Hypochondriacal Fears Research Articles

Life-time anxiety disorders in patients with late-onset psychosis

BACKGROUND. Anxiety disorders are frequently observed in patients with schizophrenia. Meanwhile lifetime frequency of these disorders in late-onset schizophrenia remains unknown.
 AIM. The aim of the study was to investigate frequency of anxiety disorders in patients with late-onset psychosis.
 MATERIAL AND METHODS. 85 patients with late-manifesting psychoses (after 40 years) aged 45 to 86 years (average age 66.5=9.5 years) were examined. Patients with late schizophrenia (n=42), late schizoaffective disorder (n=12), late chronic delusional disorder (n=15), organic schizoform psychosis (n=8), recurrent depression with psychotic symptoms (n=8) underwent psychiatric examination (PANSS, HDRS-17, MMSE, MoCA) and standard interviews. The diagnosis was carried out according to the criteria of the International Classification of Diseases of the 10th revision. The control group included 24 people over 45 years old without signs of mental disorders (average age 57.68.8 years). Statistical analysis included nonparametric criteria.
 RESULTS. Results. Patients with late schizophrenia were distinguished by certain premorbid features in the form of an increased frequency of social phobia, more animal phobias and multiple polysymptomatic habitual anxiety reactions. Patients with late schizoaffective disorder were characterized by a tendency to hypochondriac fears and multiple polysymptomatic habitual anxiety reactions. Patients with late delusional disorder were characterized by an increased frequency of animal phobias. Patients with late mental depression are characterized by the presence of multiple undeveloped anxiety reactions and hypochondriac fears. Patients with endomorphic organic psychoses were distinguished by a low frequency of hypochondriacal fears in the anamnesis.
 CONCLUSION. High frequency of anxiety disorders in patients with late-onset schizophrenia was detected. This data could improve diagnostics of late-onset psychosis.

Anxiety Sensitivity or Interoceptive Sensitivity

Abstract. The construct of anxiety sensitivity (AS) – the fear of anxiety-related symptoms – has been highly influential in current conceptualizations of anxiety disorders in general, and panic disorder specifically. However, given documented associations between AS and both non-anxiety psychological disorders as well as medical/health conditions, the extent to which measures of AS are assessing a specific fear or anxiety symptoms versus a broader fear of interoceptive or bodily sensations is unclear. Confirmatory factor analysis of data from 373 participants failed to suggest whether fears of anxiety-related symptoms were factorially distinct from fears of non-anxiety-related bodily sensations, although analyses indicated that while fears of anxiety-related symptoms were more closely associated with panic disorder severity than were fears of non-anxiety-related symptoms, both were similarly and strongly associated with hypochondriacal fears. Implications for the construct of AS, and the broader construct of somatic fears, are discussed.

Relationship between sensory processing sensitivity and hypochondriacal features and the moderating role of somatic symptoms

Background. Only very little is known about the etiology of hypochondriasis, a mental disorder characterized by the preoccupied beliefs or fears of having a serious disease or being in a life-threatening condition and the elevated focus on own physical symptoms. A relatively new concept named sensory processing sensitivity (SPS) is about the sensitivity towards stimuli and is related to an elevated self-focus. Due to its relation with an elevated self-focus, SPS might be related to hypochondriacal features. The present study investigated this relationship. Moreover, in the light of recent reformulation of hypochondriasis in the DSM-5 in illness anxiety disorder and somatic symptom disorder, this study also examined how the presence of somatic complaints affects the relationship between SPS and hypochondriacal features. Methods. A cross-sectional questionnaire study was conducted in which 302 participants from the general population were enrolled. These participants were recruited through several ways online and at several physical locations. Hypochondriacal fears and beliefs were assessed using the Illness Attitudes Scale (IAS), while SPS was assessed using the Highly Sensitive Person scale (HSP). At last, having physical complaints was assessed with descriptive items on having complaints and their duration and location. Results. The present study found that HSP and its subscales Ease of Excitation and Low Sensory Threshold were positively and significantly correlated to IAS and its subscales Health Anxiety and Illness Behavior. In contrast, it was found that the Aesthetic Sensitivity subscale of the HSP scale was not correlated to IAS or its subscales. Furthermore, a moderation test using linear regression analyses showed that having somatic complaints did not moderate the relationship between HSP and IAS. Having specifically chronic somatic complaints, however, did tend to moderate this relationship. Conclusion. The present study is the first study to show the importance of a high SPS in having hypochondriacal fears and beliefs and the role of somatic complaints in this relationship. However, future research is needed to further understand this relationship and to investigate its causality

