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Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety

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Abstract

Health anxiety (HA) involves persistent worry about one’s health and beliefs one has an illness or may contract a disease. In the present study, gender differences in Noyes et al.’s (2003) interpersonal model of health anxiety (IMHA) were examined. Using a sample of 950 undergraduates (674 women; 276 men), multigroup confirmatory factor analyses suggested the measurement model for key dimensions of the IMHA (i.e., reassurance-seeking, alienation, worry, and absorption) were invariant across gender. This suggests key dimensions of this model are applicable to and generalizable across women and men. Coefficients alpha for and bivariate correlations between these IMHA dimensions were also roughly comparable across women and men. As hypothesized, mean levels of reassurance-seeking and worry were significantly higher in women compared to men. No gender differences were observed in mean levels of alienation or absorption. Reassurance-seeking and worry appear salient in the interpersonal behavior and emotional life of women with HA. The present study helps to clarify gender differences in the IMHA and other HA models involving similar variables.

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... While dysfunctional cognitive and behavioral processes in health anxiety are well-studied (Taylor & Asmundson, 2004), research has largely ignored dysfunctional interpersonal processes such as feelings of alienation from others (Longley et al., 2005). Health anxious individuals are largely studied in-isolationfrom-others, rather than in-relation-to-others, despite theory and research suggesting health anxiety is associated with serious interpersonal problems (MacSwain et al., 2009;Noyes et al., 2003). ...
... In what little research is conducted on interpersonal processes in health anxiety, usually only unidirectional relationships are tested (MacSwain et al., 2009), thereby failing to account for cyclical interpersonal processes proposed in interpersonal models of health anxiety (Stuart & Noyes, 2005). To date, most research on interpersonal processes in health anxiety also involves little conceptual integration (see Noyes et al., 2003 for an exception). ...
... Although researchers and clinicians have long highlighted the need to develop and test models explicating interpersonal processes maintaining health anxiety (Noyes et al., 2003), research in the area is only beginning to emerge. Our study addresses the aforementioned limitations by proposing the Interpersonal Model of Health Anxiety (IMHA; MacSwain et al., 2009;Noyes et al., 2003) and testing this integrative conceptual model using path analysis in undergraduates. ...
Article
Health anxiety involves persistent worry about one’s health and is characterized by dysfunctional inter- personal processes such as excessive health-related reassurance-seeking and feelings of alienation from others. Cognitive-behavioral models largely ignore cyclical, interpersonally averse behaviors and social cognitions observed amongst health anxious individuals. The Interpersonal Model of Health Anxiety (IMHA) proposes health anxiety is maintained through activated anxious attachment insecurities, which drive frequent, but ineffective, health-related reassurance-seeking from others. Such excessive health- related reassurance-seeking leads to health-related alienation and beliefs others are unconcerned about one’s perceived health problems. Feeling alienated from others fuels further health-related worry, result- ing in continued self-defeating attempts at health-related reassurance-seeking. The present study offers the first comprehensive articulation and test of the IMHA. Using a cross-sectional design and 107 under- graduates, path analysis supported five of six hypothesized paths in the model; all paths except that from anxious attachment to health-related reassurance-seeking were significant and in the expected direction. Specificity tests suggested anxious attachment was more central than avoidant attachment to the IMHA. The present test of the IMHA as a single, coherent model provides a conceptual foundation for future research on interpersonal processes in health anxiety. Clinical implications are discussed.
... Both attachment insecurity and a distressing sense of alienation from others are also proposed to amplify worry about health problems in persons with HA. In trying to alleviate such worry, persons with HA are believed to once again seek reassurance from others and a vicious cycle of reassurance-seeking, alienation, and worry is repeated amid an already chronic pattern of attachment insecurity and worry about health (MacSwain et al., 2009;Noyes et al., 2003). ...
... The IMHA proposes insecure attachment underlies HA. However, the nature of this insecure attachment is described in only general terms and needs clarification (MacSwain et al., 2009). Noyes et al. (2003) found two forms of insecure attachment, fearful and dismissing, are uniquely related to HA. ...
... Participants respond on a scale from 1 (strongly disagree) to 5 (strongly agree). Research supports the validity and reliability of the MIHT-HW (MacSwain et al., 2009;Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). ...
Article
Health anxiety involves persistent worry about one’s health and beliefs one has an illness or may contract a disease. The interpersonal model of health anxiety (Noyes et al., 2003) is a conceptual framework linking insecure attachment to health anxiety. The present study, clarified the contribution of insecure attachment to health anxiety by studying two key dimensions of insecure attachment: anxious and avoidant attachment. The unique role of insecure attachment in health anxiety was tested by controlling for emotional instability. The potential interaction between attachment insecurity and emotional instability in predicting health anxiety was also tested using hierarchical regression analyses with data from 147 undergraduates. Anxious attachment uniquely predicted health anxiety even when avoidant attachment and emotional instability were taken into account. An interaction was also observed where high anxious attachment and high emotional instability combined to predict higher health anxiety. This interaction was specific to health anxiety (versus depressive symptoms). An unexpected interaction was found where high avoidant attachment and low emotional instability combined to predict lower health anxiety. The present study extends research on health anxiety by clarifying the nature of insecure attachment in and the role of emotional instability in the interpersonal model of health anxiety.
... Anxiety is generally due to the perception of a situation as threatening or potentially harmful and health care attention is a situation that can frequently provoke anxious reactions. Some studies have found higher levels of anxiety in women than in men and in younger people than in older people, in diverse populations and in diverse dimensions of this variable, such as social anxiety or health anxiety (Caballo et al., 2008;Daig, Herschbach, Lehmann, Knoll, & Decker, 2009;MacSwain, et al., 2009). However, other studies focused on pediatric health care have found no differences between fathers and mothers in emotional alterations, such as stress during a child's hospitalization (Fernández-Castillo & López-Naranjo, 2006a). ...
... We found higher levels of anxiety in men than in women in the sample. This result does not coincide with the findings from other studies (Caballo et al., 2008;Daig et al., 2009;MacSwain et al., 2009;McLean & Anderson, 2009), which found an inverse result or trend, or with the studies that found no differences between fathers and mothers in emotional alterations during the loss of a child's health (Fernández-Castillo & López-Naranjo, 2006a). Nevertheless, this gender difference deserves more attention in future investigations, especially because there were more women than men in our sample. ...
... When determining differences as a function of age, our data show a higher level of anxiety as age increases. This result contradicts general studies of anxiety in large samples and in other specific typologies of anxiety (Caballo et al., 2008;Daig et al., 2009;MacSwain et al., 2009), although these authors indicate that as individuals grow older they acquire more skills to cope with anxiety. This may be the case in pediatric care, in view of the tendency observed in the sample of parents studied. ...
Article
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El objetivo del presente estudio es explorar la relación entre la ansiedad paterna y las representaciones cognitivas sobre la medicación en el tratamiento pediátrico de sus hijos. Para ello, 1.772 padres de niños atendidos en centros de atención pediátrica del sistema público de salud de Andalucía participaron en este estudio. El 25.1% de la muestra eran hombres y el 74.9% mujeres. Se encontró que las creencias negativas acerca de los medicamentos se asociaron con mayores niveles de ansiedad en los padres durante la aten- ción pediátrica. Entre las variables estudiadas, la creencia de abuso de la medicación fue la variable que predijo mayores niveles de ansiedad. Iniciativas adecuadas de intervención podrían mejorar sustancial- mente el bienestar de los pacientes y sus familiares durante la consulta pediátrica, la adherencia al trata- miento e incluso la satisfacción general. Se discuten los resultados en relación con otros autores, las impli- caciones clínicas y la necesidad de futuras investigaciones.
