Abnormal Illness Behaviour Research Articles

Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain.

To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months. Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157). The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05). This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Discriminant validity of the illness behavior questionnaire and Millon Clinical Multiaxial Inventory-III in a heterogeneous sample of psychiatric outpatients.

The discriminant validity of measures of abnormal illness behaviors and psychopathology was examined in three samples differing in illness proneness: a sample of young healthy university students (n = 38), a general community sample (n = 36), and a sample of clinical psychiatric outpatients (n = 36). Adjustment to illness was measured using the Illness Behaviour Questionnaire (IBQ; Pilowsky & Spence, 1994), while the Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) was used to measure clinical syndromes and personality. MANCOVAs were performed across the three groups on the IBQ and the MCMI-III categories, separately. As expected, clinical outpatients obtained significantly higher scores than did nonclinical groups on most of the IBQ scales, suggesting discernible discriminant validity. However, the lack of discrimination between groups on several of the MCMI-III scales raises questions about the test validity of this multidimensional instrument.

Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study

Objective: To develop and assess the reliability of a group of cervical Nonorganic physical signs to be used as a simple screening tool for identifying patients with low neck pain who exhibit abnormal illness behavior.Design: Survey, consecutive sample.Data Set: Double masked.Setting: Functional restoration program.Patients: Twenty-six consecutive patients with complaints of chronic neck pain (greater than 4 months duration). Each patient was evaluated by a physician and then again by either a physical or occupational therapist, for the presence of specific cervical nonorganic signs. Both of the evaluations occurred on the same day.Main Outcome Measures: Five categories consisting of eight tests were appraised: (1) tenderness, (2) simulation, (3) range of motion, (4) regional disturvance, and (5) overreaction.Results: The percent agreement between raters ranged from a high of 100% for regional sensory disturvance, to a low of 68% for one of the simulation tests. The average agreement between raters across all of the Nonorganic test signs was 84.6%. Likewise, kappa coefficients ranged from 1.00 to .16, reflecting differences in strength of agreement.Conclusion: For many years, the lumbar Nonorganic signs (developed by Waddell and colleagues) have been a useful screening tool in the assessment of abnormal illness behavior in the low back pain population. For the first time, a group of cervical nonorganic signs have been developed, standardized, and proven reliable.

Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study

Cervical nonorganic signs: A new clinical tool to assess abnormal illness behavior in neck pain patients: A pilot study

The dangerousness of parents who have abnormal illness behaviour

The dangerousness of parents who have abnormal illness behaviour

The dangerousness of parents who have abnormal illness behaviour

The dangerousness of parents who have abnormal illness behaviour

Illness Attitudes Scale dimensions and their associations with anxiety-related constructs in a nonclinical sample

The Illness Attitudes Scale (IAS) is a self-rated measure that consists of nine subscales designed to assess fears, attitudes and beliefs associated with hypochondriacal concerns and abnormal illness behavior [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger; Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico]. The purposes of the present study were to explore the hierarchical factor structure of the IAS in a nonclinical sample of young adult volunteers and to examine the relations of each illness attitudes dimension to a set of anxiety-related measures. One-hundred and ninety-seven undergraduate university students (156 F, 41 M; mean age=21.9 years) completed the IAS as well as measures of anxiety sensitivity, trait anxiety and panic attack history. The results of principal components analyses with oblique (Oblimin) rotation suggested that the IAS is best conceptualized as a four-factor measure at the lower order level (with lower-order dimensions tapping illness-related Fears, Behavior, Beliefs and Effects, respectively), and a unifactorial measure at the higher-order level (i.e. higher-order dimension tapping General Hypochondriacal Concerns). The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986, 1987), as well as with the factor structures identified in previously-tested clinical and nonclinical samples [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463–469; Hadjistavropoulos, H. D. & Asmundson, G. J. G. (1998). Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behaviour Research and Therapy, 36, 1185–1195; Hadjistavropoulos, H. D., Frombach, I. & Asmundson, G. J. G. (in press). Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample. Behaviour Research and Therapy; Speckens, A. E., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95–104]. The Fears, Beliefs and Effects lower-order factors and the General Hypochondriacal Concerns higher-order factor, were shown to be strongly associated with anxiety sensitivity, even after accounting for trait anxiety and panic history. Implications for understanding the high degree of comorbidity between the diagnoses of panic disorder and hypochondriasis, as well as future research directions for exploring the utility of various IAS dimensions in predicting responses to lab-based bodily symptom-induction procedures, are discussed.