The Effects of Attention Training on Health Anxiety: An Experimental Investigation

According to cognitive-behavioural theories, attentional biases, especially increased symptom-focused attention, are crucial for the maintenance of health anxiety. Therefore, the attention training technique (ATT) seems to be a promising approach in reducing body-focused attention and hypochondriacal fears in people with high health anxiety. However, previous research has never implemented ATT on its own but always in combination with psychoeducation. The present study experimentally investigates the isolated impact of ATT on self-reported body-focused attention, health anxiety, and attentional bias towards health threatening stimuli. Fifty-four students with elevated health anxiety were randomised into the following conditions: attention training group (ATG), which received ATT; ATGbody, which received a variation of ATT that focused on training attention towards the body; and a control group without intervention. The ATG and ATGbody spent 1 week actively practicing the trainings. Before and after the training phase, we assessed the self-report measures, and attentional bias by using the Emotional Stroop Task. The ATG displayed no effects on self-report measures of body-focused attention or health anxiety. Against our expectations, the ATGbody experienced a significant decrease in the attentional bias (p = .001, Cohen’s d = 0.93). Attention training towards the body in people with elevated health anxiety might, therefore, be beneficial in reducing illness-related attentional bias.

Health Anxiety in Preadolescence--Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood.

Epidemiological data on the distribution, persistence, and clinical correlates of health anxiety (HA) in childhood are scarce. We investigated continuity of HA symptoms and associated health problems and medical costs in primary health services in a general population birth cohort. HA symptoms were assessed in 1886 Danish 11-12year old children (48% boys) from the Copenhagen Child Cohort using the Childhood Illness Attitude Scales (CIAS) together with information on socio-demographics and the child's somatic and mental status and healthcare expenditure. Non-parametric statistics and regression analysis were used to compare groups with low (n = 184), intermediate (n = 1539), and high (n = 161) HA symptom scores. The association between HA symptoms assessed at age 5-7years and HA symptoms at ages 11-12years was examined by Stuart-Maxwell test. HA symptoms were significantly associated with emotional disorders and unspecific somatic complaints, but not with chronic physical conditions. In regression analyses controlling for gender and physical comorbidity, healthcare expenditure peaked in children with the highest HA symptom score, that is these children used on average approximately 150 Euro more than children with the lowest score during the 2-year period preceding inclusion. HA symptoms at age 5-7years were significantly associated with HA symptoms at age 11-12years. We conclude that HA symptoms, including hypochondriacal fears and beliefs, were non-trivial in preadolescents; they showed continuity from early childhood and association with emotional disorders, unspecific somatic complaints, and increased healthcare expenditure. Further research in the clinical significance of childhood HA is required.

Adolescents' hypochondriacal fears and beliefs: Relationship with demographic features, psychological distress, well-being and health-related behaviors

ObjectiveThere is little previous literature on hypochondriacal attitudes in teens. We examined the relationship between adolescents' hypochondriacal fears and beliefs, demographic features, psychological distress and well-being, and health-related behaviors. MethodsNine hundred and forty-eight students (53.4% males), aged 14–19years (mean 15.8±1.3years), completed the Illness Attitude Scales, the Symptom Questionnaire, and the Psychological Well-Being scales. Demographic features and health-related behaviors (smoking, alcohol consumption, illicit substance use, and sedentary, eating and sleep habits) were also collected. ResultsHypochondriacal concerns were significantly higher among females and correlated with increased psychological distress and reduced well-being. One hundred and forty-nine participants (15.7% of the sample) reached the threshold of the “hypochondriacal responses”, identified by Kellner as a screening method for clinically significant hypochondriacal symptoms. The “hypochondriacal responses” were significantly associated with higher levels of psychological distress, decreased well-being, and some unhealthy behaviors: smoking, use of illicit substances, physical inactivity, and short sleep. Female gender, physical inactivity, and higher levels of hostility independently predicted the “hypochondriacal responses” pattern. ConclusionsA substantial percentage of adolescents experience significant concerns about health. Excessive illness fears are associated with less healthy behaviors. A thorough assessment of illness-related concerns may be crucial for the prevention of both the development of more structured forms of abnormal illness behavior (e.g., severe health anxiety) and the engagement in some unhealthy lifestyles in adolescents. However, it may also be that unhealthy behaviors lead to increased preoccupation with one's own health through adolescents' implicit knowledge about possible consequences of such behaviors.