... That is, the Affective factor may not capture unique information beyond that of the higher order construct. Adequate fit of the hierarchical model, as well as invariance of this model by gender, was also observed by MacSwain et al. (2009). Moreover, in their undergraduate sample (N = 950), MacSwain et al. (2009) found factor loadings for the lower order factors on the health anxiety construct (i.e., Perceptual = .51, ...
... Adequate fit of the hierarchical model, as well as invariance of this model by gender, was also observed by MacSwain et al. (2009). Moreover, in their undergraduate sample (N = 950), MacSwain et al. (2009) found factor loadings for the lower order factors on the health anxiety construct (i.e., Perceptual = .51, Cognitive = .67, ...
... Higher scores on the MIHT scales indicate greater health anxiety, with a possible total score range from 31 to 155. Previous research has provided psychometric support for the MIHT, including evidence of internal consistency, retest reliability, convergent and discriminant validity (Longley et al., 2005), and structural support for both the correlated four-factor (Longley et al., 2005, Witthöft et al., 2015 and higher-order models (MacSwain et al., 2009;Stewart et al., 2008). ...
Article
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The Multidimensional Inventory of Hypochondriacal Traits (MIHT) is a self-report measure that assesses four interrelated domains of health anxiety (i.e., Cognitive, Behavioral, Perceptual, Affective). Prior research has supported a correlated four-factor model, as well as a hierarchical model, in which each of the four factors load onto the higher order health anxiety construct. However, a bifactor modeling approach has yet to be used to examine the factor structure of the MIHT. Results supported a bifactor model of the MIHT in three different samples (i.e., unselected based on current medical status [ n = 824], and those with [ n = 348] and without [ n = 354] a self-reported medical condition). The MIHT appears to be strongly multidimensional, with three of the four subscales providing substantive value. Confirmatory factor analysis supported the configural and metric/scalar invariance of the bifactor model between those with and without a self-reported medical condition. Results provide support for a bifactor conceptualization of the MIHT and the invariance of that model across levels of current health status.
... (Ohannessian et al., 2017). Gender differences were also reported in many studies for the adult population (Burani, & Nelson, 2020;MacSwain, et al., 2009). Thus they are likely to impact both adolescents' and their parents' anxiety levels during COVID-19 process. ...
... Curr Psychol research question. The results were consistent with previous findings, which presented higher anxiety scores for females in adolescence (Bender et al., 2012;Lewinsohn et al., 1998) and in the adult population (Burani & Nelson, 2020;MacSwain et al., 2009). Although the differences were said to be due to a heightened sensitivity of females to the threat (Burani & Nelson, 2020), the result has implications for the identification of risk groups and interventions. ...
Article
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COVID-19 pandemic period presents a unique context for the investigation of anxiety symptoms among adolescents and their parents. This study investigated adolescents’ and their parents’ anxiety symptoms, the effects of parental cyberchondriasis and adolescents’ emotion regulation on anxiety symptoms. The sample consisted of 155 adolescents ( ̄x = 14.63, SD = 2.04) and one of their parents (N = 155). The results showed that after controlling for adolescents’ gender and emotion regulation, parental cyberchondriasis and anxiety accounted for an important variance in adolescents’ anxiety. Especially higher parental anxiety and compulsion were associated with higher anxiety, whereas higher distress was associated with lower anxiety. Besides, two dimensions of cyberchondriasis, compulsion, and distress, together with adolescent anxiety, predicted parental anxiety during COVID-19. While compulsion was negatively associated with anxiety, distress, and adolescent anxiety were positively associ- ated with it. The dimensions of cyberchondriasis affected anxiety differently among adolescents and their parents. The results were discussed in terms of the implications for intervention from the ecological viewpoint.
... 29 Females can be more anxious than males due to many factors, such as biological factors like imbalances in reproductive hormones, sociocultural factors, personality traits like increasing anxiety sensitivity, and cognitive factors like a high tendency to ruminate. 29,30 Likewise, Lim et al. 31 4%. 31 In a recent study, the possibility of anxiety and depression were found to escalate significantly with younger age, female gender, urban living, pre-existing medical conditions, health status about COVID-19, and concern on COVID-19. ...
Article
Objective: Our study hypothesizes that the fear and panic of COVID-19 triggers cyberchondria (CYB) in students thus increasing health anxiety. In this way, we aim to determine the effect of the belief of previously having had and not having had COVID-19 on health anxiety and CYB levels of the university students. Methods: Our study is a descriptive cross-sectional study. The target population of our study consisted of 950 students who were continuing their education in the Vocational School of Health Services, an associate degree program of a university, and the samples consisted of 794 students (85.5%) who filled out our questionnaire (n = 794). The questionnaire form included the information regarding sociodemographic characteristics and the symptoms of COVID-19, and the obtained data were electronically collected altogether with Cyberchondria Scale (CS) and Health Anxiety Inventory. Findings: Health anxiety mean scores were significantly higher in people who lived alone, had a chronic disease, searched for symptoms online, and took herbal supplements against COVID-19 (p < 0.05). The mean total scores of Health Anxiety Inventory, CS, Anxiety-Increasing Factors Subscale of the students who believe they have had COVID-19 were significantly lower compared to the scores of those who believe they have not had COVID-19. Nevertheless, women and people living alone and in cities had significantly high CS scores (p < 0.05). Conclusion: The increase in infodemia can be prevented with the services offered by specialists through mental health helpline or websites to people with high health anxiety or CYB levels, especially to women, and to people living alone and in urban areas.
... Another notable finding was that males participated in a significantly greater number of Trialogue Meetings than females across the study period; while fewer males participated in Trialogue Meetings overall, males returned to more Trialogue Meetings than their female counterparts. This is striking in light of the prevalent findings in the broader literature that men tend to engage in less help-seeking behaviours for both mental health (MacSwain et al., 2009;Tamres et al., 2002) and physical health (Courtenay, 2014;Evans et al., 2005;Liang et al., 1999;Parslow et al., 2004) problems than women. This has typically been attributed to culturally conditioned gender stereotypes of masculinity, where help-seeking may undermine men's sense of independence and self-sufficiency (Courtenay, 2000a, b;McCreary et al., 2005;Courtenay, 2014). ...
... Women composed the majority of our university undergraduate-based sample, perhaps because of the preponderance of psychology undergraduates in our sample, the greater prevalence of health anxiety in women (Faravelli et al., 1997;Marcus & Church, 2003) and/or the increased tendency for women to seek reassurance (potentially from the Internet) for health-related issues (MacSwain et al., 2009). Future research replicating these findings in male/older participants would be beneficial. ...
Article
Background: Health-related Internet use has grown rapidly, yet little research has considered how health anxious individuals use the Internet for this purpose. Aims: To examine the relationships between health anxiety and the extent of, reasons for, and consequences of health-related Internet usage in university students (n=255). Method: Responses on a purpose-made Internet use questionnaire were correlated with health anxiety scores; multiple regression analyses controlling for depression and anxiety were also conducted. Results: Health anxiety positively correlated with (all p< .01): frequency of health-related searching (rs=.163), proportion of health-related information sought (rs=.200), time spent online for health purposes (rs=.166), and number of searches for both illness (rs=.453) and wellness (rs=.208) information. Health anxiety further positively correlated with advantages perceived in health-related Internet use (rs=.183), heightened tension (rs=.364) and relief (rs=.174) post-search, and perceived doctor disadvantages (rs=.306), yet a greater likelihood to visit a doctor post-search (rs=.217). Health anxiety also correlated with six measures of possible addiction to using the Internet for health purposes (rs range=.171-.366, all p< .01). Conclusions: Some (including several potentially dysfunctional) aspects of health-related Internet use correlate with health anxiety. Research evaluating the possible role of Internet use in the development and maintenance of health anxiety is warranted.
