Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample.

The Illness Attitudes Scale (IAS) assesses fears, beliefs and attitudes associated with hypochondriasis [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers.]. Recent factor analytic investigations of the IAS in non-clinical samples have suggested a number of different factor solutions. In study 1, we used principal components analysis with both orthogonal and oblique rotation to better explore the structure of this measure. Using a random selection of 390 participants from a larger pool of 780, a five-factor solution was identified: (1) fear of illness, death, disease and pain, (2) effects of symptoms, (3) treatment experiences, (4) disease conviction and (5) health habits. In study 2, confirmatory factor analysis (CFA) of responses from the remaining 390 students evaluated: (a) a single-factor model, (b) Kellner's original nine-factor model, (c) a four-factor model proposed by Ferguson and Daniel [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469.], (d) a different four-factor model proposed by Stewart and Watt [Stewart, S. H. & Watt, M. C. (1998). A psychometric investigation of the Illness Attitudes Scale (IAS) in a nonclinical young adult sample. Submitted for publication.] and (e) the five-factor model derived in study 1. Of these models, greatest support was obtained for our five-factor model. However, it was also clear that this model could be improved. Based on the results of the CFA, as well as previous research and theoretical considerations, we tested a revised model in which the health habits factor was deleted. Analysis of the revised model showed that it received the greatest support and could be conceptualized as either four distinct factors or as hierarchical in nature, with four lower-order factors loading on a single higher-order factor. Future directions for research as well as suggestions for scoring and using the IAS with nonclinical samples are discussed.     

Factor analytic investigation of the Illness Attitudes Scale in a chronic pain safmple

The Illness Attitudes Scale (IAS) is a self-report instrument comprising nine subscales designed to assess fears, beliefs and attitudes associated with hypochondriasis and abnormal illness behaviour [Kellner (1986). Somatization and hypochondriasis. New York: Praeger.]. The purpose of the present study was to explore the factor structure of the IAS in a chronic pain sample as a preliminary step toward determining the use of this measure in this sample. Hypochondriacal tendencies have been postulated to play a role in maintaining and exacerbating responses to chronic pain and, therefore, appropriate measurement in this sample is important. In the present study, consecutive chronic pain patients presenting to a pain treatment program (N=198) were administered the IAS. Principal component analysis with oblique (Oblimin) rotation identified that five factors best explain the measure in this population. These factors were (1) fear of illness, (2) effects of symptoms, (3) health habits, (4) disease phobia and conviction and (5) fear of death. The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986), as well as with the factor structure identified in a non-clinical sample [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences, 18, 463–469.]. There were enough discrepancies, however, to suggest an alternative method for scoring the IAS with chronic pain patients. Implications for the use of the measure with chronic pain patients, as well as future research directions for exploring the utility of this measure with chronic pain patients, are discussed.     

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.     

Body vigilance in nonclinical and anxiety disorder samples: structure, correlates, and prediction of health concerns

The Body Vigilance Scale (BVS) is a measure developed to assess one’s conscious attendance to internal cues. The present report investigated the structure, correlates, and predictive utility of the BVS in nonclinical (N = 442) and anxiety (N = 135) disorder samples. The findings of Study 1 suggest that the BVS is 1-dimensional in a nonclinical sample, and Study 2 replicated the factor structure of the BVS in an anxiety disorder sample. Correlations between the BVS and related (i.e., anxiety sensitivity) and unrelated (i.e., social anxiety) variables were consistent with predictions in both studies. Study 2 also showed that body vigilance is primarily elevated in patients with panic disorder relative to other anxiety disorders. Relative elevations in body vigilance were also observed for patients with hypochondriasis and generalized anxiety disorder. The BVS also demonstrated a specific association with medical utilization and health-related safety-seeking behaviors after controlling for related variables in nonclinical and anxiety disorder samples. The implications of our findings for the nature and measurement of body vigilance as a predictor of health concerns in anxiety disorders are considered.     

Hierarchical structure of dysfunctional beliefs in obsessive-compulsive disorder

The Obsessive Beliefs Questionnaire was developed as a comprehensive measure of dysfunctional beliefs, which cognitive models consider to be etiologically related to obsessive-compulsive disorder. Obsessive Beliefs Questionnaire subscales tend to be highly correlated, which raises the question of whether obsessive-compulsive-related beliefs are hierarchically structured, consisting of lower-order factors loading on 1 or more higher-order factors. To investigate the nature and relative importance of these factors, a hierarchical factor analysis was conducted (n = 202 obsessive-compulsive disorder patients), using a Schmid-Leiman transformation. Results indicated a higher-order (general factor) and 3 lower-order factors: (i) responsibility and overestimation of threat, (ii) perfectionism and intolerance of uncertainty and (iii) importance and control of thoughts. The high-order factor accounted for more variance in Obsessive Beliefs Questionnaire scores (22%) than did the lower-order factors (6-7%), thereby underscoring the importance of the higher-order factor. Despite the importance of the higher-order factor, the lower-order factors significantly predicted unique variance in measures of obsessive-compulsive symptoms, including severity ratings of compulsions. These finding suggest that cognitive models of obsessive-compulsive disorder should take into consideration the hierarchic structure of obsessive-compulsive-related beliefs.     

