Disease Conviction Research Articles

An Investingation of Psychological Factors in Patients with Functional Dyspepsia

Objectives: This study investigated the psychological characteristics of patients with functional dyspepsia. Methods: The subjects included ninety patients with functional dyspepsia and sixty four psychiatric out-patients. We administered Minnesota Multiphasic Personality Inventory(MMPI) and Illness Behavior Questionnaire(IBQ). Results: There were no significant differences between the patients with functional dyspepsia and the psychiatric out-patients by MMPI. Two groups both showed a higher distribution in hypochondriasis, depression, hysteria subscales than in any other subscales. The patients with functional dyspepsia showed lower scores in disease conviction and affective disturbance subscales in IBQ than the psychiatric out-patients. The distribution of scores of the other IBQ subscales were similar between the patients with functional dyspepsia and the psychiatric out-patients. The patients with functional dyspepsia were divided into three groups for the Multivariate cluster analysis: normal, similar to psychiatric out-patient, and severe neurotic. The severe neurotic group showed higher scores in hypochondriasis, depression, hysteria, psychathenia, and schizophrenia subscales in MMPI and showed significant different scores in affective disturbance, disease conviction, psychological and somatic concerns, affective disturbance, denial, and irritability subscales in IBQ. Conclusion: If patients with functional dyspepsia show severe neurotic behavior, such as those in, they would need appropriate psychiatric intervention.

Illness behavior in the acute phase of motor disability in neurological disease and in conversion disorder: A comparative study

Sixty patients with a sudden onset of motor disability were assessed for illness behavior and depression. In 30 of the patients, etiology was attributed to a definite structural lesion. The remaining 30 patients were diagnosed as having conversion disorder. The Illness Behaviour Questionnaire (IBQ) and the Hamilton Rating Depression Scale (HRDS) were used as instruments for assessment. The mean HRDS score was significantly higher in the conversion group, indicating a higher degree of affective disease in these patients. According to the results of the IBQ, the patients with conversion disorder showed a higher degree of irritability, disease conviction, and phobic preoccupation, and also, to a greater extent, rejected psychological explanations for their symptoms. Denial was high in both patient groups, coexisting with affective symptoms in the conversion patients but not in the neurological patients. Although valuable information could be extracted from the IBQ, it was not found to be a reliable instrument for distinguishing between psychogenic and organic causes of motor disability.

Feminine Gender Role and Illness Behavior in Irritable Bowel Syndrome

The purpose of this study was to investigate the relationship between aspects of the feminine gender role and modes of illness behavior in patients with irritable bowel syndrome (IBS). Fifty IBS patients (34 women and 16 men) completed the Personal Attributes Questionnaire (PAQ), which assesses aspects of gender role, and the Illness Behavior Questionnaire (IBQ), which assesses components of illness behavior. The Communal Femininity subscale of the PAQ, which is characterized by traits of servility and subordination, showed a significant positive correlation with the Disease Conviction subscale of the IBQ, which is characterized by symptom preoccupation and rejection of physician reassurance (r = .55; p < .001). The Communal Femininity subscale of the PAQ also correlated positively with the General Hypochondriasis subscale of the IBQ, which is characterized by a high level of anxiety over one's state of health (r = .55; p < .001). These results suggest that characteristics of the feminine gender role, such as the nurturing of others before oneself, may influence the experience of physical symptoms by contributing to a heightened focus on physiological cues and by increasing levels of psychosocial stress.

The syndrome of hypochondriasis: a cross-national study in primary care.

The nature and correlates of hypochondriasis are still poorly understood, especially in settings other than those in North America and Western Europe. A total of 25,916 consecutive patients making ambulatory visits to primary care clinics at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Based on the screen-score performance, a stratified sample of 5447 of respondents was evaluated at the second-stage (response rate: 62%). Evaluation consisted of physician-rated physical and psychological health status and self-ratings of overall health, physical disability and GHQ-28. Interviewers conducted assessment of psychiatric status, using the Composite International Diagnostic Interview (CIDI) and occupational disability. Across the sites, the occurrence of ICD-10 hypochondriasis was 0.8% (95% Confidence Interval, 0.5-1.0%) and over 1.5% at only two sites. A less restrictively-defined form of the disorder had a pooled frequency of 2.2% (95% Confidence Interval, 1.8-2.6%) across the sites. Patients with this abridged hypochondriasis were more likely than those without to have co-morbid major depression and generalized anxiety disorder. They had a poorer perception of their health, were more physically disabled, were more impaired in the performance of occupational role, and were above-average utilizers of health service. Patients with ICD-10 hypochondriasis were no more impaired than those with abridged hypochondriasis. Even though the ICD-10-defined hypochondriasis is rare, a form consisting of the triad of disease conviction, associated distress and medical help-seeking is present in primary-care settings in different cultures. This syndrome is associated with considerable psychiatric ill-health and functional disability.