... We primarily used repeated measures analyses of covariance (ANCOVAs) to examine differential changes over time in clinical outcomes between the two groups. We included gender as a covariate to examine its potential effect on training, given the existing evidence for gender differences in HA (MacSwain et al., 2009). Second, for exploratory purposes, we conducted hierarchical regression analyses to examine baseline variables (i.e., AB scores and clinical measures) as potential therapeutic moderators. ...
Article
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Background and objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.
... Confirmatory factor analyses showed that the MIHT may be conceptualized either as involving the originally found four correlated factors or as being hierarchical in nature, with the four lower order factors loading on a single higher order global health anxiety factor. Multigroup confirmatory factor analyses using a sample of 950 undergraduates suggested that the four dimensions of the MIHT are invariant across gender (MacSwain et al., 2009). ...
Article
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Severe health anxiety constitutes a disabling and costly clinical condition. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) represents an innovative instrument that was developed according to cognitive-behavioral, cognitive-perceptual, interpersonal, and trait models of hypochondriasis. We aimed at evaluating the psychometric properties of the MIHT in a sample of patients with the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnosis of hypochondriasis. Using confirmatory factor analysis (CFA), the postulated four-factor structure of the MIHT was found in a first CFA in patients with hypochondriasis (n = 178) and in a second CFA based on a mixed sample, with other somatoform disorders (n = 27), panic disorder (n = 25), and healthy controls (n = 31) added to the original group of patients with hypochondriasis (n = 178). In terms of specificity, patients with hypochondriasis showed larger scores on all four MIHT subscales (i.e., affective, cognitive, behavioral, and perceptual) compared to all other groups. Analyses of convergent and discriminant validity revealed promising results concerning the MIHT affective and perceptual scales but also point to certain problematic issues concerning the MIHT cognitive and behavioral scales. The findings suggest that the proposed structure of the MIHT is valid also in patients with hypochondriasis and demonstrate the specificity of the four hypochondriacal traits assessed in the MIHT.
... It was hypothesized that, after controlling for the effects of gender, number of medical problems, and negative affectivity, that there would be a significant indirect effect of mindfulness on symptoms of health anxiety through IU. The covariates were selected on an a priori basis due to previously reported relationships with health anxiety (MacSwain et al. 2009;Marcus et al. 2008). ...
Article
Full-text available
Health anxiety is characterized by the misinterpretation of body sensations as signs of an illness, leading to health-related worry and increased healthcare utilization. Research has demonstrated the effectiveness of mindfulness-based interventions in the treatment of severe health anxiety, yet mechanisms of this association remain unexplored. Therefore, the present investigation sought to examine the indirect effect of mindfulness on health anxiety through intolerance of uncertainty (IU) or fear of the unknown. Undergraduate psychology students completed a series of online self-report measures for course credit. Bias-corrected bootstrapping (k = 10,000 samples) was used to generate a 95 % confidence interval to test the significance of the indirect effect. There was a significant indirect effect of greater levels of mindfulness on lower levels of health anxiety through decreases in intolerance of uncertainty. Higher levels of mindfulness may lead internal experiences to be perceived as less threatening, thereby increasing one’s ability to tolerate uncertainty and decreasing the need to worry and engage in safety behaviors that maintain health anxiety.
... Regarding research hypotheses, first, based on the IMHA, it was expected that health-related reassurance-seeking would lead to health-related alienation, health-related alienation would lead to health-related worry, and health-related worry would lead to health-related reassurance-seeking. Given that significant correlations have been found between the perceptual dimension of health anxiety (absorption) and the other three dimensions of it (Longley et al., 2010;MacSwain et al., 2009;Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008), the role of health-related absorption was also explored in this study. The addition of absorption to the proposed model was supported by previous research results suggesting that health-anxious individuals are more sensitive and intolerant of bodily sensations (Barsky, Wyshak, & Klerman, 1990;Lee, Watson, & Frey Law, 2010). ...
Article
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The purpose of this study was to explore an extended interpersonal model of health anxiety, according to which health-anxious individuals are trapped in a vicious circle of health-related reassurance-seeking, alienation from others, and worry about health, while somatic absorption with body sensations, insecure attachment, neuroticism, safety-seeking behaviors, and medical services utilization were also included in the model. Data were collected from 196 Greek university students using standardized instruments. Results indicated that anxious attachment was directly related to absorption (β = .163, p < .05) and alienation (β = .204, p < .05), while avoidant attachment was directly related to absorption (β = −.344, p < .001), reassurance-seeking (β = −.130, p < .05), and alienation (β = .148, p < .05). Neuroticism was positively and significantly associated with all dimensions of health anxiety. Absorption, alienation, and anxious attachment were related to medical services utilization, which, in turn, was related to safety-seeking behaviors (β = .200, p < .01). Neuroticism and anxious attachment were also indirectly and positively associated with worry. Moreover, absorption was positively related to worry and reassurance-seeking, worry was positively related to reassurance-seeking, and alienation was positively related to worry. Study results highlight the key role that interpersonal (e.g., alienation from others) and perceptual factors (e.g., the tendency to focus on bodily sensations) can play in health anxiety maintenance, and the importance of anxious and avoidant attachment in safety-seeking behavior engagement. Implications of the results and suggestions for future research and practice are outlined.
... This may point to phenotypic differences in affective symptoms experienced by men and women, an area in which little research has been done (Kornstein et al., 2000). One study suggests that gender differences do exist across specific dimensions of health anxiety (i.e., reassurance-seeking and worry), while core dimensions of this condition remain invariant across gender and generalize to both men and women (MacSwain et al., 2009). Sex-specific differences in these phenotypic or dimensional presentations of depression and anxiety may be impactful, especially given the recent finding that while depression and anxiety appear to have long term effects on mortality in all individuals with Type 2 diabetes, these excess mortality rates associated with these symptoms are more pronounced in men than women (Naicker et al., 2017). ...
Article
Objective To determine if symptoms of depression and anxiety are differentially associated with clinical diabetes measures and self-management behaviours in individuals with Type 2 diabetes, and whether these associations vary by patient sex. Research Design and Methods A cross-sectional analysis using data from 2,035 adults with Type 2 diabetes in the Nord-Trøndelag Health Study. Multivariate logistic regression was used to explore associations between symptoms of depression and anxiety and waist girth, HDL cholesterol, systolic blood pressure, triglycerides, c-reactive protein, glycemic control, diet adherence, exercise, glucose monitoring, foot checks for ulcers, and the subjective patient experience. Analyses were stratified by sex. Results Depression was associated with a lower likelihood of avoiding saturated fats (OR = 0.20 [95% CI: 0.06, 0.68]) and increased odds of physical inactivity (OR = 1.69 [95% CI: 1.37, 2.72]). Anxiety was associated with increased odds of eating vegetables (OR = 1.66 [95% CI: 1.02, 2.73]), and an over two-fold increase of feeling that having diabetes is difficult. In women, anxiety was associated with elevated c-reactive protein levels (OR = 1.57 [95% CI: 1.05, 2.34]). In men, depressive symptoms were associated with elevated HbA1c (OR = 5.00 [95% CI: 1.15, 8.23). Conclusions Symptoms of depression and anxiety were differentially associated with some key diabetes-related measures. Our results suggest sex-specific differences with respect to two important clinical outcomes (i.e., anxiety and CRP in women and depression and glycemic control in men). These findings should alert practitioners to the importance of detection and management of psychological symptoms in individuals with Type 2 diabetes.