Anxiety sensitivity in adolescents: factor structure and relationships to trait anxiety and symptoms of anxiety disorders and depression

The current study examined the anxiety sensitivity construct in a large sample of normal Dutch adolescents aged 13-16 years (n=819). Children completed the Childhood Anxiety Sensitivity Index (CASI; Silverman, W. K., Fleisig, W., Rabian, B. & Peterson, R. A. (1991). Journal of Clinical Child Psychology, 20, 162-168) and measures of trait anxiety, anxiety disorder symptoms and depression. Results showed that (1) anxiety sensitivity as indexed by the CASI seems to be a hierarchically organized construct with one higher-order factor (i.e., anxiety sensitivity) and three or four lower-order factors, (2) anxiety sensitivity and trait anxiety were strongly correlated, (3) anxiety sensitivity was substantially connected to symptoms of anxiety disorders (in particular of panic disorder and agoraphobia) and depression, and (4) anxiety sensitivity and trait anxiety both accounted for unique proportions of the variance in anxiety disorder symptoms. Altogether these findings are in agreement with those of previous research in adult and child populations, and further support the notion that anxiety sensitivity should be viewed as an unique factor of anxiety vulnerability.     

Health Anxiety: Latent Structure and Associations with Anxiety-related Psychological Processes in a Student Sample

Although currently classified as a somatoform disorder, cognitive-behavioral models conceptualize hypochondriasis (HC) as a severe form of health anxiety. The Short Health Anxiety Inventory (SHAI) is a measure derived from this conceptualization that measures health anxiety symptoms across the range of severity. Previous studies have reported inconsistent findings regarding this measure’s factor structure, but these studies employed factor analytic tools that did not account for the categorical nature of SHAI items. The present psychometric study was designed to address these inconsistencies using categorical factor analysis. Using data from a large student sample we found that the SHAI had two factors: Illness Likelihood and Illness Severity. We also examined the relationship between these domains and cognitive variables associated with other anxiety disorders. Results suggested that the psychological processes present in obsessive-compulsive disorder and panic disorder are also associated with health anxiety. Implications for the conceptualization and classification of severe health anxiety are discussed.     

Health anxiety, anxiety sensitivity, and attentional biases for pictorial and linguistic health-threat cues

The study investigated attentional biases for pictorial and linguistic health-threat stimuli in high and low health anxious individuals, who were selected from the upper and lower quartile ranges of a normal sample using a screening measure of health anxiety. Attentional bias was assessed using a visual probe task which presented health-threat and neutral pictures and words at two exposure durations, 500 ms and 1250 ms. The prediction that the high health anxious group would show a greater attentional bias for health-threat cues than the low health anxious group was not supported despite the groups being well-differentiated on a general measure of health anxiety, the Illness Attitudes Scale (IAS). Instead, the results indicated that individuals with high levels of anxiety sensitivity showed a significantly greater initial attentional bias for threat pictures compared with those with low anxiety sensitivity, as assessed by the Anxiety Sensitivity Index (ASI).     

Health anxiety,anxiety sensitivity,and attentional biases for pictorial and linguistic health‐threat cues

The study investigated attentional biases for pictorial and linguistic health‐threat stimuli in high and low health anxious individuals, who were selected from the upper and lower quartile ranges of a normal sample using a screening measure of health anxiety. Attentional bias was assessed using a visual probe task which presented health‐threat and neutral pictures and words at two exposure durations, 500 ms and 1250 ms. The prediction that the high health anxious group would show a greater attentional bias for health‐threat cues than the low health anxious group was not supported despite the groups being well‐differentiated on a general measure of health anxiety, the Illness Attitudes Scale (IAS). Instead, the results indicated that individuals with high levels of anxiety sensitivity showed a significantly greater initial attentional bias for threat pictures compared with those with low anxiety sensitivity, as assessed by the Anxiety Sensitivity Index (ASI).     

