Elevated Health Anxiety Research Articles

A behavioral test of contamination fear in excessive health anxiety

Background and objectivesHealth anxiety is characterized by a preoccupation with the possibility of having a serious health condition or disease. Contemporary conceptualizations of health anxiety have improved in recent years to incorporate a fear of acquiring an illness; however, there is limited experimental data demonstrating the presence of fear of contamination among health anxious individuals. MethodThe present study utilized behavior approach tasks (BATs) to examine the degree to which contamination fear is present in elevated health anxiety. Participants were 60 undergraduate students who reported elevated health anxiety, contamination fear, or no anxiety about either health or contamination. Participants completed four BATS from which avoidance, anxiety, and disgust ratings were derived. ResultsHealth anxious and contamination fearful individuals exhibited a similar degree of avoidance during the BATs. Contamination fearful participants reported significantly more anxiety and disgust relative to the non-anxious controls, but not the health anxious participants. Health anxious participants did not report more anxiety or disgust than the non-anxious participants. LimitationsThe use of an analogue sample may limit the extension of these findings to clinical populations. Additionally, the role of general negative affect could not be reliably determined in the absence of an anxious control group. ConclusionsThese findings suggest that contamination fear may be a source of conceptual overlap between health anxiety and other disorders characterized by contamination fear. This highlights the importance of considering contamination fear in excessive health anxiety.

Negative Automatic Evaluation and Better Recognition of Bodily Symptom Words in College Students with Elevated Health Anxiety

This study explored whether better recognition of symptom words is associated with stronger negative automatic evaluations of these words. We compared participants with health anxiety (HA; N = 27) to dysphoric (N = 29) and to non-health-anxious and non-dysphoric control participants (N = 28) in the Implicit Association Test (IAT) and in a word recognition task using health-threat-related, negative emotional, and neutral control words. Participants with HA made significantly more mistakes on the IAT than both other groups, in pairing the evaluation “harmless” with specific “symptoms” (p = .02, η2 = .10). Additionally, recognition performance was positively related to the IAT evaluation bias. The findings suggest that persons with HA automatically interpret symptoms as being more dangerous than the others saw them. This evaluation bias might explain the facilitation of access to symptom information in working memory that underlies cognitive biases observed in HA.

Exploration of health anxiety among individuals with diabetes: Prevalence and implications

Health anxiety has been infrequently examined in individuals with diabetes. In this study, individuals with Type 1 or 2 diabetes (n = 414) completed questionnaires assessing health anxiety and related constructs. Elevated health anxiety was reported by 24.1 percent of the sample and was greater among younger individuals, females, unmarried participants, and those recently diagnosed with diabetes. The construct was related to trait anxiety, fear of diabetes complications, poorer adherence to dietary and exercise self-care activities as well as lower physical quality of life. The research improves our understanding of health anxiety among individuals with diabetes.

Health anxiety in a non-population-based, pre-publicised glaucoma screening exercise

To investigate whether anxiety plays a role in self-recruitment for non-population-based glaucoma screening. In a non-population-based pre-publicised trial, self-recruited Caucasian participants were screened for glaucoma, and also completed the Trait Anxiety Inventory and Shortened Health Anxiety Inventory questionnaires. In pre-publicity for the trial, information on risk factors for glaucoma was given. Participants classified as possible glaucoma cases later underwent a detailed glaucoma investigation. Of the 120 total participants (72 females, 48 males), 12 were considered glaucoma suspects at the screening, although only three (2.5%) were ultimately diagnosed with glaucoma. Health anxiety showed significant correlation with trait anxiety (r=0.525, P<0.001). Trait anxiety was similar for both the genders; this score was significantly below the normal Hungarian population value in women (P<0.001) and at the normal population level in men (P=0.560). In contrast, health anxiety was significantly higher than for both the 'normal' and 'anxious' reference groups (P<0.001), although smaller than that for hypochondriacs (P<0.001). Participants with pre-existing ocular symptoms, and those who attended because of fear of blindness, had significantly higher trait- and health-anxiety scores (P<0.05 for all comparisons). In this screening trial, the health anxiety of the self-recruited participants was significantly above normal, whereas the prevalence of glaucoma was within the usual range for a Caucasian population. This suggests that providing pre-publicity information on risk factors for glaucoma does not necessarily increase the prevalence of glaucoma among self-recruited participants in non-population-based screening, as some individuals may participate on account of elevated health anxiety, rather than because of higher potential risk for glaucoma.