The differential diagnosis of generalized pain

Patients whose symptoms include widespread, diffuse musculoskeletal pain are commonly referred for rheumatological evaluation, even when the underlying cause may lie out with the remit of rheumatology. A diagnosis of fibromyalgia may seem highly probable even from the referral letter, or after a few leading questions during the consultation. However, the lack of specificity of the many symptoms associated with widespread pain means that other diagnoses have to be considered. The history and examination must bear in mind alternative and concomitant musculoskeletal disorders, such as mild systemic lupus erythematosus, polyarticular osteoarthritis, rheumatoid arthritis, polymyalgia rheumatica, hypermobility syndromes and even osteomalacia. Non-rheumatological diseases may also have symptomatic similarities to fibromyalgia, including neoplastic and neurological diseases, hypothyroidism and other endocrine disorders, chronic infections, as well as a variety of psychiatric conditions. A rational approach to investigation will usually allow other diagnostic possibilities to be excluded without reinforcing the abnormal illness behaviour so common in chronic pain states.

Toward empirically based criteria for the classification of somatoform disorders

There is a major need for an empirical evaluation of classification criteria for somatoform disorders. The present study analyzes psychometric properties of the existing criteria for somatization disorder. The full sample consisted of 324 patients seeking help because of “psychosomatic problems.” Data from a subsample of carefully diagnosed patients with somatization syndrome (n=76) and a clinical comparison group (n=32) permitted the analysis of the discriminative power of items. Twenty-one somatic symptoms adopted from DSM-IV and ICD-10 criteria did not exhibit the necessary psychometric characteristics (item probability, item-total correlation, etc.). Thirty-two somatic symptoms showed a satisfactory psychometric performance. A cut-off of seven or more symptoms yielded the best discrimination between low and high disability. New criteria for somatization syndrome (“polysymptomatic somatoform disorder”) are proposed taking into account for the strong association of somatization and abnormal illness behavior.

Psychological correlates of outcome following rehabilitation from stroke.

To confirm, in a new sample, the value of our previously described procedure for identifying abnormal illness behaviour (AIB) in stroke rehabilitation patients, and to examine the relative effects of AIB, depression, family functioning, knowledge of stroke, and expectations of rehabilitation on long-term rehabilitation outcome. A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Sixty twelve-month stroke survivors, residing in a family environment, who had undergone an inpatient rehabilitation programme. AIB was assessed using the Illness Behaviour Questionnaire, depression with the Zung Self-Rating Depression Scale, family functioning with the McMaster Family Assessment Device, stroke knowledge with the Stroke Care Information Test, and expectations of rehabilitation with an open-ended question. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Using our previously derived AIB classification rule, AIB cases scored poorly on functional, social and psychological indicators. Further, cluster analysis of discharge data replicated the rule for identifying patients with AIB. AIB was a strong predictor of functional competence and performance at rehabilitation discharge and both six and twelve months later, while depression was associated with an inactive lifestyle at both six and twelve months. Greater stroke knowledge and clearer expectations of rehabilitation were associated with better functional outcome at discharge. Family functioning was strongly associated with lifestyle activities and ADL performance at both six and twelve months. The procedure for identifying AIB in this rehabilitation environment appears to be robust. AIB was a key determinant of long-term functional disability, while depression was associated with poorer social functioning. Family functioning was an important determinant of social activities, and of the activities the patient actually does, rather than those the patient is capable of carrying out. Good stroke knowledge and clear expectations of rehabilitation were important determinants of rehabilitation success, and should be fostered to ensure a good rehabilitation outcome. Psychological factors are crucial in determining long-term outcomes after rehabilitation from stroke.