Sixteen-item Anxiety Sensitivity Index: confirmatory factor analytic evidence, internal consistency, and construct validity in a young adult sample from the Netherlands

The present investigation examined the factor structure, internal consistency, and construct validity of the 16-item Anxiety Sensitivity Index (ASI; Reiss Peterson, Gursky, & McNally 1986) in a young adult sample (n = 420) from the Netherlands. Confirmatory factor analysis was used to comparatively evaluate two-factor, three-factor, and four-factor models of the anxiety sensitivity construct. Support was found for a hierarchical structure of anxiety sensitivity, with one global higher-order factor and four lower-order factors. Internal consistency for the global and lower-order factors of the 16-item ASI was adequate. Convergent and discriminant associations between the 16-item ASI and general mood and panic-specific variables were consistent with anxiety sensitivity theory. In addition, incremental validity of the anxiety sensitivity construct was established, relative to negative affectivity, for unexpected panic attacks and agoraphobic avoidance.     

Effects of anxiety sensitivity on anxiety and pain during a cold pressor challenge in patients with panic disorder

Fear of anxiety symptoms, or anxiety sensitivity (AS), has been extensively studied in anxiety disorders and more recently has been linked to other psychopathological conditions including pain. Asmundson and colleagues have suggested that AS may act as a risk factor for chronic pain and several studies have demonstrated an association between AS, avoidance behaviors and pain. The present study assessed whether AS levels would be predictive of pain and anxiety during a brief pain induction task. Clinical participants meeting DSM-IV criteria for panic disorder (n = 22) were age and sex matched with nonclinical controls (n = 22) and exposed to a 2-min cold pressor challenge. Diagnostic status and AS were significantly predictive of pain and anxiety during the cold pressor task. Moreover, AS appears to mediate the relationship between diagnostic status and pain. However, AS appears to be only indirectly associated with pain through its contribution to anxiety.     

Anxiety sensitivity and panic symptomatology: the mediator role of hypochondriacal concerns

The present study tests the mediating role of hypochondriasis to explain the relation between anxiety sensitivity and panic symptomatology. Fifty-seven outpatients with clinically significant levels of panic symptomatology were selected to participate in the study. Measures of anxiety sensitivity, hypochondriasis, and panic symptomatology were obtained from standardized, self-administered questionnaires: the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the Whiteley Index of Hypochondriasis (WI; Pilowsky, 1967), and the Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001). Regression analyses were performed to test for the mediation models. The results show that the effect of anxiety sensitivity on panic symptomatology is not significant when controlling the hypochondriacal concerns, whereas the latter predicted panic symptoms. This result holds for the overall ASI as well as for the Physical Concerns and the Mental Incapacitation Concerns dimensions of the ASI scale. No evidence of a direct relation between the Social Concerns dimension and panic symptoms was found. The findings suggest that hypochondriacal concerns might represent the mechanism through which anxiety sensitivity is able to influence panic symptoms.     

Psychometric properties of the Illness Attitudes Scale in psychiatric patients.

This study assessed the factorial structure of the 29-item Illness Attitudes Scale in a population of 82 psychiatric patients hospitalized for gastrointestinal complaints. Factor analysis yielded three factors of the Illness Attitudes Scale in these patients, which have been interpreted Health Anxiety, Illness Behavior, and Health Habits. The internal consistency of these factors, estimated by Cronbach alpha, were .86, .80, and .58, respectively. The Health Anxiety and Illness Behavior scores were significantly intercorrelated .43, but scores on Health Habits were not significantly correlated with either Health Anxiety (r = .19) or Illness Behavior (r = .14). These findings are consistent with previous reports that two factors of the Illness Attitudes Scale possess reliable psychometric properties. Cross-validation with other patient populations is required to confirm the validity of the Illness Attitudes Scale factor structure testing at least 5 participants per item of the scale.     

Integrating Anxiety Sensitivity, Distress Tolerance, and Discomfort Intolerance: A Hierarchical Model of Affect Sensitivity and Tolerance

The purpose of the present investigation was to concurrently examine the latent dimensional and hierarchical structure of anxiety sensitivity (AS) and two key theoretically relevant and related affect (in)tolerance and sensitivity constructs: distress tolerance and discomfort intolerance. These constructs were measured using the Anxiety Sensitivity Index (Reiss, Peterson, Gursky, & McNally, 1986), the Distress Tolerance Scale (Simons & Gaher, 2005), and the Discomfort Intolerance Scale (Schmidt, Richey, & Fitzpatrick, 2006). A total of 229 individuals (124 females; M_age = 21.0 years, SD = 7.5) without current Axis I psychopathology participated by completing a battery of self-report questionnaires. A two-stage exploratory factor analysis was conducted to examine the lower- and higher-order latent structural relations among the variables. The factor solution was subsequently evaluated in relation to negative affectivity, anxious arousal, and anhedonic depression. AS and distress tolerance appeared to be related to one another as distinct lower-order facets of a common higher-order affect tolerance and sensitivity factor, whereas discomfort intolerance did not appear to demonstrate similar relations with either AS or distress tolerance at the lower-order or higher-order levels. A unique pattern of association with theoretically-relevant criterion variables was observed between the affect tolerance and sensitivity higher-order factor, the AS and distress tolerance lower-order factors, and the discomfort intolerance factor. Findings are discussed in the context of theoretical and clinical implications and future directions for the study of affect tolerance and sensitivity in relation to emotional vulnerability.     