... Another notable finding was that males participated in a significantly greater number of Trialogue Meetings than females across the study period; while fewer males participated in Trialogue Meetings overall, males returned to more Trialogue Meetings than their female counterparts. This is striking in light of the prevalent findings in the broader literature that men tend to engage in less help-seeking behaviours for both mental health (MacSwain et al., 2009;Tamres et al., 2002) and physical health (Courtenay, 2014;Evans et al., 2005;Liang et al., 1999;Parslow et al., 2004) problems than women. This has typically been attributed to culturally conditioned gender stereotypes of masculinity, where help-seeking may undermine men's sense of independence and self-sufficiency (Courtenay, 2000a, b;McCreary et al., 2005;Courtenay, 2014). ...
Article
Purpose – The purpose of this paper is to evaluate the usefulness of the first Trialogue Meetings throughout Ireland for individuals from mental health communities by using a participatory action research (PAR) framework. Design/methodology/approach – Seven communities participated in monthly Trialogue Meetings as a community-based PAR project. A mixed-methods PAR evaluation was performed on data from 48 participants (service users, service providers, family members/friends and interested community members) who participated in the final Trialogue Meetings. Findings – Participants identified that Trialogue increased knowledge/awareness of mental health, irrespective of gender, mental health role, age or employment status. Trialogue Meetings provided a supportive environment for many, where men may be comfortable talking and where service providers may benefit from exposure to broader perspectives on mental health. Participants also perceived that Trialogue Meetings deconstructed pre-existing mental health power structures, allowed them to understand mental health from different perspectives and express themselves better. Research limitations/implications – The study identifies barriers to Trialogue efficacy such as low service provider engagement and political dynamics extraneous to the meetings themselves. Practical implications – Where desirable conditions are present, Trialogue Meetings appear to be sustainable community development initiatives where pre-existing mental health power dynamics may be levelled and knowledge/communication surrounding mental health may be enhanced. Originality/value – This is the first large-scale evaluation of the innovative Trialogue method among mental health stakeholders using a PAR approach.
... Existing evidence on the demographic characteristics of health-anxious individuals is not consistent regarding differences in the prevalence of the disorder related to gender or age. While there was no evidence for gender differences in HA in a series of previous reports (American Psychiatric Association, 2013; Barsky, Wyshak, Klerman, & Latham, 1990;Gureje, Üstun, & Simon, 1997;Leibbrand, Hiller, & Fichter, 2000), there is one study reporting a significant difference between genders, with women reporting higher levels of HA, compared to men (MacSwain et al., 2009). Regarding age, existing evidence linked younger age to hypochondriasis (Magariños, Zafar, Nissenson, & Blanco, 2002), whereas other studies reported nonsignificant correlations between age and hypochondriasis (Barsky, Frank, Cleary, Wyshak, & Klerman, 1991;Leibbrand et al., 2000). ...
Chapter
Severe health anxiety is the preoccupation that one has or will acquire a severe medical disease and impairs individual’s functioning in the psychological, social, professional, and other domains of daily life. This chapter briefly describes this category of symptomatology in terms of epidemiology, predispositional factors, and impact, and it focuses on reviewing the mechanisms that were linked to the maintenance of health anxiety, which stem from the cognitive-behavioral conceptualization and existing empirical evidence. In addition, this chapter introduces a mechanism that potentially buffers the impact of health anxiety on individual’s functioning and provides an overview of behavioral and cognitive approaches in therapy. Directions for future research in areas that warrant further investigation are also provided.
... In addition, the sample size in the current study precluded examination of the IGS-10 by gender, which may be an important future direction given that gender differences in gambling motives () have been found. Prior to examining broad gender differences on this questionnaire, however, it is critical that future work in this area first test the structural integrity (i.e., invariance) of the IGS-10 across gender (see Grant et al. 2007; MacSwain et al. 2009). A larger sample size will be needed for such an examination, as well, as larger sample size would permit other potential group differences, such as differences across race/ethnicity. ...
Article
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The Inventory of Gambling Situations (IGS-63; Turner and Littman-Sharp, Inventory of gambling situations users guide, 2006) is a 63-item measure of high-risk gambling situations. It assesses gambling across 10 situational subscales that load onto two higher-order factors: negative and positive situations (Stewart et al. Psychology of Addictive Behaviors, 22:257-268, 2008). While the IGS-63 has excellent psychometric properties (Littman-Sharp et al., The Inventory of Gambling Situations: Reliability, factor structure, and validity (IGS Technical Manual), in press) its length may preclude its use in time-limited contexts. The purpose of this study was to develop and validate a 10-item short-form of the IGS (IGS-10). Each IGS-10 item reflects one of the ten subscale categories from the IGS-63, with two items from the original subscales included as examples for each IGS-10 item. The IGS-10 was administered to 180 undergraduate gamblers along with the IGS-63 and the Problem Gambling Severity Index (PGSI; Ferris and Wynne, Canadian Problem Gambling Index: Final report, 2001). IGS-10 items showed convergent validity with the corresponding IGS-63 subscales (r's = .60-.73). Principal components analysis of the IGS-10 revealed two factors: negative (α = .84) and positive (α = .85). PGSI scores correlated significantly with all IGS-10 items (r's = .33-.58) and with both IGS-10 higher-order subscales (r's = .66 [negative] and .49 [positive]), supporting the criterion validity of the IGS-10. Since minimal information is lost when using the IGS-10, the short form may prove particularly useful when respondent burden prevents using the full IGS-63.
... Each factor of this first-order model (i.e., Cognitive, Perceptual, Affective, and Behavioral) is hypothesized to account for the common variability among items that represent it, (2) a second-order measurement model assuming that MIHT items are determined by four first-order factors that are, in turn, explained by one higher-order factor representing the global hypochondriacal traits construct. Such a model was fitted to MIHT data by MacSwain et al. (2009), and by Stewart et al. (2008), and (3) a bifactor model in which all the items of the MIHT were simultaneously determined by a general factor and each of their respective domain-specific factors. All these factors are assumed to not correlate with each other. ...
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In this article, we present an Arabic adaptation and validation of the Multidimensional Inventory of Hypochondriacal Traits (MIHT). This measure is based on the cognitive-behavioral model of health anxiety. For this purpose, two studies (i.e., validation and cross-validation), using three independent samples (i.e., community samples and clinical sample), were carried out. The two studies failed to confirm the 4-factor model of the MIHT. Consequently, we proposed a short-form of the scale containing the items with factor loadings ≥ .60 (i.e, a 17-item MIHT-SF). Confirmatory factor analyses supported the 4-factor structure of the MIHT-SF. The MIHT-SF scores demonstrated good reliability and were significantly and positively related to negative affectivity and perceived stress. Results of the receiver operating characteristic (ROC) curve analysis indicated good accuracy of the MIHT-SF. Using a cutoff score of 63.50, the MIHT-SF can be prudently used as a screening tool for pathological hypochondriasis (sensitivity = .64, specificity = .74, and accuracy = .74). In conclusion, the results of this study provide validity evidence for the MIHT-SF as a measure of hypochondriasis, and thus, could be utilized in research and clinical settings.
... An early study conducted by Noyes et al. (2003) found a weak-to-modest negative correlation (r = 0.2-0.3) between the quality of patient-doctor encounter and health anxiety, suggesting there is an interpersonal element to health-related anxiety. An interpersonal model of health anxiety, which views health anxiety as a maladaptive behavioral manifestation of attachment insecurity developed from one's early years, has found increasing empirical support in recent years (MacSwain et al., 2009;Birnie et al., 2013;Sherry et al., 2014). Given that people with high health anxiety are more likely to seek help from medical professionals, many studies on health anxiety were conducted in primary care settings (Robbins and Kirmayer, 1996;Gureje et al., 1997;Escobar et al., 1998;Toft et al., 2005;Hanel et al., 2009). ...