Illness behaviour in elite middle and long distance runners.

OBJECTIVES: To examine the illness attitudes and beliefs known to be associated with abnormal illness behaviour (where symptoms are present in excess of objective signs and pathology) in elite middle...

Chiropractic rehabilitation of a patient with S1 radiculopathy associated with a large lumbar disk herniation

Objective: To describe the nonsurgical treatment of acute S1 radiculopathy from a large (12 × 12 × 13 mm) L5-S1 disk herniation. Clinical Features: A 31-year-old man presented with severe lower back pain and pain, paresthesia, and plantar flexion weakness of the left leg. His symptoms began 5 days before the initial visit and progressed despite nonsteroidal anti-inflammatory drugs and analgesic medication. An absent left Achilles reflex, left S1 dermatome hypesthesia, and left gastrocnemius/soleus weakness was noted. Magnetic resonance imaging demonstrated a large L5-S1 disk herniation. Intervention and Outcome: Initial treatment of this patient included McKenzie protocol press-ups to reduce and centralize symptoms, nonloading exercise for cardiovascular fitness, and lower leg isotonic exercises to prevent atrophy. Counseling was provided to reduce abnormal illness behavior risk. Later, flexion distraction and side-posture manipulation were provided to improve joint function. Sensory motor training, trunk stabilization exercises, and trigger point therapy were also used. He returned to modified work 27 days after symptom onset. A follow-up, comparative magnetic resonance imaging (MRI) study was unchanged. He was discharged as asymptomatic (zero rating on both the Oswestry and numerical pain scales) after 50 days and 20 visits, although the left S1 reflex remained absent. Reassessment 169 days later revealed neither significant symptoms nor lifestyle restrictions. Conclusion: This case demonstrates the potential benefit of a chiropractic rehabilitation strategy by use of multimodal therapy for lumbar radiculopathy associated with disk herniation. (J Manipulative Physiol Ther 1999;22:38–44)

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.

Abnormal Illness Behaviour

Abnormal Illness Behaviour

Management of somatisers in primary care: are family doctors motivated?

The aim of this paper is to assess the attitudes of Spanish general practitioners towards somatisers and the degree of involvement that family doctors are ready to adopt in the care of these patients. A postal questionnaire on attitudes was sent to a representative sample (n = 135) of general practitioners from two health districts of the region of Aragon. Seventy (51.8%) of them returned usable questionnaires. Most of the general practitioners were interested in the treatment of somatisers and considered that they should be treated at primary care level. However, when specific treatment tasks were proposed, they only accepted to act as a filter to specialised care and to care for patients with chronic functional syndromes. Additionally, they refuse to detect presenting somatisers, to prescribe psychotropic drugs or offer any psychological approach, and to avoid reinforcing abnormal illness behaviour in these patients and their families. These findings can be explained because the main emotions somatisers produce in doctors are frustration and anger. Family doctors need a lot more help, education and support in the management of somatisers, and psychiatrists need to provide it. Any management program for the treatment of somatisers in primary care should include methods to modify general practitioners' attitudes towards these patients.

The effects of depression and abnormal illness behaviour on outcome following rehabilitation from stroke.