Dimensional Assessment of Hypochondriacal Fears and Beliefs

Background: The hypochondriacal spectrum includes several clinical phenomena, such as disease phobia, thanatophobia and health anxiety. The major challenge for a dimensional tool is to capture the different features which sensitively differentiate the hypochondriacal syndrome from other clinical phenomena, such as somatization. This article provides a qualitative review of the instruments designed for the dimensional assessment of hypochondriacal fears and beliefs. Methods: Articles were retrieved by means of both computerized (Medline, PsycINFO) and manual searches. Results: In the 1960s, the Whiteley Index (WI) was the first instrument specifically built to measure the severity of hypochondriacal symptoms. In the 1980s, Kellner developed the nine Illness Attitude Scales (IAS), each of them concerns a specific cluster of attitudes, fears and beliefs. They were designed to reflect the clinimetric properties, in particular content validity and sensitivity to treatment-related changes. In the 1990s, the refinement of the cognitive-behavioral model of hypochondriasis was followed by an upsurge of questionnaires aimed at assessing the dimensions of hypochondriasis according to this model. However, most of these instruments need to be further validated and the amount of incremental information they yield remains to be established. In the last decade, the interest of the studies has been focused on the measurement of specific features of hypochondriasis, such as response to medical reassurance and obsessive-compulsive symptoms. Conclusions: Kellner’s IAS and Pilowsky’s WI are the most validated and widely used instruments. The clinimetric properties make the IAS the gold standard for the dimensional assessment of hypochondriacal fears and beliefs. Keywords: Cognitions About Body and Health Questionnaire, Health Anxiety Inventory, Health Anxiety Questionnaire, Hypochondriasis Yale-Brown Obsessive-Compulsive Scale, Illness Attitude Scales, Multidimensional Inventory of Hypochondriacal Traits, Reassurance Questionnaire, Somatosensory Amplification Scale, Whiteley Index.

Diagnostic criteria for psychosomatic research and somatic symptom disorders

The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 ‘psychosomatic syndromes’ which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients’ psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients’ functioning. The additional information provided by the DCPR may enhance the decision-making process.

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.

Distinctiveness of Perceived Health in Panic Disorder and Relation to Panic Disorder Severity

The aims of this study were to investigate to what extent perceived health in panic disorder (PD) is distinct from related constructs and to examine the relationship between perceived health and various domains of PD severity. Seventy-five PD outpatients were administered instruments measuring perceived health, anxiety sensitivity, hypochondriacal fears and beliefs, catastrophic appraisals of the consequences of physical symptoms of anxiety and panic, various aspects of psychopathology, and PD severity. Results of the correlation, partial correlation, and multiple regression analyses suggest the following: (1) among PD patients there is much overlap between negatively perceived health, catastrophic appraisals of the consequences of physical symptoms of anxiety and panic, and hypochondriacal beliefs; (2) negatively perceived health is not significantly related to PD severity nor to any aspect of PD severity, whereas anxiety sensitivity and hypochondriacal beliefs have a significant relationship with the severity of anticipatory anxiety, and in that regard may be more clinically useful than perceived health before the beginning of treatment.