Is health anxiety a significant problem for individuals with multiple sclerosis?

Although symptoms of anxiety and depression are often present in individuals with Multiple Sclerosis (MS), less is known about the role of health anxiety in this population. This study investigated the relationship between health anxiety and coping in a sample of people with MS (n = 246). Participants with MS reported higher levels of health anxiety compared to an age-matched control sample. Furthermore, compared to normal levels of health anxiety, participants with MS with elevated health anxiety (around 25%) were differentiated by endorsement of greater use of Emotional Preoccupation and Social Support and less use of Problem-Focused Coping. In addition, participants with elevated health anxiety experienced greater disability and generalized anxiety. We further explored the overlap between generalized anxiety and health anxiety in understanding coping strategies and found that health anxiety and generalized anxiety were both uniquely associated with Emotional Preoccupation coping, whereas only health anxiety was uniquely associated with Problem-Focused coping. The results provide support for the importance of assessing health anxiety in individuals with MS over and above generalized anxiety. Potential avenues for research and clinical practice are described.

Enhanced Early Emotional Intrusion Effects and Proportional Habituation of Threat Response for Symptom and Illness Words in College Students with Elevated Health Anxiety

Studies evaluating attentional biases in health anxiety have produced equivocal results. Little is known about the details and potential moderators of prioritized processing of illness related information. We compared individuals with health anxiety (HAG; N = 54) to not health anxious participants (CG; N = 53) in a blocked emotional Stroop paradigm. Analyses focused on differences between categories of health threatening information (words referring to symptoms and illnesses), on the time course of the emotional intrusion effect, and on test order effects. When symptom words were presented first in the experiment (i.e., before the illness words), the HAG showed a stronger emotional intrusion effect to symptom words in the first test half (trials 1–20) compared to the CG. A similar pattern of results with a smaller effect size was apparent for the illness words, when they were presented first in the experiment. The results contribute to a more fine-grained understanding of attentional processes towards external sources of threat in health anxiety. In particular, they emphasize the importance of taking into account the time course when analyzing data from an emotional Stroop paradigm.

Does anxiety about health influence eating patterns and shape-related body checking among females?

In clinical practice, patients who have elevated worries about health often report a desire to diet and a preoccupation with body shape; furthermore, they report that information about dieting can trigger significant health anxiety. To date, there has been no research that has systematically investigated the relationships among elevated health anxiety, eating patterns, and body shape preoccupation. In this study, 122 female participants completed measures of health anxiety, eating patterns, and body checking. Participants were also randomly given either positive ( n = 59) or negative ( n = 63) information about the effects of dieting on health allowing us to examine the consequences of receiving differential dieting information on health anxious and non-health anxious individuals. Health anxiety was positively correlated with dieting and food preoccupation; it was also correlated with body checking to assess shape. Analysis of variance showed that after reading both positive and negative information about dieting, individuals highly health anxious experienced greater concern about their health and a greater desire to diet and exercise than individuals with lower levels of health anxiety. Further research should explore dieting and body shape checking as behavioural responses to health anxiety, and, clinically, practitioners should consider monitoring these behaviours when assessing and treating health anxiety.

Attentional Bias Toward Illness Threat in Individuals with Elevated Health Anxiety

This investigation examined attentional biases for illness-related information in persons varying in their degree of health anxiety (HA). Consistent with cognitive behavioural conceptualizations, it was hypothesized that individuals with high HA would be more likely than those with lower levels to exhibit attentional biases to illness-related information when tested using a modified Stroop colour-naming task. Participants were 26 individuals with each of high, medium, and low HA as assessed using the Illness Attitudes Scale (R. Kellner, P. Abbott, W. W. Winslow, & D. Pathak, 1987). Results indicated that participants with high HA, compared to those with lower levels of HA, selectively attend to illness-related but not other categories of emotionally laden stimuli. These findings, indicative of an attentional bias for illness-related cues in high HA, are discussed in the context of cognitive behavioural conceptualizations of HA. Future research directions are outlined.