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.     

Interpretation of symptoms in chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is an illness characterised by fatigue and other symptoms. Both psychological and biological aetiological factors have been proposed, but the disorder is of uncertain origin. The aetiology of the symptoms is therefore ambiguous. It has been suggested (a) that patients with CFS tend to interpret their symptoms as indicating physical illness and (b) they tend not to interpret these symptoms in terms of negative emotion. In order to test these hypotheses we developed a self-report questionnaire to assess the interpretation of symptoms in patients with CFS. It was administered to patients with CFS, patients with depression, patients with multiple sclerosis (MS), and normal controls. Preliminary results suggest that the measure has acceptable psychometric properties. Patients with CFS were more likely than either depressed patients or normal controls to interpret symptoms (characteristic of CFS) in terms of physical illness, but did not differ in this from the MS patients. When compared with all three other groups (including the MS patients), the patients with CFS were least likely to interpret symptoms in terms of negative emotional states. The theoretical and clinical implications of the findings are discussed.     

Anxiety and bodily symptoms under the threat of missile attacks: The israeli scene

Abstract

The present research, conducted in Israel during the recent “Desert Storm” operation in the Gulf, sets out to assess the degree of anxiety and bodily symptoms of Israeli citizens, threatened by Scud missile attacks and undergoing a period of acute stress. Data were gathered via questionnaires distributed during the crisis period to over 500 respondents, most of them residing in Haifa, one of the high-risk areas for the missile attacks at the time. State anxiety was reported to be highly elevated during the crisis period, in comparison with norm group data collected during normal times. The most frequently reported bodily symptoms were changes in eating habits (loss of appetite or overeating), fatigue, and insomnia. Women reported more anxiety and bodily symptoms, on average, than men, as well as higher tension, fear and depression. The younger adults in the sample reported more anxiety and bodily symptoms, as well as tension, fear and depression, than their older counterparts. Lower levels of fear and depression were reported at the later stages of the crisis than at the earlier ones; most stress indicators evidenced lower levels with the passage of time. Finally, a strong positive relationship between anxiety and bodily symptoms was found, over and above the contribution of background variables and response tendencies. The possible explanations for the effects of background variables, as well as the strong relationship between anxiety and symptoms reported, are discussed.     

An experimental analysis of hypochondriasis

Hypochondriasis (HC) involves preoccupation with fears of having a serious medical illness based on the misinterpretation of benign bodily perturbations. Individuals with HC also perform behaviors such as checking and reassurance-seeking presumably to reduce health-related fears. Experimental behavioral analyses of HC symptoms, however, are lacking. In the present study, 27 patients with HC were exposed to personally relevant health-related stimuli under one of two conditions: (a) subsequently performing safety-seeking behaviors (e.g., checking) (n=14) or (b) subsequently being instructed not to perform such behaviors (n=13). In both groups, subjective anxiety and urges to perform safety behaviors were monitored for 1h. Results indicated that exposure to the personally relevant health trigger provoked anxiety and urges to perform safety behaviors. For patients who performed such behaviors, these feelings were reduced. For patients who did not, a more gradual reduction of anxiety and urges was observed. Findings are discussed in terms of the conceptualization and treatment of HC behavior, and are relevant to HC's possible relationship to panic and obsessive-compulsive disorder.     

Anxiety as a context for understanding associations between hypochondriasis, obsessive-compulsive, and panic attack symptoms

In the context of the integrative model of anxiety and depression, we examined whether the essential problem of hypochondriasis is one of anxiety. When analyzed, data from a large nonclinical sample corresponded to the integrative model's characterization of anxiety as composed of both broad, shared and specific, unique symptom factors. The unique hypochondriasis, obsessive-compulsive, and panic attack symptom factors all had correlational patterns expected of anxiety with the shared, broad factors of negative emotionality and positive emotionality. A confirmatory factor analysis showed a higher-order, bifactor model was the best fit to our data; the shared and the unique hypochondriasis and anxiety symptom factors both contributed substantial variance. This study provides refinements to an empirically based taxonomy and clarifies what hypochondriasis is and, importantly, what it is not.     

Interpretation bias and depressive symptoms: The role of self-relevance

Cognitive theories of depression emphasize negatively biased interpretations as an important target of therapy. Much of the research on interpretation bias in depression has focused on selection, or deciding which of several interpretations is likely. However, depressive biases may also exist in the generation of possible interpretations, or the ability to think of positive alternatives. If biases exist for generation as well as selection, therapeutic techniques to encourage the generation of more positive interpretations would be warranted. Asking therapy clients to consider someone else in a similar situation is a commonly used therapy strategy but has not been sufficiently examined empirically. In the current studies, we examine interpretation generation and selection in dysphoric and nondysphoric individuals, and contrast interpretations made for the self to interpretations made for two types of “other.” Our studies reveal depressive biases in both interpretation generation and selection, and indicate that interpretation valence is highly sensitive to the type of other considered. All participants generated and selected significantly more positive interpretations for friends than for themselves, but generated significantly more negative interpretations for hypothetical others than for themselves. Our results suggest that encouraging dysphoric individuals to imagine others can be beneficial, but the type of “other” used is critically important, with instructions to consider a close friend most likely to be effective in decreasing negativity in interpretation.     