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Background: Little research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM). Methods: The participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data. Results: We found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety-driven treatment seeking as measured by annual clinic visits. Conclusion: These findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).
... Each domain of this model, i.e. affective, perceptual, cognitive, and behavioral is considered among each item to account for common variability. A similar model is tested and fit by (MacSwain et al., 2009). Factor loading values were computed on each item, and based on factor loadings, the validity coefficients were confirmed. ...
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There is a desperate need in Arab societies for an accurate tool to assess Illness Anxiety Disorder (IAD) or hypochondriasis symptoms. This research aims to verify the Arabic variant of the Hypochondriacal Traits Multidimensional Inventory (MIHT) and its psychometric validation. The original American version of the MIHT translated from the English-language into the Arabic language and conducted on a non-clinical sample of 300 seniors and junior university students. An exploratory factor analysis (EFA) was performed in SPSS software using varimax rotation method via Principal Component Analysis. The results found that 31-itesm of four factor health anxiety domains fit into the health anxiety assessment model, i.e. Affective, Perceptual, Behavioral, and Cognitive domain. To validate the Arabic version of MIHT, EFA analysis was performed which confirms the validity of the instrument. Further, the percentiles were computed as norms for row scores, and the prevalence of IAD was found as 2%. The research developed the Arabic version of MIHT and validated its applicability on IAD. This study's implication is originally centered on Arabic speakers to diagnose the disorder; however, this would also contribute to developing more Arabic research in this field.
... Secondary complications of surgical interventions including [6] postoperative pain prediction, separation from the family, loss of independence, and fear of surgery and death are among the most common causes of preoperative anxiety [10]. In this regard, anxiety in women is reported to be more likely than men [11]. ...
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Background Anxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects. Objectives The purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open heart surgery. Method This is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoint over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study. Results The results showed that before acupressure,there was no statistically significant difference between state anxiety scores and intergroup traits (p-value˃0.05), and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group (p-value˂0.05), but these changes in the control group did not show a statistically significant difference (p-value˃0.05).After completing the second phase of the intervention at the actual sites, systolic blood pressure (p-value=0.007) and heart rate (p-value=0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups (p-value >0.05). Conclusion Based on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety.
... The results of these studies indicate that people always do something to alleviate the discomfort caused by intrusive cognitions, regardless of their frequency and the discomfort they cause (Belloch, Roncero & Perpiñ a, 2012Garc ıa-Soriano & Belloch, 2013;Giraldo-O'Meara & Belloch, 2018;Pascual-Vera et al., 2019;Pascual-Vera & Belloch, 2018b). It is important to note that the consequences associated with the illness-ITs were more negative for women than for men, a result that agrees with studies reporting that women with IAD use more reassurance-seeking than men (MacSwain et al., 2009). Greater discomfort associated with illness-ITs in women has also been found in studies with non-clinical participants Table 3. Coefficients, standard errors (SE), and confidence intervals (CI) of the parallel multiple mediation for dysfunctional appraisals associated with a highly upsetting illness-IT, its frequency, and IAD symptoms (Arn aez et al., 2017), as well as in studies investigating different contents of intrusive cognitions (obsessional, eating disorder-related, and appearance defect-related; Pascual-Vera & Belloch, 2018a;2018b). ...
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Introduction: Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. Methods: Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage = 32.74 [SD = 9.69]). Their severity was assessed with the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale -Modified version, with scores ranging from 15 to 58 (M = 46.12, SD = 9.41). Results: Illness-ITs are common in both non-clinical individuals and in patients with IAD, and they instigate dysfunctional emotional, cognitive, and behavioral consequences, although with greater intensity in patients than in non-clinical individuals. The relationship between illness-ITs and IAD is mediated by overestimation of threat and thought-action fusion-probability appraisals. Conclusion: Illness-ITs are a dimensional cognitive experience. The way they are appraised facilitates their escalation into symptoms of IAD. Practitioner points: Provides support for the cognitive explanatory model of IAD and its usefulness in clinical practice. Indicates that the way people interpret and react to naturally occurring intrusive thoughts about illness seems to be a vulnerability marker for developing an illness anxiety disorder. Emphasizes that the meaning that patients with IAD ascribe to their intrusive thoughts about illnesses must be a main target in the cognitive-behavioral treatment of IAD. Suggests that the importance of intrusive thoughts in IAD does not lie in the frequency with which they are experienced, but in the way, they are appraised/interpreted, which is what determines whether they become a clinically significant symptom. Indicates that the relationship between illness intrusive thoughts and IAD symptoms in non-clinical individuals is based on: overestimating the negative consequences of experiencing an illness intrusive thought; and the appraisal that having such a thought would increase its likelihood of coming true. Shows that the frequency of illness-related intrusive cognitions is associated with worse cognitive and behavioral consequences.
... As different countries are affected differentially by the COVID-19 pandemic, and media reports as well as legal restrictions differ among countries, this fear might differ among countries. Furthermore, women have reported higher levels of health-related fears than men [20] and a recent study showed that fear was reported more frequently by women (67%) than men (33%) when asked which emotions they felt at the time of the COVID-19 pandemic [21,22]. Gender differences were also revealed to exist with regard to the prevalence of posttraumatic stress symptoms after the COVID-19 outbreak in China, with stronger emotional changes in women [23]. ...
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Psychotherapists around the world are facing an unprecedented situation with the outbreak of the novel coronavirus disease (COVID-19). To combat the rapid spread of the virus, direct contact with others has to be avoided when possible. Therefore, remote psychotherapy provides a valuable option to continue mental health care during the COVID-19 pandemic. The present study investigated the fear of psychotherapists to become infected with COVID-19 during psychotherapy in personal contact and assessed how the provision of psychotherapy changed due to the COVID-19 situation and whether there were differences with regard to country and gender. Psychotherapists from three European countries: Czech Republic (CZ, n = 112), Germany (DE, n = 130) and Slovakia (SK, n = 96), with on average 77.8% female participants, completed an online survey. Participants rated the fear of COVID-19 infection during face-to-face psychotherapy and reported the number of patients treated on average per week (in personal contact, via telephone, via internet) during the COVID-19 situation as well as (retrospectively) in the months before. Fear of COVID-19 infection was highest in SK and lowest in DE (p < 0.001) and was higher in female compared to male psychotherapists (p = 0.021). In all countries, the number of patients treated on average per week in personal contact decreased (p < 0.001) and remote psychotherapies increased (p < 0.001), with more patients being treated via internet than via telephone during the COVID-19 situation (p < 0.001). Furthermore, female psychotherapists treated less patients in personal contact (p = 0.036), while they treated more patients via telephone than their male colleagues (p = 0.015). Overall, the total number of patients treated did not differ during COVID-19 from the months before (p = 0.133) and psychotherapy in personal contact remained the most common treatment modality. Results imply that the supply of mental health care could be maintained during COVID-19 and that changes in the provision of psychotherapy vary among countries and gender.
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The Reassurance Questionnaire (RQ; Speckens, Spinhoven, Van Hemert, & Bolk, (200020. Speckens , A. E.M. , Spinhoven , P. , Van Hemert , A. M. and Bolk , J. H. 2000. The reassurance questionnaire (RQ): Psychometric properties of a self-report questionnaire to assess reassurability. Psychological Medicine, 30: 841–847. [CrossRef], [PubMed], [Web of Science ®], [CSA]View all references) is a self-report measure designed to assess the extent to which patients feel reassured by their attending physicians. While the original RQ was validated in Dutch, the invariance of the factor structure has not been examined in the English version of the RQ. In the current study, the English RQ was completed by university (n = 459), community (n = 244), and medical samples (n = 281). Unlike the original one-factor solution found for the Dutch RQ, a two-factor solution for the English RQ was found for all three samples. The two factors were labeled: (1) Doubt in Physician, and (2) Persistent Health Anxiety. Item loadings were invariant across the community and medical samples. Implications of the findings along with directions for future research are discussed.