Erratum to “Non-organic symptom reporting in patients with chronic nonmalignant pain” [Pain 68 (1996) 329-342

Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physical disease. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale (Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.

Organic Pathology and Disease Conviction

Dworkin, Robert H. Ph.D.; Cooper, Edith M. Ph.D.; Siegfried, Richard N. M.D. Author Information

Hypochondriacal concerns and somatization in panic disorder

To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood–injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis. Depression and Anxiety 6:78–85, 1997. © 1997 Wiley-Liss, Inc.

Hypochondriacal concerns and somatization in panic disorder

To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood-injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis.

Posttraumatic stress disorder and illness behaviour in HIV+ patients.

24 asymptomatic HIV+ patients completed the Impact of Event Scale and the Illness Behaviour Questionnaire. Analysis indicated above-average scores on posttraumatic stress reactions as well as significant intercorrelations of this score with scores on three factors on the Illness Behaviour Questionnaire, namely, hypochondriasis, affective inhibition, and disease conviction. Theoretical and practical implications are discussed in terms of these findings.

Non-organic symptom reporting in patients with chronic non-malignant pain

Patients with chronic non-malignant pain are often suspected of reporting medical symptoms that have non-organic as opposed to purely organic origins. According to the somatization hypothesis, non-organic reporting occurs when affective or other benign physical sensations are misconstrued as symptoms of physi. Paper presented at the 3rd International Symposium on Childrenss Pain, Philadelphia, PA, 1994cal disease. Psychological tests purporting to assess somatization are limited by their self-report format and may be confounded in patients with physical disease or injury. Measures of somatization may also be influenced or biased by underlying differences in depression or anxiety. In order to obtain an unbiased estimate of somatization, therefore, it is necessary to control for the influence of extraneous variables. In the present study, symptom report scales designed to assess somatization, symptom amplification, and disease conviction were administered to a group of 100 patients with chronic non-malignant pain. The strategy was to determine whether any of these tests could account for individual differences in illness behavior. Specifically, the set of dependent measures included: length of disability; frequency of medical visitation; activity level; and level of domestic functioning. The most successful predictor of patient behavior was the Somatization Scale ( Derogatis et al. 1974) which correlated positively and significantly with each dependent measure. In order to examine the possibility that scores on this test were biased by differences in organic pathology, three physician pain specialists were asked to rate the morbidity of each item on the scale. A multiple regression analysis was then performed to examine whether differences in symptom morbidity, depression, or anxiety could account for the correlation between symptom ratings and illness behavior. The analysis showed that while depression and anxiety were significantly correlated with measures of illness behavior, the Somatization Scale still accounted for a significant amount of unique variance in three out of five dependent variables. Symptom morbidity was significantly correlated with only one measure of illness behavior (Activity Level). In view of these findings, scores on the Somatization Scale were used to classify 25 patients as Symptom Minimizers and another 25 as Symptom Amplifiers. When compared to Minimizers, Amplifiers were disabled for a significantly greater number of days, reported significantly more impairment in domestic functioning, were significantly less active, visited the doctor significantly more often, and were significantly more distressed. The results suggest that substantial differences in disability and medical visitation may exist among patients who may not differ appreciably in their level of organic pathology. Instead, differences in illness behavior may, to some extent, be mediated by differences in somatization.

Psychosocial Morbidity and Adjustment to Illness Among Long-Term Cancer Survivors: A Six-Year Follow-Up Study

Psychiatric morbidity (DSM-III-R) and adjustment to illness (psychological stress, illness behavior, and coping) were prospectively studied in 52 cancer patients who had been evaluated at the time of cancer diagnosis 6 years earlier. The prevalence of psychiatric disorders decreased from 47% to 37%. Improvement in psychological adjustment (low interpersonal sensitivity, psychoticism, paranoia, disease conviction, and anxious preoccupation) was found between these two assessment points. A lifetime history of psychopathology and psychiatric problems at baseline was associated with a current mental disorder. External locus of control, low social support, abnormal illness behavior, emotional stress, and poor coping mechanisms, as evaluated at first assessment, were also associated with psychological symptoms and maladjustment to cancer at follow-up. From the data reported, the need to maintain a continuity of psychosocial care among cancer survivors is inferred.

