Bodily Preoccupations Research Articles

Vegetarian and omnivorous diets: A cross-sectional study of motivation, eating disorders, and body shape perception

Vegetarianism, which is increasingly widespread in Western societies, is underpinned by various motivations (ethical, environmental, health concerns …) and the question of its association with eating disorders continues to divide the literature.This cross-sectional study aimed to explore and compare eating motives/attitudes and bodily preoccupations of vegetarian and omnivorous participants from the general population. Forty-nine vegetarians and 52 omnivores, aged between 18 and 70 years, completed a battery of questionnaires including sociodemographic characteristics, Body Mass Indexes (BMI - current, ideal, lifetime lowest, and lifetime highest), the Food Choice Questionnaire (FCQ), the Eating Attitudes Test-26 (EAT-26), and the Body Shape Questionnaire (BSQ).Compared to omnivores, vegetarians reported lower current (p = .017), ideal (p = .009), and lifetime lowest (p = .005) BMIs, more motivations related to health (p = .001) and natural content (p < .0001), but less weight control motivations (p = .015). While no differences were observed in EAT-26 scores, vegetarians had lower BSQ total scores (p = .043), and lower scores on the Body Dissatisfaction related to Lower body parts (p = .025) and Unsuited Cognitions and Behaviors (p = .015) subscales compared to omnivores. Separate gender comparisons revealed that these differences existed only among women. Hierarchical regressions revealed that the natural content motivation was the strongest positive statistical predictor of the vegetarian group (Expβ = 1.18, p = .002), while the weight control motivation was a negative statistical predictor (Expβ = .710, p = .023).Results demonstrated that vegetarians expressed motivation for a healthy and natural diet, and were less concerned about controlling their weight than the omnivores. Vegetarian women had lower BMIs but expressed fewer psychological concerns associated with eating disorders than omnivorous women. Vegetarian diets appeared to be associated with health benefits and less body and weight concerns, particularly among women in the general population.

Smaller Pituitary Volumes in Patients with Delusional Disorder.

Introduction:Delusional disorder shares some clinical characteristics of OCD and hypochondriasis. Delusions compared to obsessions in the OCD and compared to bodily preoccupations in the hypochondriasis are more established beliefs.Aim:To measure pituitary volumes in patients with delusional disorder and hypothesized that volumes would be reduced in those patients by a mechanism that we could not account for before for patients with OCD and hypochondriasis.Methods:Eighteen patients with delusional disorder and healthy controls were included into the study. Pituitary gland volumes were measured.Results:When using independent t test, the mean total pituitary volume was 777.22±241.28 mm3 in healthy controls, while it was 532.11±125.65 mm3 in patients with delusional disorder. The differences in regard to pituitary gland volumes between patients with delusional disorder and healthy control subjects were statistically meaningful (p<0.01), as supported by ANCOVA, with the covariates of age, gender and total brain volumes as covariates.Conclusion:We determined that patients with delusional disorder had smaller pituitary volumes compared to those of healthy control subjects.

A second look at the validity of widely used Rorschach indices: comment on Mihura, Meyer, Dumitrascu, and Bombel (2013).

We comment on the meta-analysis by Mihura, Meyer, Dumitrascu, and Bombel (2013), which examined the validity of scores in Exner's Comprehensive System (CS) for the Rorschach. First, we agree there is compelling evidence that 4 categories of cognitive scores-the "Rorschach cognitive quartet"-are related to cognitive ability/impairment and thought disorder. We now feel comfortable endorsing the use of these scores in some applied and research settings. Second, we conducted new meta-analyses (k = 44) for the 4 noncognitive Rorschach scores with highest validity in the Mihura et al. findings. Unlike Mihura et al., we included unpublished dissertations (although we did not attempt to exhaustively unearth all unpublished studies), calculated correlations instead of semipartial correlations, and used the Rorschach International Norms for a larger proportion of comparisons. Our validity estimates for the Suicide Constellation and Weighted Sum of Color were similar to or even higher than those of Mihura et al., although we concluded that support for the Suicide Constellation is limited and that Weighted Sum of Color probably does not measure its intended target. Our validity estimates for Sum Shading and the Anatomy and X-ray score were much lower than those of Mihura et al. We conclude that their meta-analysis accurately reflects the published literature, but their exclusion of unpublished studies led to substantial overestimates of validity for some and perhaps many Rorschach scores. Therefore, the evidence is presently insufficient to justify using the CS to measure noncognitive characteristics such as emotionality, negative affect, and bodily preoccupations.

Hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine and modern health worries predict patient satisfaction.

SummaryObjectiveTo investigate how hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine (CAM) and modern health worries (MHWs) related to patient satisfaction with their general practitioner.DesignParticipants completed a five-part questionnaire anonymously which measured satisfaction with one’s doctor, hypochondriacal beliefs, attitudes to CAM, MHWs and personality.SettingEnglandParticipantsIncluded 215 adults from a variety of cultural backgrounds.Main outcome measureThe Illness Attitudes Scales measuring the attitudes, fears and beliefs associated with hypochondriasis; Worry about Illness; Concerns about Pain, Health Habits, Hypochondriacal beliefs; Thanatophobia, Disease phobia, Bodily preoccupations; Treatment experience and Effects of symptoms.ResultsCorrelations (around r = .10 to .25) and Regressions (R square from .06 to .09) showed demographic and personality variables only modestly related to patient satisfaction. Hypochondriasis, CAM and MHWs were associated with greater patient dissatisfaction as predicted with the former as the most powerful correlate.ConclusionThe study indicates the different needs of potential patients in a typical medical consultation. It is important to ascertain patients’ health beliefs and practices with regard to medical history, attitudes to CAM and MHWs to increase consultation satisfaction.

Assessing Bodily Preoccupations is sufficient: Clinically effective screening for hypochondriasis

ObjectiveHypochondriasis is a persistent psychiatric disorder and is associated with increased utilisation of health care services. However, effective psychiatric consultation interventions and CBT treatments are available. In the present study, we provide evidence of clinically effective screening for hypochondriasis. We describe the clinically effective identification of patients with a high probability of suffering from hypochondriasis. This identification is achieved by means of two brief standardised screening instruments, namely the Bodily Preoccupation (BP) Scale with 3 items and the Whiteley-7 (WI-7) with 7 items. MethodsBoth the BP scale and the WI-7 were examined in a sample of 228 participants (72 with hypochondriasis, 80 with anxiety disorders and 76 healthy controls) in a large psychotherapy outpatients' unit, applying the DSM-IV criteria. Cut-off values for the BP scale and the WI-7 were computed to identify patients with a high probability of suffering from hypochondriasis. Additionally, other self-report symptom severity scales were completed in order to examine discriminant and convergent validity. Data was collected from June 2010 to March 2013. ResultsThe BP scale and the WI-7 discriminated significantly between patients with hypochondriasis and those with an anxiety disorder (d=2.42 and d=2.34). Cut-off values for these two screening scales could be provided, thus identifying patients with a high probability of suffering from hypochondriasis. ConclusionsIn order to reduce costs, the BP scale or the WI-7 should be applied in medical or primary care settings, to screen for patients with a high probability of hypochondriasis and to transfer them to further assessment and effective treatment.

Screening for Hypochondriasis With the Illness Attitude Scales

The Illness Attitude Scales (IAS; Kellner, 1986, 1987) may prove highly useful for the screening of hypochondriasis. We expected the IAS subscales to be equally as effective as the 7-item short version of the Whiteley Index (Whiteley–7; Fink et al., 1999), which has previously been shown to be useful in screening for somatoform disorders. We investigated participants of a German population (n = 1,575) and 61 patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM–IV]; American Psychiatric Association, 1994) diagnosis of hypochondriasis. The Bodily Preoccupations (BP) subscale showed high sensitivity (.92) and specificity (.90) as well as demonstrating convergent and discriminant validity. We found evidence for the superiority of the BP subscale over the Whiteley–7 in the screening of hypochondriasis.

The Illness Attitude Scales

Background: The Illness Attitude Scales (IAS) were developed by Robert Kellner as a clinimetric index for measuring hypochondriacal fears and beliefs (worry about illness, concerns about pain, health habits, hypochondriacal beliefs, thanatophobia, disease phobia, bodily preoccupations, treatment experience and effects of symptoms). The IAS have been extensively used in the past two decades, but there has been no comprehensive review of their properties and applications. Methods: A review of the literature using both computerized (Medline, PsycINFO) and manual searches was performed. Results: The IAS were found to successfully discriminate between hypochondriacal patients and control subjects, and between patients with various manifestations of illness behaviour. They showed a high test-retest reliability in normal subjects, and changed in the expected direction after treatment of hypochondriasis. The IAS were also positively related to other hypochondriasis-related measures, and yielded important information in a variety of medical and surgical settings. Their content has paved the way for the development of some of the Diagnostic Criteria for Psychosomatic Research. Conclusions: The clinimetric properties and high sensitivity of the IAS make them the gold standard for the self-rated assessment of hypochondriacal fears and beliefs.