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Worrying about health and diseases is a mostly circumstantial, moderate and transient concern. But, health worries can heat up to become excessive, persistent and pathological, despite some attempts to cope with it (reassurance seeking, bodily checking, avoidance of illness situations). Between ordinary health concerns and hypochondriasis, clinical slight differences should be identified. Although they are not described in international classifications, they cause psychological distress and/or health-related risk-taking. Still little known and used in France, the concept of health anxiety emphasizes this clinical diversity. This literature review aims to specify this concept in describing the nature of cognitive and behavioral factors that initiate, reinforce and perpetuate anxiogenic process, but also emphasizes the clinical relevance of the concept of health anxiety.
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Although worry is central to the diagnosis of generalized anxiety disorder (GAD), it is also commonly observed in other anxiety disorders. In this meta-analytic review, we empirically evaluated the extent to which worry is specific to GAD relative to patients with other anxiety disorders, those with other psychiatric disorders, and nonpsychiatric controls. A total of 47 published studies (N=8,410) were included in the analysis. The results yielded a large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among anxiety disorder patients v. nonpsychiatric controls (d=1.64). In contrast to the many differences emerging from comparisons between anxiety disordered patients and nonpsychiatric controls, when anxiety disordered patients were compared to people with other psychiatric disorders they differed only on severity/frequency and not on meta-worry or domains of worry. A large effect size indicating greater severity/frequency of worry, meta-worry, and domains of worry among patients with GAD v. nonpsychiatric controls was also found (d=2.05). However, differences between GAD and those with other psychiatric disorders also emerged for severity/frequency of worry. GAD was associated with greater worry difficulties than other anxiety disorders, which generally did not differ from those with other psychiatric disorders and each other. The implications of these findings for conceptualizing worry in GAD and other anxiety disorders, and the potentially moderating effects of age and gender are discussed.
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L’anxiété envers la santé est une forme d’anxiété très particulière, faisant actuellement l’objet d’un nombre considérable de travaux scientifiques et d’essais cliniques en découlant. Elle se caractérise par une hypervigilance envers les sensations physiques, couplée à une propension à les interpréter systématiquement comme les signes avant-coureurs d’une maladie somatique grave. Ce processus tend à générer des peurs et des inquiétudes très spécifiques et envahissantes, contre lesquelles le sujet lutte en mobilisant des stratégies de coping dysfonctionnelles. Le concept d’anxiété envers la santé rend compte de toute une diversité clinique, allant de simples inquiétudes relatives à l’état de santé jusqu’à l’hypocondrie, en passant par des formes plus modérées susceptibles d’avoir des répercussions plus ou moins négatives, tant sur la santé que sur le bien-être des individus. Ainsi, il paraît primordial de prendre en charge le plus efficacement possible les formes modérées et sévères d’anxiété envers la santé. L’objectif principal des prises en charge cognitivo-comportementales est principalement d’agir sur les facteurs de maintien des formes sévères d’anxiété envers la santé. Il s’agit de lutter contre des comportements excessifs d’évitement et de recherche de réassurance, d’une part, et de modifier ou d’assouplir les croyances dysfonctionnelles concernant les sensations et les modifications corporelles, ainsi que la vulnérabilité personnelle face à la maladie, d’autre part. Cet article vise à présenter les connaissances les plus récentes portant sur la prise en charge cognitivo-comportementale des formes modérées à sévères d’anxiété envers la santé.
Background: Health anxiety is common, impairing, and costly. The role of catastrophizing of bodily sensations (i.e. rumination about, overconcern with, and intolerance of bodily sensations) in maintaining health-related anxiety (i.e. anxiety about perceived health problems) is important, but understudied, in the health anxiety literature. Aims: The present study investigates the role of catastrophizing of bodily sensations as a maintenance factor for health-related anxiety over time. Method: Undergraduates (n = 226 women; n = 226 men) completed a baseline assessment, 14-day daily diary study, and 14-day longitudinal follow-up. Results: Path analysis indicated catastrophizing of bodily sensations maintains health-related anxiety from one month to the next in both men and women. Conclusions: The present study bridges an important gap between theory and evidence. Results support cognitive behavioral theories and extend cross-sectional research asserting catastrophizing of bodily sensations maintains health-related anxiety over time. A cyclical, self-perpetuating pattern was observed in the present study wherein catastrophizing of bodily sensations and health-related anxiety contribute to one another over time. Results also suggest targeting catastrophizing of bodily sensations may reduce health-related anxiety.
Article
Objective: To examine the role of 3 dimensions of Health Locus of Control (HLOC) on the relationship between health anxiety and illness behavior. Methods: Cross-sectional survey study of 202 college women. Path analysis and bootstrapping techniques were used to test the significance of mediated models. Results: The indirect effect of Powerful Others HLOC was significant (β = .06, p < .001), and together health anxiety and Powerful Others HLOC explained 27% of the variance in illness behavior. Conclusion: Health anxiety and illness behavior are common problems in college women, and that Powerful Others HLOC is a key mechanism underlying the relationship between health anxiety and illness behavior.
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Intolerance of uncertainty (IU)-a multidimensional cognitive vulnerability factor-is associated with a variety of anxiety disorders and health anxiety (HA). To date, few studies have assessed whether IU dimensions (prospective and inhibitory IU) are differentially associated with HA and whether their contributions are independent of anxiety sensitivity (AS). This study addressed these issues using independent community (n = 155; 81% women) and undergraduate (n = 560; 86% women) samples. Results indicated that prospective IU, but not inhibitory IU, had significant positive associations with HA in community dwellers and undergraduate students. AS somatic and cognitive concerns were also significant predictors among both samples. In addition, severity of IU dimensions among individuals reporting elevated HA were compared against individuals diagnosed with generalized anxiety disorder, social anxiety disorder, panic disorder, and obsessive-compulsive disorder. Results indicated minimal differences between those with elevated HA and each of the anxiety disorder diagnoses. Findings lend support to the unique transdiagnostic nature of IU and support commonalities between HA and anxiety disorders.
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Anxiety is an innate human response to situations that cause fear, worry or concern. One such type is health anxiety. Health anxiety is a term derived from hypochondriasis and divided into two disorders: illness anxiety disorder and somatic symptom disorder. Symptoms can range from mild-to-moderate expressions of worry to clinical diagnoses. Previous research has shown pregnancy-specific anxiety to be an autonomous anxiety disorder. When a woman conceives, immediate somatic changes are experienced, and although all pregnancies are different, these changes could cause either illness anxiety disorder or somatic symptom disorder. This review explores the possibility of pregnancy-specific health anxiety in greater detail.
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This study examined the relationship between childhood abuse experiences and health anxiety in adulthood and investigated the role of attachment in this relationship. In total, 181 university students (aged 18–29 years) completed a battery of measures that assessed childhood abuse, health anxiety, and attachment orientation. Health anxiety was associated with all categories of childhood abuse and overall childhood abuse severity. Anxious attachment partially mediated the relationship between overall childhood abuse and health anxiety in adulthood. The results further our understanding of the relationship between childhood abuse and health anxiety in adulthood and provide support for the interpersonal model of health anxiety.
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Current diagnostic criteria suggest that some individuals experience health anxiety and severe somatic symptoms, whereas others experience health anxiety and either no or mild somatic symptoms. However, to date, our understanding of potential differences among individuals with health anxiety and varying severity of somatic symptoms remains limited. Adopting a dimensional approach, we completed this study to help fill this gap in the literature by examining whether the interactive effect between health anxiety and somatic symptoms was related to health-related beliefs among men (n = 211) and women (n = 220). Among both men and women, health anxiety was related to certain health-related beliefs, particularly anxiety sensitivity, only when coupled with severe somatic symptoms. Conceptual and therapeutic implications of these results are discussed.
