed to the development of effective treatment protocols for some anxiety disorders. However, intrusive imagery in severe health anxiety (hypochondriasis) has been comparatively neglected. Hence, the current study investigates the prevalence, nature and content of intrusive imagery in 55 patients who met DSM-IV-TR (APA, 2000) criteria for the diagnosis of hypochondriasis. A semi-structured interview was used to assess the prevalence, nature and possible role of intrusive imagery in this disorder. Over 78% of participants reported experiencing recurrent, distressing intrusive images, the majority (72%) of which either were a memory of an earlier event or were strongly associated with a memory. The images tended to be future orientated, and were reliably categorised into four themes: i) being told ‘the bad news’ that you have a serious/life threatening-illness (6.9%), ii) suffering from a serious or life-threatening illness (34.5%), iii) death and dying due to illness (22.4%) and iv) impact of own death or serious illness on loved ones (36.2%). Participants reported responding to experiencing intrusive images by engaging in avoidance, checking, reassurance seeking, distraction and rumination. Potential treatment implications and links to maintenance cycles are considered.     

Positive und negative Metakognitionen über Krankheitssorgen

Background

Metacognitions have been shown to be relevant in the emergence and maintenance of worry processes, particularly for generalized anxiety disorder (GAD). In contrast, metacognitions have been neglected in hypochondriasis and health anxiety, perhaps due to the traditional assignment of hypochondriasis to the somatoform disorders. Is worrying about illness associated with metacognitions and are these associated with other features of health anxiety?

Material and methods

In this study 1,246 people took part in an online survey. Items capturing positive (PM) and negative metacognitions (NM) were presented together with instruments for the assessment of health anxiety and depressive symptoms. The dimensional structure of PM and NM over illness worries was examined with nonlinear confirmatory factor analyses. Associations with depressivity and the number of consultations by different physicians were examined in structural equation models (SEM), separately for subgroups with and without a diagnosed somatic disease.

Results

The PMs and NMs about illness worries varied relatively independently from one another along two dimensions. The PMs were specifically associated with health anxiety and the number of different physician consultations and NMs were related to all dimensions of the Whiteley index and particularly strongly to depressivity.

Conclusions

Illness-related anxiety provokes metacognitions, similar to other worries as known from GAD. Considering the strong associations of PMs and NMs with several facets of health anxiety found, it appears promising to take them into account for the formulation of cognitive-behavioral models of health anxiety and its treatment.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

Health anxiety in children: development and psychometric properties of the Childhood Illness Attitude Scales

The course of severe anxiety surrounding health issues is unknown. The available literature suggests that adults who are overly anxious about health issues often interpret or misinterpret their bodily signs and symptoms to be indicative of a serious illness. The construct of health anxiety has not been examined in children and, to date, there has not been an instrument developed for this purpose. The Illness Attitude Scales is one of the most commonly used instruments for evaluating fears, beliefs, and attitudes that are associated with hypochondriasis and abnormal illness behaviour in adults. We sought to adapt the Illness Attitude Scales for use with children ages 8-15 years. The adapted Illness Attitude Scales was renamed the Childhood Illness Attitude Scales. Revisions to the adult version consisted of simplification of language, revision of Likert scale (i.e. 5-point to 3-point scale), and the addition of 7 questions to evaluate the role parents/guardians play in facilitating medical attention or treatment. Correlations between Childhood Illness Attitude Scales total scores and other self-report measures were supportive of the construct-related validity of the Childhood Illness Attitude Scales and suggested that it is a useful measure of health anxiety in school-age children. Practical and theoretical implications of the present results are discussed.     

Health Anxiety in Children: Development and Psychometric Properties of the Childhood Illness Attitude Scales

The course of severe anxiety surrounding health issues is unknown. The available literature suggests that adults who are overly anxious about health issues often interpret or misinterpret their bodily signs and symptoms to be indicative of a serious illness. The construct of health anxiety has not been examined in children and, to date, there has not been an instrument developed for this purpose. The Illness Attitude Scales is one of the most commonly used instruments for evaluating fears, beliefs, and attitudes that are associated with hypochondriasis and abnormal illness behaviour in adults. We sought to adapt the Illness Attitude Scales for use with children ages 8–15 years. The adapted Illness Attitude Scales was renamed the Childhood Illness Attitude Scales. Revisions to the adult version consisted of simplification of language, revision of Likert scale (i.e. 5-point to 3-point scale), and the addition of 7 questions to evaluate the role parents/guardians play in facilitating medical attention or treatment. Correlations between Childhood Illness Attitude Scales total scores and other self-report measures were supportive of the construct-related validity of the Childhood Illness Attitude Scales and suggested that it is a useful measure of health anxiety in school-age children. Practical and theoretical implications of the present results are discussed.     