The objects of bodily awareness

Is it possible to misidentify the object of an episode of bodily awareness? I argue that it is, on the grounds that a person can reasonably be unsure or mistaken as to which part of her body he or she is aware of at a given moment. This requires discussing the phenomenon of body ownership, and defending the claim that the proper parts of one’s body are at least no less ‘principal’ among the objects of bodily awareness than is the body as a whole. I conclude with some reasons why this should lead us to think that bodily awareness, unlike introspection, is a form of perception.     

The where of bodily awareness

Synthese - In bodily awareness body parts are felt to occupy locations relative to the rest of the body. Bodily sensations are felt to be, in Brian O’Shaughnessy’s terms...     

Metaphors of a bodily mind

Patients' metaphors in analysis may allow access to ineffable experiences. This is understandable, since the mind is a bodily mind, and language is a fully embodied function of this mind. That is, both are dependent for their existence upon the physical body. The ontogenic accumulation of perceived sensory impressions and affective processes far exceeds what can be put into words. Research in cognitive psychology suggests that the active mind functions in such a manner that later perceptions are organized by means of earlier ones. However, since the mind can know only its own representations, it inhabits two ever unknown realms: the external world itself, and the domain of internal unconscious processes that sustain the mind's functions. As a result, the world and the self we know are constructed by the mediation of our bodies. In language also, the active mode by which we perceive, process, and feel makes our understanding of words dependent on previous experience. The fact that the limbic system is activated immediately in the moment of processing experience means that all modalities of representation include an affective valuation.This inevitable processing of information through the mediation of affectively valued bodily perceptions gives the metaphorical function-the human capacity to organize experience and life in metaphoric ways-the ability to create linguistic metaphors that can capture and express otherwise inexpressible psychic experiences. This manner of understanding metaphor has implications for psychoanalytic technique.     

Spatial aspects of bodily self-consciousness

Visual, somatosensory, and perspectival cues normally provide congruent information about where the self is experienced. Separating those cues by virtual reality techniques, recent studies found that self-location was systematically biased to where a visual–tactile event was seen. Here we developed a novel, repeatable and implicit measure of self-location to compare and extend previous protocols. We investigated illusory self-location and associated phenomenological aspects in a lying body position that facilitates clinically observed abnormal self-location (as on out-of-body experiences). The results confirm that the self is located to where touch is seen. This leads to either predictable lowering or elevation of self-localization, and the latter was accompanied by sensations of floating, as during out-of-body experiences. Using a novel measurement we show that the unitary and localized character of the self can be experimentally separated from both the origin of the visual perspective and the location of the seen body, which is compatible with clinical data.     

Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies.

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.     

Self-directed attention, awareness of bodily states, and suggestibility.

Two studies tested the hypothesis that self-directed attention would cause increased awareness of internal states and would thus reduce suggestibility effects. Experiment 1 applied this reasoning to the experience of an emotion. Males viewed moderately arousing slides of female nudes after being led to expect the slides to be either highly arousing or nonarousing. As predicted, ratings of the slides corresponded less with these experimentally-manipulated anticipations when self-focus was heightened by the presence of a mirror than when it was not. Experiment 2 examined a different internal experience: the perception of taste. Some subjects were led to expect a strong flavor as part of a test series, and other subjects were led to expect a weak flavor. Subjects high in private self-consciousness were less affected by this expectancy manipulation and more accurate in reporting their actual internal state than were subjects low in private self-consciousness. Discussion centers on the theoretical implications of the findings.     

Frame-differencing methods for measuring bodily synchrony in conversation

The study of interpersonal synchrony examines how interacting individuals grow to have similar behavior, cognition, and emotion in time. Many of the established methods of analyzing interpersonal synchrony are costly and time-consuming; the study of bodily synchrony has been especially laborious, traditionally requiring researchers to hand-code movement frame by frame. Because of this, researchers have been searching for more efficient alternatives for decades. Recently, some researchers (e.g., Nagaoka & Komori (IEICE Transactions on Information and Systems, 91(6), 1634–1640, 2008); Ramseyer & Tschacher, 2008) have applied computer science and computer vision techniques to create frame-differencing methods (FDMs) to simplify analyses. In this article, we provide a detailed presentation of one such FDM, created by modifying and adding to existing FDMs. The FDM that we present requires little programming experience or specialized equipment: Only a few lines of MATLAB code are required to execute an automated analysis of interpersonal synchrony. We provide sample code and demonstrate its use with an analysis of brief, friendly conversations; using linear mixed-effects models, the measure of interpersonal synchrony was found to be significantly predicted by time lag (p < .001) and by the interaction between time lag and measures of interpersonal liking (p < .001). This pattern of results fits with existing literature on synchrony. We discuss the current limitations and future directions for FDMs, including their use as part of a larger methodology for capturing and analyzing multimodal interaction.