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This present study examined the specificity of disgust sensitivity in predicting health-related anxiety and behavioral avoidance. Participants (n = 60) completed self-report measures of disgust sensitivity, health anxiety, anxiety, and depression. They then completed three randomly presented health-related behavioral avoidance tasks (BATs) that consisted of potential exposure to the common cold, the flu, and mononucleosis. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the health-related BATs. This association also remained largely intact after controlling for gender, anxiety, depression, and health anxiety. These findings indicate that disgust sensitivity has a specific and robust association with health-related anxiety and avoidance commonly observed among those with excessive health anxiety and obsessive compulsive disorder. The unique role of disgust sensitivity in relation to health anxiety is discussed in the context of a disease-avoidance model. Published by Elsevier Ltd.
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Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.
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Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily‐life activities. The current two studies sought to explore: (i) the factor‐structure of the Italian version of the Cyberchondria Severity Scale; and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health‐related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five‐factor structure, with the resulting scales demonstrating good internal consistency, five‐week test‐retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain (“thoughts are uncontrollable”) shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between “thoughts are uncontrollable” and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.
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Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates. Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12. Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings. Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.
Article
Health anxiety is commonly seen in medical clinics and is related to the overutilization of primary care services, but existing studies have not yet considered the possible moderating effect of age. We examined if age moderated the association between health anxiety and medical utilization. A secondary aim was to examine potential racial/ethnic differences in health anxiety. An ethnoracially diverse group of patients (N = 533) seeking treatment from a primary care clinic completed a self-report measure of health anxiety. Three indices of medical utilization were assessed using medical records, including the number of: (a) clinic visits over the past two years, (b) current medications, and (c) lab tests over the past two years. Age moderated the effect of health anxiety on multiple indices of medical utilization. Supplemental analyses found that the moderating effect of age was specific to a somatic/body preoccupation, rather than health worry, dimension of health anxiety. Mean-level differences in health anxiety were either not supported (health anxiety composite, somatic/body preoccupation) or were small in magnitude (health worry) among self-identifying Black, Latino, and White participants. Results indicate that assessing for health anxiety could be particularly important for older adult patients who frequently seek out medical services.
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Medical student syndrome is related to health anxiety and the amount of specialized knowledge of students. This study conducted to examine medical student syndrome on Vietnamese psychology students when they are studying courses related to clinical psychology and psychotherapy. This study used Medical Students Syndrome Questionnaire including 5-item Medical Students' Disease Perception Scale and 5-item Medical Students' Disease Distress Scale, and Health Anxiety Questionnaire to survey 249 psychology students from the Ho Chi Minh University of Education and The University of Danang – University of Science and Education in Ho Chi Minh City and Danang City, Vietnam. The findings of our study showed that the number of clinical courses had predictive power on Medical student syndrome. Students participating in more than one clinical course were more likely to increase distress. Besides, the results also indicated that Medical Students Syndrome and health anxiety were significantly and positively correlated.
Conference Paper
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The Problem of the Study: The presence of health anxiety affects people in many areas of their lives. With the advancement of technology, the number of resources to obtain information about health and disease has increased. In this period of information pollution, easy access to resources can adversely affect health of individuals. Purpose of the Study: In this study, it was planned as descriptive in order to determine the health anxiety levels of the students. Method: In this study, sampling method and quantitative research design were used. 18-item Health Anxiety Scale, developed by Salkovskis et al. (2002) was used. The data obtained from the survey were analyzed in SPSS version 21 program. The analyzes performed in the study were T test, Anova test, descriptive analysis and Correlation analysis. The Cronbach Alpha value of the study was found as 0,83. Health Management, nursing, nutrition and dietetics, child development and social service students of Selcuk University Faculty of Health Sciences were included in the study. The universe of the study is 3500 people and the sample consists of 413 people. Findings and Results: According to the findings obtained from the study, there was no significant difference between the gender and health anxiety status of the students, whereas there was a significant difference between the Departments of the students and the health anxiety status. According to the results obtained from the study, health anxiety levels of nursing students were higher than those of Child Development and social work.
Article
Psychological screening is essential within primary care settings, with growing evidence that health anxiety could be important to screen for in such settings. Brief screeners in primary care settings are considered most viable for routine use. This study provided the first known examination of a version of the Whiteley Index (WI; Pilowksy, 1967) as a screener for primary care patients who are experiencing DSM-5 presentations of severe health anxiety (i.e., somatic symptom disorder, illness anxiety disorder). A six-item short form of the WI (i.e., WI-6), with item responses made using an ordered-category response option, was examined. Consecutively enrolled U.S. patients presenting for treatment at a community health center (N = 202) completed the WI-6 and a semi-structured interview assessing clinically severe health anxiety in the form of somatic symptom disorder and illness anxiety disorder. A total of 61 participants met criteria for clinically severe health anxiety and were compared to patients who did not meet criteria for clinically severe health anxiety. Results from a receiver operating characteristic (ROC) analysis indicated that a cutoff score of 18 on the WI-6 adequately balanced sensitivity (75%) and specificity (77%). The area under the curve (AUC) indicated the WI-6 did a reasonable job discriminating between the two groups (AUC = 0.83, p < .001, 95% confidence interval = 0.77-0.89). Study results offer preliminary support for the WI-6 as a practical screener for identifying cases of severe health anxiety in U.S. primary care settings that may warrant further evaluation.
Article
As the number of individuals with dementia and exposure to dementia increases, worrying about dementia may threaten individuals' health and lifestyle. This cross-sectional study compared dementia worry and related factors between middle-aged and older adults in South Korea. A self-reported descriptive survey or face-to-face interview was conducted with 154 middle-aged adults (mean age = 55.8 years; 64.3% women) and 51 older adults (mean age = 71.3 years; 52.9% women) in South Korea. Older adults were more worried about dementia than middle-aged adults. For middle-aged adults, compared to their counterparts, being a female, having less than a high school education, and having lower family function was associated with more dementia worry. Contrastingly, for older adults, having more diseases, having lower family function, and being economically dependent was associated with more dementia worry. Health care providers should consider individuals' age and family function to develop a program that addresses dementia worry in Asian cultures. [Research in Gerontological Nursing, xx(x), xx-xx.].
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Background and objectives: Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty. Methods: Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit. Results: Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity. Conclusions: These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
Article
Emotion reactivity, defined as heightened sensitivity, intensity, and persistence of emotional states, has been shown to contribute to the exacerbation of anxiety. However, the association between emotion reactivity and health anxiety has yet to be examined. The aim of the present investigation was to examine the unique predictive ability of emotion reactivity in terms of health anxiety in a sample of medically healthy undergraduates ( n = 194; 59.3% female, Mage = 19.42, SD = 1.51, range = 18-26 years; 84.0% Caucasian). Findings indicated that, after controlling for the effects of gender, age, and anxiety sensitivity, greater emotion reactivity significantly predicted greater overall health anxiety (3.1% variance), as well as higher levels of affective (4.1% unique variance) and behavioral (4.8% unique variance) components. Findings suggest that experiencing emotions more frequently, intensely, and for longer durations of time prior to returning to baseline are associated with greater health preoccupations.