The Impact of Anxiety Sensitivity, Bodily Expectations, and Cultural Beliefs on Menstrual Symptom Reporting: A Test of the Menstrual Reactivity Hypothesis

According to the menstrual reactivity hypothesis, certain women report more severe as well as a greater number of menstrual symptoms due to accurate reports of physical symptoms and expectations (e.g., cultural beliefs, sex roles, bodily sensations). To test this hypothesis and to further examine the role that anxiety sensitivity plays in menstrual symptom reporting, women varying in levels of anxiety sensitivity completed measures of sex role socialization, menstrual attitudes, bodily preoccupations, affect, and fear of illness. To assess psychophysiological reactivity and the applicability of response styles theory to individuals varying in anxiety sensitivity, skin conductance was measured as participants engaged in a rumination or distraction task. In addition, participants completed a modified Stroop task consisting of anxiety, menstrual, and neutral words followed by a surprise recognition task. Retrospectively and prospectively, women high in anxiety sensitivity consistently reported more severe menstrual symptoms. High anxiety sensitivity women also reported preoccupation with bodily sensations and more negative attitudes toward illness, but did not differ from low anxiety sensitivity women on measures of menstrual attitudes or sex role socialization. While engaging in a rumination task, high anxiety sensitivity women exhibited more frequent skin conductance responses and greater skin conductance response magnitude than low anxiety sensitivity women. In addition, after the rumination task, high anxiety sensitivity women recognized more anxiety-related words from the Stroop task. Menstrual cycle phase had less of an impact than anxiety sensitivity level on the current results. Implications of these results for the menstrual reactivity hypothesis and rumination are discussed.

Thirty‐Three Cases of Body Dysmorphic Disorder in Children and Adolescents

Body dysmorphic disorder (BDD), a preoccupation with a nonexistent or slight defect in appearance, usually begins during adolescence. Because there have been no studies of the clinical features of BDD in children and adolescents, the authors assessed these features in the largest series to date. Thirty-three children and adolescents with DSM-IV BDD were assessed for demographic characteristics, phenomenology, associated psychopathology, and treatment history and response. Bodily preoccupations most often focused on the skin (61%) and hair (55%). All subjects had associated compulsive behaviors, most often camouflaging (e.g., with clothing) in 94%, comparing with others (87%), and mirror checking (85%). Ninety-four percent reported impairment in social functioning and 85% in academic or job functioning due to BDD. Thirty-nine percent had had psychiatric hospitalizations, and 21% had made a suicide attempt. Ten (53%) of 19 subjects treated with a serotonin reuptake inhibitor had much or very much improvement in BDD symptoms; in contrast, 0 of 8 trials with other psychotropic medications, 0 of 1 trial of cognitive-behavioral therapy, and 1 of 20 psychotherapy trials resulted in improvement. Twelve (36%) subjects received surgical, dermatological, or dental treatment, with a poor outcome in all cases. BDD can cause significant morbidity in children and adolescents. These preliminary data suggest that serotonin reuptake inhibitors may be an effective treatment in this age group.

Additional Findings on the Association Between Anxiety Sensitivity and Hypochondriacal Concerns: Examination of Patients with Major Depression

Hypochondriacal concerns ranging from disease phobias to bodily preoccupations are common among patients with panic disorder. In a previous study of patients with panic disorder, we found that, of a number of symptom dimensions examined, anxiety sensitivity was the strongest predictor of hypochondriacal concerns. This finding has been the topic of subsequent debate in the anxiety literature, with concerns raised whether true hypochondriacal concerns were confounded with typical panic-related concerns. To clarify this issue, we now report on the association between anxiety sensitivity and hypochondriacal concerns in 100 patients with major depression and no history of panic disorder. Consistent with our previous study, we found that of the symptoms examined—anxiety sensitivity, depressed mood, anxious mood, somatic symptoms, and anger/hostility—anxiety sensitivity was the strongest predictor of hypochondriacal concerns. Findings are discussed in relation to the role of catastrophic interpretations of somatic symptoms in depression, panic disorder, and hypochondriasis.