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...

Illness behavior and somatization in general practice

In the primary care setting, the early recognition that a patient has psychological problems is frequently hindered by the deceptive mode of presentation known as somatization. In a cross-sectional survey of patients attending suburban General Practitioners in a large metropolitan city, the General Health Questionnaire-30 (GHQ-30) and the Illness Behavior Questionnaire (IBQ) were completed by 201 patients. A comparison was made between somatizing and nonsomatizing patients with new inceptions of illness in terms of the risk of the presence of a mild nonpsychotic psychiatric illness and aspects of illness behavior. For the group as a whole, somatizing patients were more likely to be older and female. Male somatizers differed from male nonsomatizers by showing greater disease conviction and affective disturbance and more readiness to acknowledge difficulties in their lives other than health problems. No differences were found between female somatizing and nonsomatizing patients. We conclude that, while male patients who somatize psychological distress may be distinguished from male nonsomatizers early in their illness, in terms of their illness behavior, these differences are not seen as early distinguishing characteristics in female patients who present to their General Practitioners with physical problems for which no organic cause can be established.

Heart-focused anxiety, illness beliefs, and behavioral impairment: comparing healthy heart-anxious patients with cardiac and surgical inpatients.

Psychological features and complaints of persons presenting to medical settings with heart-focused anxiety and noncardiac chest pain are poorly understood. Comparing 20 healthy heart-anxious patients to cardiac and surgical inpatients and nonpatient controls, we found that healthy heart-anxious patients (a) were as afraid of chest pain and heart palpitations as inpatients with heart disease, (b) were as incapacitated by symptoms and using medical services as much as both inpatient groups; and (c) reported higher levels of cardiac disease conviction, heart awareness, and behaviors designed to protect their heart than surgical patients and nonpatients. Compared to all other groups, healthy heart-anxious patients reported more panic and other anxiety disorders, hypochondriacal beliefs, physical symptoms, obsessive-compulsive concerns, and negative affect. Following a hyperventilation test, heart-anxious patients also indicated more distressing symptoms and thoughts, and felt less safe and in control than surgical patients and nonpatients. Results support efforts for a timely recognition, diagnosis, and behavioral treatment of persons with heart-focused anxiety.

Psychiatric and Psychosocial Concomitants of Abnormal Illness Behaviour in Patients with Cancer

Previous studies of medically ill patients suggest that abnormal illness behaviour (i.e. high hypochondriasis, disease conviction, dysphoria and irritability) is associated with depressive symptoms. The present study was carried out in order to examine more in detail the role of psychiatric and psychosocial variables in moulding abnormal illness behaviour in patients with cancer. Two-hundred and one newly diagnosed cancer patients were submitted to a semistructured interview to assess past and current psychiatric disorders (DSM-III-R) and social support. Self-report questionnaires were also given in order to evaluate psychological stress symptoms (Symptom Check List-90-R-SCL-90-R), external locus of control (ELC) and illness behaviour (Illness Behaviour Questionnaire-IBQ). A pattern of abnormal illness behaviour was shown in patients with a life-time history of psychiatric disorders (n = 33) and in those with a current DSM-III-R diagnosis (n = 101). IBQ dimensions were associated with SCL-90-R, ELC and low social support. The patients' tendency to deny life events other than cancer was related both to the progression of the illness and to their receiving chemotherapy. The study confirms the association between psychological disorders and abnormal illness behaviour and points out a role for personality variables (external locus of control) and low social support in favouring maladaptive responses to cancer.

Patient-related factors influence treatment choice in operable breast cancer

<h2>Abstract</h2> The aim of this study was to determine whether specific patient-related factors influence the patients' choice between breast conserving treatment (BCT) and total mastectomy for symptomatic breast cancer. Forty-six women, in whom BCT was an option, were investigated using a structured interview and a self-administered illness behaviour questionnaire. The results demonstrated significant differences between the two groups: (1) patients with partners were more likely to choose BCT; (2) women who chose to have total mastectomy demonstrated higher scores on disease conviction and affective inhibition. Knowledge of these characteristics may be of further assistance to clinicians in optimizing assessment for surgical treatment of women with breast cancer.