Managing Hypochondriasis in Elderly Clients

The present paper provides a diagnostic and treatment overview of geriatric hypochondriasis. It is suggested that our current definition of hypochondriasis may be inadequate in describing the complexity of the disorder and its varied manifestations in the general population and especially in our geriatric population. Attempts by researchers to provide greater diagnostic clarity are reviewed, including the concepts of hypochondriasis as a discrete disorder (primary hypochondriasis) and hypochondriasis as part of a comorbid mix of disorders (secondary hypochondriasis). Diagnostic features of geriatric hypochondriasis are discussed, including comorbidity, prevalence, the relationship of medical illness to hypochondriacal symptomatology, and etiology. Treatment considerations which are reviewed include: the importance of respect for the defenses of the client, the importance of venting and expressions of feeling by the client, the creation of a psychological atmosphere of professional and interpersonal support, and reattribution training. It is suggested that hypochondriasis is a social “communication” and that comorbidity itself may be the key to unlocking the unspoken “messages” of hypochondriacal older adults.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.     

Coping and psychological distress for men with substance use disorders

Coping with stress is a major focus for chemically dependent persons in relapse prevention programs. The relationships among coping and psychological distress were investigated in 71 men with substance use disorders, at both pre—and post-treatment. It was predicted that low task-oriented coping, high emotion-oriented coping, and high avoidance-oriented coping would predict psychological distress (e.g., anxiety and depression). It was also expected that use of task-oriented coping would increase following treatment and that use of emotion-oriented coping and avoidance-oriented coping, and reported levels of psychological distress would all decrease following treatment. Participants completed the Coping Inventory for Stressful Situations and the General Health Questionnaire, took part in an intensive treatment program (e.g., relaxation, drug education, stress management) and completed these questionnaires again following treatment. Results indicated that high emotion-oriented coping predicted hypochondriasis, anxiety and depression. Task-oriented and avoidance-oriented coping did not predict psychological distress, although task-oriented coping was negatively related to hypochondriasis, anxiety and depression. The results regarding change in coping styles and levels of psychological distress were as hypothesized, except that avoidance-oriented coping did not significantly change following treatment. Theoretical and practical implications of the research are discussed.     

The self-serving function of hypochondriacal complaints: physical symptoms as self-handicapping strategies

The present experiment tested the hypothesis that hypochondriacal individuals commonly use reports of physical illness and symptoms as a strategy to control attributions made about their performances in evaluative settings (i.e., self-handicapping strategies). Specifically, it was predicted that hypochondriacal individuals would report more recent physical illness and complaints and more current physical symptoms in an evaluative setting in which poor health could serve as an alternative explanation for poor performance than would either individuals in an evaluative setting in which poor health was precluded as an excuse or individuals in a nonevaluative setting. As predicted, results supported this self-protective pattern of complaints in a hypochondriacal sample but not in a nonhypochondriacal group. The self-protective role of hypochondriacal behavior is discussed in relation to other theory and research on the nature and treatment of hypochondriasis.     

Health anxiety, hypochondriasis, and the anxiety disorders

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.     

Fear of future illness, chemical AIDS, and cancerphobia: a review.

A review of the literature indicates that fear of future illness shares many characteristics with a wide variety of conditions. Concepts such as hypochondriasis, adjustment disorders, generalized anxiety, and mass hysteria must be considered. Also, factors such as reporting bias, influential others, collective behavior, political groups, and litigation appear to induce symptom reporting from patients complaining of fear of illness and cancerphobia. Cancerphobia may result in impairment ranging from avoidance behaviors to cognitive dysfunctions. Various treatment modalities have been used successfully in treating cancerphobia, and the prognosis is typically good. Complaints of chemical AIDS, universal allergy, or twentieth century disease have little medical or empirical support and require further investigation. Researchers and clinicians must recognize multiple factors contribute to fear of future illness or cancerphobic complaints, and additional research must be undertaken if a thorough understanding of fear of future illness, cancerphobia, and perceptions of chemical AIDS is to be obtained.     