Evaluation of General Practitioners’ Training: How to Manage Patients With Unexplained Physical Symptoms

Patients with unexplained physical symptoms ("somatoform disorders") tend to overuse the healthcare system. Therefore, the authors aimed to assess whether a training session for general practitioners (GPs) on managing patients with unexplained physical symptoms would be acceptable to GPs and lead to improvements in patient care. In a randomized clinical trial (GPs randomized), GPs got a 1-day training session and additional materials. Included were 26 GP offices in primary care and 295 patients with unexplained physical symptoms (minimum of two symptoms required). Outcome measures were healthcare utilization (number of doctor visits) 6 months before and 6 months after the index visit to the GP, somatization severity, depression, and hypochondriacal fears at the index visit to the GP's office and 6 months later. Training GPs to manage these patients led to significant reductions in healthcare utilization; patients of untrained GPs showed comparable attendance rates in the 6 months before and after the index visit. Differences in depression, somatization, and hypochondriacal fears, however, could not be attributed to the GP training. GPs rated the training as being highly relevant for their everyday practices, underlining the need for and acceptance of the training. Training GPs in managing patients with unexplained physical symptoms seems to be helpful for the reduction of excessive healthcare utilization. These 1-day workshops have high acceptability, so this approach could be a good model for empirically-validated continuing-education programs.

Searching for a Gastrointestinal Subgroup Within the Somatoform Disorders

The authors examined whether patients suffering from functional gastrointestinal symptoms constitute a separate group within the broader concept of the somatoform disorders. The authors compared 103 patients with a severe gastrointestinal syndrome, 220 patients with a somatization syndrome according to DSM-IV, and 250 clinical control subjects with nonsomatoform mental disorders. The gastrointestinal group showed more catastrophizing thinking, complained more about autonomic sensations, felt bodily weaker, was less tolerant towards bodily discomfort, had developed more hypochondriacal fears and behaviors, was more depressed, and was more severely disabled in different areas of psychosocial functioning than the other groups. These differences, however, disappeared when general somatization was controlled for by analysis of covariance. Only a small effect related to dysfunctional cognitions remained specific to the gastrointestinal syndrome. Because these results do not confirm the idea of an independent gastrointestinal syndrome, general mechanisms of somatization seem to play the dominant role.

Treating Hypochondriasis: Additional Support for Cognitive-Behavioral Therapy

Can short-term cognitive-behavioral treatment help patients with hypochondriasis? To find out, researchers compared the efficacy of a waiting-list control condition with that of 2 cognitive-behavioral approaches: exposure plus response prevention (exposure to hypochondriacal fears; prevention of reassurance seeking, checking, and avoidance), and cognitive therapy (systematic monitoring, evaluation, and testing of hypochondriacal …

Assessing Hypochondriasis: Findings on the Survey of Health Concerns

We describe a brief self-report measure for assessing hypochondriacal fears in adults. Called the Survey of Health Concerns (SHC), the measure was developed using DSM IV criteria for diagnosing hypochondriacal disorder as a guide. The measure was standardized on a sample of 188 college students. It was shown to have good internal and temporal reliability over a 2-week period. Moreover, scores on the SHC correlated significantly with worry proneness as measured by the Penn State Worry Questionnaire, and with the Hs scale of the MMPI-2, which together support the convergent validity of the measure. While men and women scored the same, participants who were being treated for a medical condition scored higher than those who were not being treated. Men who were under a doctor's care scored especially high, although this was based on a small sample of men and the effect could be spurious. A principal component factor analysis revealed two primary factors: one that described participants who felt poorly, made frequent trips to the doctor, and were fearful of illness and dying, and another that described participants who were particularly fearful of infectious diseases and took active steps to avoid becoming sick. Relatively little is known about hypochondriacal disorder. One reason for the dearth of knowledge in this area is that there has been no practical and reliable way to assess hypochondriacal fears, or more generally speaking, people's tendency to worry about their health. The SHC may help to fill this void. Results are admittedly preliminary and further study in medical settings is needed.

Hypochondriacal fears and beliefs in obsessive-compulsive disorder.