"Abnormal" illness behaviour in chronic fatigue syndrome and multiple sclerosis

To investigate the presence of abnormal illness behaviour in patients with a diagnosis of chronic fatigue syndrome. A cross sectional descriptive study using the illness behaviour questionnaire to compare illness behaviour scores and illness behaviour profiles of patients with chronic fatigue syndrome and patients with multiple sclerosis. A multidisciplinary fatigue clinic and a teaching hospital neurology outpatient clinic. 98 patients satisfying the Oxford criteria for chronic fatigue syndrome and 78 patients with a diagnosis of multiple sclerosis. Responses to the 62 item illness behaviour questionnaire. 90 (92%) patients in the chronic fatigue syndrome group and 70 (90%) in the multiple sclerosis group completed the illness behaviour questionnaire. Both groups had significantly high scores on the general hypochondriasis and disease conviction subscales and significantly low scores on the psychological versus somatic concern subscale, as measured in relation to normative data. There were, however, no significant differences in the subscale scores between the two groups and the two groups had identical illness behaviour profiles. Scores on the illness behaviour questionnaire cannot be taken as evidence that chronic fatigue syndrome is a variety of abnormal illness behaviour, because the same profile occurs in multiple sclerosis. Neither can they be taken as evidence that chronic fatigue and multiple sclerosis share an aetiology. More needs to be known about the origins of illness beliefs in chronic fatigue syndrome, especially as they are important in determining outcome.

Invasive dental treatment, pain reports, and disease conviction in chronic facial pain patients. A retrospective study.

Patients with chronic orofacial pain often undergo endodontic therapy or surgery in an attempt to eliminate or relieve their symptoms. This study examined the relationship among invasive dental treatment, pain reports, and disease conviction in a group of patients referred for pain management. Forty-eight patients referred to the Facial Pain Diagnostic Group at the Karolinska Institute, School of Dentistry, Stockholm, were investigated retrospectively. There were 43 women and 5 men (age range, 30-81 years) with orofacial pain of more than 6 months' duration, which the patients considered to be of dental or paradental origin. Despite dental treatment intended to relieve the pain, no permanent relief had been achieved. There was no statistical correlation among the different pain reports, the individual types of treatment, and the disease conviction. The reason for the high degree of disease conviction in this type of patient warrants further investigation.

Lack of disability in patients with chronic orofacial pain. a retrospective study.

Although patients with chronic orofacial pain are frequently disabled, the disability is not necessarily due to the orofacial pain: various other factors may contribute. This retrospective study investigated the possible relationship between reports of pain, fatigue, disease conviction (DC), and denial of psychologic factors as explanation of the suffering (P-S) and limitations in occupational, domestic, physical, social, and sexual activities. The subjects comprised 30 patients referred to the Facial Pain Diagnostic Group at the Karolinska Institute, School of Dentistry, Huddinge, Sweden. None of the disability measures were significantly (p < or = 0.01) correlated with the facial pain reports. Fatigue was not correlated with degree of reported pain. DC was significantly (p < or = 0.01) correlated only with the minimum pain intensity. P-S was negatively correlated (p < or = 0.01) with maximum pain intensity and pain distribution (number of zones) outside the face. In 50% of the patients chronic orofacial pain was the formal reason for their occupational disability. However, such disability was related only to pain distribution (number of zones) outside the face. Social activity was negatively correlated (p < or = 0.01) with fatigue and positively correlated (p < or = 0.01) with P-S. It is suggested that the findings could be satisfactorily explained by a symptom perception hypothesis.

Convergent validation of the Illness Effects Questionnaire.

The Illness Effects Questionnaire, Illness Behavior Questionnaire, and visual analog scales of mood were given to 100 adults with nonmalignant headaches. Using regression analysis, scores on IBQ Disease Conviction, IBQ Irritability, and depression accounted for 50.6% of the variance in predicting IEQ scores. Scores on the Illness Effects Questionnaire correlated with the Illness Behavior Questionnaire subscales of General Hypochondriasis (.33), Disease Conviction (.60), Affective Disturbance (.49), and Irritability (.40), and also with rated depression (.38) and anxiety (.26).