To examine the relative effects of depression and abnormal illness behaviour (AIB) on long-term rehabilitation outcome following stroke. A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and twelve months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Ninety-four twelve-month stroke survivors who had undergone an inpatient rehabilitation programme. AIB was assessed using the Illness Behaviour Questionnaire, and depression with the Zung Self-Rating Depression Scale. The General Health Questionnaire and a visual analogue mood scale were also used. Functional outcome was assessed with the competence and performance assessments of the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Multivariate analysis of outcome controlled for age and stroke severity. AIB was a better predictor of functional competence and performance than either age or stroke severity, at rehabilitation discharge and both six and twelve months later. Depression was not related to functional competence and performance at any assessment, but was strongly predictive of an inactive lifestyle at both six and twelve months. By contrast, lifestyle activities were not related to AIB. Depression and AIB appear to have quite distinct effects on outcome. AIB emerged as a key determinant of long-term functional disability, while depression was associated with poorer social functioning. The early recognition and treatment of AIB and depression is important for the ultimate social and functional outcomes of stroke rehabilitation patients.

Knowledge of stroke in rehabilitation and community samples

This study examined the stroke knowledge of 60 stroke rehabilitation patients, 46 spouses, 25 family members, and 103 people in the general community. Changes in stroke knowledge with time, and determinants of stroke knowledge, were also examined. Clinical participants were assessed on acute admission, admission to and discharge from rehabilitation, and 6 and 12 months after discharge. Community participants were assessed once. Instruments used were the Stroke Care Information Test, Australian ADL Index, Frenchay Activities Index, Illness Behaviour Questionnaire and Zung Self-rating Depression Scale. The stroke knowledge of all participants, particularly patients, was poor, but improved with time. Better-informed patients were younger, had milder strokes, were less depressed, were less likely to develop abnormal illness behaviour, and made a better functional recovery than patients with poorer knowledge. Structured information programmes are needed for stroke patients and their families. Improved community awareness of stroke may help the prospects for recovery and quality of life for people who have strokes.

Relation between psychiatric disorder and abnormal illness behaviour in patients undergoing operations for cervical discectomy

OBJECTIVETo test the hypothesis that depression in patients being considered for cervical disc surgery is associated with severe organic pathology. Secondly, to test whether depression and abnormal illness attitudes recorded...

Dying to be Ill: The Role of Self-Enhancement Motives in the Spectrum of Factitious Disorders

It has long been observed that people sometimes fake or exaggerate symptoms of physical illness or injury. These gratuitous symptom complaints, together with doctor visits, medication use, and so forth, are collectively called Abnormal Illness Behavior (AIB). In this article we examine some associated features of extreme cases of AIB, which suggest that these behaviors may reflect attempts at self-definition and self-esteem management. Four specific hypotheses are offered to explain the mechanisms through which these motives might maintain severe forms of AIB. We then consider the utility of looking for the operation of these mechanisms in less extreme cases. Studies are reviewed which suggest that identity and self-esteem motives do affect AIB in non-clinical samples. Finally we discuss the potential for our self-enhancement theory to integrate extant theories of the causes of AIB, as well as the clinical implications of our approach.

Abnormal illness behaviour in rehabilitation from stroke.

To examine the effect of abnormal illness behaviour (AIB) on rehabilitation outcome following stroke. A longitudinal design, with assessments on admission to and discharge from rehabilitation, and six and 12 months after discharge. The study was undertaken in the rehabilitation unit at Repatriation General Hospital, in Adelaide, South Australia. Ninety-four 12-month stroke survivors who had undergone an inpatient rehabilitation programme. AIB was assessed using the Illness Behaviour Questionnaire. Additional psychological measurements comprised the Zung Self-Rating Depression Scale, General Health Questionnaire, and a visual analogue mood scale. Functional ability was assessed with the Australian ADL Index, and lifestyle activities with the Frenchay Activities Index. Cluster analysis of discharge data was used to define a rule for identifying patients with AIB. AIB was apparent in nearly 30% of patients at discharge, and persisted for 12 months. Patients with AIB scored more poorly than non-AIB patients on functional, social and psychological indicators. AIB emerged as a key determinant of long-term disability. It is important to consider why AIB develops during rehabilitation, and how to identify patients at risk.