Psychological vulnerabilities in patients with major depression vs panic disorder

The tripartite model (Clark & Watson, 1991: Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336) posits that anxiety and depression share nonspecific features of neuroticism but that somatic arousal appears unique to anxiety, and low positive affect appears unique to depression. The present study controlled for these higher-order effects and evaluated the relative contributions of four, specific lower-order vulnerabilities (anxiety sensitivity, rumination, self-criticism, self-oriented perfectionism). Participants were 38 depressed patients and 38 patients with panic disorder matched as closely as possible for age and gender, and all were diagnosed using the same structured interview by an experienced clinician. Results from hierarchical logistic regression analysis were consistent with predictions from the tripartite model in that only the unique features of arousal and positive affectivity differentiated the two diagnostic groups. At a lower-order level, only anxiety sensitivity (and its facet of fear of physical symptoms) and a ruminative response style demonstrated incremental predictive ability. The discussion focuses on the relationships among these higher-order and lower-order variables, and their potential importance for understanding specific manifestations of psychopathology.     

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.     

Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device

Acceptance of illness is related to better mental health among patients with chronic illness; however, this construct has not been evaluated as part of routine transplantation evaluations. The purpose of this study was to create a brief measure of acceptance of illness for patients pursuing organ transplantation and examine how acceptance is related to distress. Retrospective medical record reviews were conducted for 290 patients who completed a routine psychosocial evaluation prior to transplant listing which included the Illness Acceptance Scale (IAS). Internal consistency for the IAS was excellent (Cronbach’s alpha?=?.92). Illness acceptance was negatively correlated with depression, anxiety, and catastrophizing and was not related to health literacy or health numeracy. The IAS is a reliable and valid measure for patients who are pursuing thoracic transplant or left ventricular assist device. Clinicians may want to screen transplant candidates for illness acceptance and refer those with lower levels to psychological interventions.

     

Agoraphobia in women: factor analysis of symptoms and personality correlates of factor scores in a clinical population

One hundred and sixty female patients with a DSM-III diagnosis of agoraphobia completed a measure of fears and general symptoms (FSS) and personality (HDHQ). Many patients had significant psychological symptoms in addition to their agoraphobia. FSS scores were factor analysed. First-order analysis revealed agoraphobia as a heterogeneous clinical entity occurring independently of a large General Symptoms factor which included panic attacks. Second-order analysis revealed a General Symptoms/Social Phobia factor and a well-defined but heterogeneous Agoraphobia factor comprising the lower-order factors Claustrophobia, Travel Fears and Agoraphobia (fear of crowded public places). Correlations of first- and second-order factors with HDHQ scores showed that the Travel Fears factor was not associated with abnormal personality traits, whereas the Claustrophobia and Agoraphobia factors were. This suggested that travel fears should respond well to behaviour therapy per se, whereas additional treatment aimed at modifying abnormal personality traits may sometimes be indicated for claustrophobia and fear of crowded places. The heterogeneous nature of agoraphobia and the large size of the independent General Symptoms factor underlined the desirability of a multi-modal approach to treatment and research.     

Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension.

Increasing evidence suggests that anxiety sensitivity (AS) may be a premorbid risk factor for the development of anxiety pathology. The principal aim of this study was to replicate and extend a previous longitudinal study evaluating whether AS acts as a vulnerability factor in the pathogenesis of panic (N. Schmidt, D. Lerew, & R. Jackson, 1997). A large nonclinical sample of young adults (N = 1,296) was prospectively followed over a 5-week, highly stressful period of time (i.e., military basic training). Consistent with the authors' initial study, AS predicted the development of spontaneous panic attacks after controlling for a history of panic attacks and trait anxiety, and AS was found to possess symptom specificity with respect to anxiety versus depression symptoms. AS 1st-order factors differentially predicted panic attacks, with the Mental Concerns factor being the best predictor of panic in this sample.     

DAPP-BQ: factor structure and relations to personality disorder symptoms in a non-clinical sample

We assessed the factor structure of the DAPP-BQ (Livesley & Jackson, in press), as well as the relations between DAPP-BQ higher- and lower-order personality trait scores and DSM-IV (APA, 2000) personality disorder symptoms in a sample of approximately 300 nonclinical young adults. The four-factor structure of the DAPP-BQ was replicated, and DAPP-BQ higher-order and lower-order scores were related to personality disorder symptoms in predictable ways. Finally, regression analyses revealed that specific DAPP-BQ traits accounted for variance in individual personality disorder scores above and beyond comorbid personality disorder symptoms.