Hypochondriacal concerns: The roles of raw and calibrated medical knowledge

Abstract Based on similarities between hypochondriacal concerns and the ‘medical students' syndrome’ factual medical knowledge was identified as one factor important to the understanding of hypochondriacal concerns. The relationship between factual medical knowledge and hypochondriacal concerns was assessed in a sample of 58 volunteer participants. Four domains of factual medical knowledge were examined: anatomy, vital signs, disease aetiology and symptomatology. These domains of knowledge were assessed in terms of raw scores and the degree of knowledge calibration (people's accuracy in judging what they know). Hypochondriacal concerns were assessed using the three dimensions of the Whiteley Index (disease fear, disease conviction and bodily preoccupations) Results indicated a number of associations between levels of medical knowledge and the dimensions of hypochondria. Bodily preoccupations were associated with a tendency towards over-confidence in knowledge about anatomy (i.e. subjects thought they knew...

Body dysmorphic disorder: 30 cases of imagined ugliness

Body dysmorphic disorder, preoccupation with an imagined defect in appearance, is included in DSM-III-R but has received little empirical study. The authors investigated the demographics, phenomenology, course, associated psychopathology, family history, and response to treatment in a series of 30 patients with the disorder. The patients (including 12 whose preoccupation was of probable delusional intensity) were assessed with a semistructured interview and the Structural Clinical Interview for DSM-III-R, and their family histories were obtained. The 17 men and 13 women reported a lifetime average of four bodily preoccupations, most commonly "defects" of the hair, nose, and skin. The average age at onset of body dysmorphic disorder was 15 years, and the average duration was 18 years. Seventy-three percent of the patients reported associated ideas or delusions of reference; 73%, excessive mirror checking; and 63%, attempts to camouflage their "deformities." As a result of their symptoms, 97% avoided usual social and occupational activities, 30% had been housebound, and 17% had made suicide attempts. Ninety-three percent of the patients had an associated lifetime diagnosis of a major mood disorder; 33%, a psychotic disorder; and 73%, an anxiety disorder. The patients generally responded poorly to surgical, dermatologic, and dental treatments and to adequate trials of most psychotropic medications, with the exception of fluoxetine and clomipramine (to which more than half had a complete or partial response). This often secret, chronic disorder can cause considerable distress and impairment, may be related to obsessive-compulsive disorder or mood disorder, and may respond to serotonin reuptake-blocking antidepressants.

Differential Diagnosis of Hypochondriacal Fears and Beliefs

Any undue concern with bodily function is often labeled as hypochondriacal. Kellner's Illness Attitude Scales, self-rating instruments, distinguish between generic worry about illness, concern about pain, health habits, hypochondriacal beliefs, thanatophobia, disease phobia, and bodily preoccupations. The Illness Attitude Scales have been used in a number of studies concerned with patients suffering from DSM-III-R hypochondriasis, panic disorder, melancholia, in the medically ill, in pregnant women, during medical procedures such as mammography, and in experiments in therapeutics, such as drug trials. The results of these studies and of clinical investigations suggest that the differential diagnosis between hypochondriacal beliefs (characterized by resistance to reassurance), disease phobia, thanatophobia, and the other less specific illness attitudes, is worthy of clinical attention and may entail prognostic and therapeutic implications. Pilowsky's concept of abnormal illness behavior, unlike the DSM-III-R, provides a framework for such differentiation.

Hypochondriacal fears and beliefs in pregnancy

Illness attitudes were evaluated in 26 pregnant women and 26 control subjects matched for sociodemographic variables, by means of a self-rating scale, on 3 different occasions. For each trimester of pregnancy, women displayed more hypochondriacal fears and beliefs and conviction of disease (disease phobia) than normal controls. In the third trimester, they also reported more fear of dying and bodily preoccupations. The findings should alert physicians to ask their pregnant patients whether they are preoccupied with fear of dying, or are concerned that they suffer from an undiagnosed physical illness, or dread a specific illness such as cancer or heart disease. Hypochondriacal fears and beliefs are liable to affect well-being and the health attitudes of pregnant women. If properly recognized, they may effectively be treated.

Health attitudes and psychological distress in patients attending a lithium clinic.

Health attitudes and psychological distress were investigated in 50 patients attending a lithium clinic and in 50 normal controls. Patients receiving lithium treatment did not report more worry about illness, hypochondriacal attitudes, concern about pain, disease phobia and bodily preoccupations than normals, even though they took fewer precautions about their health and exhibited more self-rated psychological distress. Since most of the psychiatric patients were found to display more fears about illness and death than controls in other studies, this preliminary report may suggest that normal health attitudes are associated with lithium compliance in affective illness.

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients.

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.