The relationship of obsessions and compulsions with hypochondriasis is receiving increasing attention, but has not been substantiated by adequate research. The Illness Attitude Scales (IAS), which identify hypochondriacal patients, were administered to 30 patients with DSM-IV obsessive-compulsive disorder and 30 healthy control subjects matched for sociodemographic variables. All IAS scales were significantly higher in patients with obsessions and compulsions. However, there were no significant differences between patients and controls in the number of subjects whose symptom intensity exceeded a clinical threshold for hypochondriasis and disease phobia. Furthermore, hypochondriacal fears and beliefs were poorly correlated with obsessions and compulsions. The results suggest the presence of mild abnormal illness behaviour in patients with obsessive-compulsive disorder, unlike the situation in patients with panic disorder and depression.

Hypochondriacal fears and beliefs in obsessive-compulsive disorder

Hypochondriacal fears and beliefs in obsessive-compulsive disorder

The Clinical Course of Palpitations in Medical Outpatients

The aim of this study was to describe the longitudinal course of patients who were referred for ambulatory electrocardiographic monitoring because of palpitations. A prospective, follow-up examination was conducted of patients who had been studied 6 months previously when referred for monitoring. The inception cohort consisted of 145 consecutive patients with palpitations and 70 asymptomatic, nonpatient volunteers. At follow-up, the patients completed the same research battery as at inception, consisting of structured interviews and self-report questionnaires. These assessed cardiac symptoms, medical care use, role impairment, somatization, hypochondriacal fears and beliefs, and psychiatric disorder. At 6 months' follow-up, 130 patients with palpitations (89.7% of the original cohort) and 69 nonpatients (98.6%) were reinterviewed. Eighty-four percent of the patients had recurrent palpitations during the 6-month follow-up period. At follow-up, patients with palpitations scored significantly higher than the comparison group on measures of cardiac symptoms and role impairment, and had made more physician visits in the preceding 6 months. They had a higher prevalence of panic disorder and more psychopathologic symptoms, somatized more, and were more hypochondriacal. Psychiatric symptoms and the tendency to amplify bodily sensation, measured at inception, were significant but modest predictors of subsequent palpitations. There was considerable confusion and misunderstanding among patients as to the findings of their ambulatory electrocardiogram and the presence or absence of panic disorder. Patients with palpitations remain symptomatic and functionally impaired and have increased rates of physician visits in the 6 months following Holter monitoring. They also continue to have elevated rates of panic disorder and to evidence some confusion about the cause of their symptoms.

Cultural aspects of morbid fears in Qatari women

The contents of morbid fears are patterned by cultural factors that decide the nature of the objects of the fears. Common factors in Western cultures do not obtain in local culture, which provides other objects for morbid fears in predisposed individuals. In the muslim community in Qatar, after-death fears dominated panic attacks, agoraphobia was rare, social phobias mirrored shame rather than guilt about failure to fulfil socially accepted norms of social behaviour, and obsessional fears revolved around fears of failure to control devil-induced impulses to harm self or others. Hypochondriacal fears of disease thrived because somatically oriented physicians colluded with somatizing patients in an endless search for presumed organic aetiology. Generalized anxiety fears were not encountered independently of other morbid fears.

Generalized anxiety disorder, worries about illness, and hypochondriacal fears and beliefs.

In order to compare hypochondriacal phenomena in patients with generalized anxiety disorder (GAD) and panic disorder (PD), and in order to examine the relationship between worries about illness on one hand, and disease fears/phobias and hypochondriacal beliefs on the other, the authors administered the Illness Attitudes Scales to patients with both GAD and PD, and determined the spheres of worry in patients with GAD. Patients with GAD were significantly less hypochondriacal than PD patients. A specific relationship between GAD and hypochondriasis was not found because worries about illness, which characterize some GAD patients, were largely independent from disease fears/phobias and hypochondriacal beliefs, which are a hallmark of hypochondriasis.

Prodromal symptoms in panic disorder with agoraphobia: A replication study

The majority of 20 patients suffering from panic disorder with agoraphobia reported experiencing agoraphobic avoidance, generalized anxiety, and/or hypochondriacal fears and beliefs before the first panic attack. The results replicated those of a previous investigation and are in accordance with an increasing number of studies concerned with prodromal symptoms, epidemiologic surveys, and analysis of mechanisms of change upon treatment.