The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

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.     

The role of illness perceptions in the attachment-related process of affect regulation

Abstract

Based on the predictions of the attachment theory and the Common Sense Model of illness perceptions, the current study focused on the role played by illness perceptions in explaining the path linking attachment orientations to negative affect during recovery from cardiac illness. We predicted two putative mechanisms: (1) illness perceptions would mediate the direct association between attachment-related insecurity (especially attachment anxiety) and levels of distress at follow-up and (2) illness perceptions would interact with attachment orientations (attachment avoidance in particular) in explaining patients' distress. The sample consisted of 111 male patients admitted to the Cardiac Care Unit of the Meir Medical Center, located in the central region of Israel. Patients completed a measure of attachment orientations during hospitalization (baseline). One month later, patients' illness perceptions were measured. Patients' depression and anxiety symptoms were measured at baseline and at the six-month follow-up. The associations between attachment-related anxiety and anxiety symptoms at follow-up were fully mediated by illness perceptions. Attachment-related avoidance was found to interact with illness perceptions in the prediction of depressive symptoms at follow-up. The findings shed light on the possible dynamics among personality, cognitive appraisals, and affect regulation efforts when coping with illness.     

Evidence-based psychological treatments for late-life anxiety

This project identified evidence-based psychotherapy treatments for anxiety disorders in older adults. The authors conducted a review of the geriatric anxiety treatment outcome literature by using specific coding criteria and identified 17 studies that met criteria for evidence-based treatments (EBTs). These studies reflected samples of adults with generalized anxiety disorder (GAD) or samples with mixed anxiety disorders or symptoms. Evidence was found for efficacy for 4 types of EBTs. Relaxation training, cognitive-behavioral therapy (CBT), and, to a lesser extent, supportive therapy and cognitive therapy have support for treating subjective anxiety symptoms and disorders. CBT for late-life GAD has garnered the most consistent support, and relaxation training represents an efficacious, relatively low-cost intervention. The authors provide a review of the strengths and limitations of this research literature, including a discussion of common assessment instruments. Continued investigation of EBTs is needed in clinical geriatric anxiety samples, given the small number of available studies. Future research should examine other therapy models and investigate the effects of psychotherapy on other anxiety disorders, such as phobias and posttraumatic stress disorder in older adults.     

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility

Background/ObjectiveThe Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis.MethodA total of 342 community participants (61.6% women; M_age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M_age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive.ResultsThe original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis.ConclusionsThe SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.     

Transient state-dependent fluctuations in anxiety measured using STAI, POMS, PANAS or VAS: a comparative review

Abstract Several psychometric instruments can be used to measure state-dependent variations in anxiety, including the State-Trait Anxiety Inventory (STAI), the Profile of Mood States (POMS), the Positive and Negative Affect Schedule (PANAS) and the Visual Analog Scales (VAS). Each of these instruments rests on specific theoretical assumptions about the construct of state anxiety, and has been widely used for this purpose in different research domains. However, it remains difficult to determine what may be the specificities of these four instruments, when the goal is to measure transient state-dependent variations in anxiety. In this work, we provide a systematic and comparative literature review of studies which have explored rapid fluctuations (i.e., test-retest intervals not exceeding 24 hours) in state anxiety by means of these specific instruments. Almost 200 studies were eventually included in our review. This comparative review confirms that, despite some disparities and specificities, each of these four instruments provides a reliable measure to capture rapid state-dependent variations in anxiety, although they have been used in non-overlapping research domains or experimental contexts.     

Assessment of Implicit Health Attitudes: A Multitrait–Multimethod Approach and a Comparison Between Patients With Hypochondriasis and Patients With Anxiety Disorders

Two adaptations of the Implicit Association Task were used to assess implicit anxiety (IAT–Anxiety) and implicit health attitudes (IAT–Hypochondriasis) in patients with hypochondriasis (n = 58) and anxiety patients (n = 71). Explicit anxieties and health attitudes were assessed using questionnaires. The analysis of several multitrait–multimethod models indicated that the low correlation between explicit and implicit measures of health attitudes is due to the substantial methodological differences between the IAT and the self-report questionnaire. Patients with hypochondriasis displayed significantly more dysfunctional explicit and implicit health attitudes than anxiety patients, but no differences were found regarding explicit and implicit anxieties. The study demonstrates the specificity of explicit and implicit dysfunctional health attitudes among patients with hypochondriasis.