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To test Coyne's (1976b) theory of depression, students' levels of depressive symptoms, reassurance seeking, and self-esteem were assessed at Time 1, and their same-gender roommates' appraisals of them were assessed 5 weeks later. Mildly depressed students engaged in the type of reassurance seeking described by Coyne. Among men, but not women, mildly depressed students were rejected if they strongly sought reassurance and had low self-esteem but not if they did not seek reassurance or had high self-esteem. Although induction of depressed symptoms in roommates did occur, this contagion effect did not account for the depression-rejection relationship. The prediction that unsupportive, intolerant, or unempathic others would be particularly likely to respond with rejection to reassurance-seeking depressed students with low self-esteem received partial support. Implications for future work on the interpersonal aspects of depression are discussed.
Article
The Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley, Watson, & Noyes, 2005) appears to address shortcomings of other common measures of health anxiety, but further research is required prior to using this measure in treatment planning and outcome assessment. This study was designed to explore the hierarchical structure of this health anxiety measure and relations of the various MIHT health anxiety components to anxiety sensitivity. A sample of 535 university students (362 women) was administered the 31-item MIHT and the 16-item Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986). Confirma-tory factor analyses of participants' responses on the MIHT showed that this measure may be conceptualized either as involving four correlated factors (i.e., Affective, Cognitive, Behavioral, and Perceptual) or as being hierarchical in nature, with the four lower-order factors loading on a single higher-order global health anxiety factor. Correlational analyses revealed significant relations of anxiety sensitivity to each of the four MIHT subscales and to the MIHT total score. Of the three established anxiety sensitivity components, ASI Physical Concerns were most strongly and consistently related to the various dimensions of health anxiety on the MIHT. Additional analyses revealed that the ASI and MIHT are better represented as two correlated but independent traits as opposed to common manifestations of a single underlying trait. The
Article
Four meta-analyses were conducted to examine gender differences in personality in the literature (1958-1992) and in normative data for well-known personality inventories (1940-1992). Males were found to be more assertive and had slightly higher self-esteem than females. Females were higher than males in extraversion, anxiety, trust, and, especially, tender-mindedness (e.g., nurturance). There were no noteworthy sex differences in social anxiety, impulsiveness, activity, ideas (e.g., reflectiveness), locus of control, and orderliness. Gender differences in personality traits were generally constant across ages, years of data collection, educational levels, and nations.
Article
Four meta-analyses were conducted to examine gender differences in personality in the literature (1958-1992) and in normative data for well-known personality inventories (1940-1992). Males were found to be more assertive and had slightly higher self-esteem than females. Females were higher than males in extraversion, anxiety, trust, and, especially, tender-mindedness (e.g., nurturance). There were no noteworthy sex differences in social anxiety, impulsiveness, activity, ideas (e.g., reflectiveness), locus of control, and orderliness. Gender differences in personality traits were generally constant across ages, years of data collection, educational levels, and nations.
Article
Anxiety is a common human experience, and ranges in depth and intensity. The experience is most typically in response to life stressors, and may be temporary. However, many people experience anxiety symptoms in association with a diagnosable mental illness. Individuals with an anxiety disorder are functionally impaired by the condition that is beyond a reasonable temporary response to trauma, stress or danger Anxiety disorders are common in that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime (Kessler et al., 1994a). The US National Comorbidity Survey (NCS), a community prevalence study, found the following risk factors to be associated with a lifetime anxiety disorder: lower income, less education, living in the northeast and female sex. The likelihood of developing an anxiety disorder was 85% higher in women than men. Although there are many characteristics that differ among the anxiety disorders, the greater risk associated with being female is consistent across the various types of pathological anxiety. In this chapter, we review sex differences in the epidemiology, clinical characteristics and illness course for the anxiety disorders. Additionally, we discuss the influence of the premenstruum as well as gestation and delivery on the expression of anxiety disorders. We do not specifically address treatment issues; the reader is referred to Chapters 5, 8 and 9 for consideration of treatment issues pertinent to women Panic disorder Panic disorder is a pattern of brief but intense recurrent episodes of fear or discomfort that occur without a notable precipitant. © Cambridge University Press 2006 and Cambridge University Press, 2009.
Article
Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females ≤ 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence (47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.
Article
We used meta-analysis to examine recent studies of sex differences in coping. Women were more likely than men to engage in most coping strategies. The strongest effects showed that women were more likely to use strategies that involved verbal expressions to others or the self—to seek emotional support, ruminate about problems, and use positive self-talk. These sex differences were consistent across studies, supporting a dispositional level hypothesis. Other sex differences were dependent on the nature of the stressor, supporting role constraint theory. We also examined whether stressor appraisal (i.e., women's tendencies to appraise stressors as more severe) accountedfor sex differences in coping. We found some support for this idea. To circumvent this issue, we provide some data on relative coping. These data demonstrate that sex differences in relative coping are more in line with our intuitions about the differences in the ways men and women cope with distress.
Article
Interest in modeling the structure of latent variables is gaining momentum, and many simulation studies suggest that taxometric analysis can validly assess the relative fit of categorical and dimensional models. The generation and parallel analysis of categorical and dimensional comparison data sets reduces the subjectivity required to interpret results by providing an objective Comparison Curve Fit Index (CCFI). This study takes advantage of developments in the generation of comparison data to examine the robustness of taxometric analyses to unfavorable data conditions. Very large comparison data sets are treated as populations from which many samples are drawn randomly, placing the method on a firmer statistical foundation and increasing its run-time efficiency. The impressive accuracy of the CCFI was consistent with prior findings and robust across novel manipulations of asymmetry, tail weight, and heterogeneous variances. Analyses, an empirical illustration using Minnesota Multiphasic Personality Inventory (MMPI) hypochondriasis data, and discussion focus on the practical implications for differentiating categories and dimensions.
Article
The establishment of measurement invariance across groups is a logical prerequisite to conducting substantive cross-group comparisons (e.g., tests of group mean differences, invariance of structural parameter estimates), but measurement invariance is rarely tested in organizational research. In this article, the authors (a) elaborate the importance of conducting tests of measurement invariance across groups, (b) review recommended practices for conducting tests of measurement invariance, (c) review applications of measurement invariance tests in substantive applications, (d) discuss issues involved in tests of various aspects of measurement invariance, (e) present an empirical example of the analysis of longitudinal measurement invariance, and (f) propose an integrative paradigm for conducting sequences of measurement invariance tests.
Article
Measurement invariance is usually tested using Multigroup Confirmatory Factor Analysis, which examines the change in the goodness-of-fit index (GFI) when cross-group constraints are imposed on a measurement model. Although many studies have examined the properties of GFI as indicators of overall model fit for single-group data, there have been none to date that examine how GFIs change when between-group constraints are added to a measurement model. The lack of a consensus about what constitutes significant GFI differences places limits on measurement invariance testing. We examine 20 GFIs based on the minimum fit function. A simulation under the two-group situation was used to examine changes in the GFIs (ΔGFIs) when invariance constraints were added. Based on the results, we recommend using Δcomparative fit index, ΔGamma hat, and ΔMcDonald's Noncentrality Index to evaluate measurement invariance. These three ΔGFIs are independent of both model complexity and sample size, and are not correlated with the overall fit measures. We propose critical values of these ΔGFIs that indicate measurement invariance.
Article
An approximate statistical test is derived for the hypothesis that the reliability coefficients (Cronbach's ) associated with two measurement procedures are equal. Control of Type I error is investigated by comparing empirical sampling distributions of the test statistic with the theoretical model derived for it. The effect of platykurtosis in the test-score distribution on the test statistic is also considered.
Article
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.
Article
Psychological processes are critical to understanding self-assessed health. While the literature suggests that motivated or self-enhancing processes contribute to this understanding, such processes have not been adequately explored. In a sample of healthy young adults (n = 271; 49.1% female), we used structural equation modeling to examine whether trait anxiety (TA), hypochondriasis (H), and anxious attachment (AA) relate to self-assessed health through a motivated process of medical excuse-making. When each personality variable was examined individually, medical excuse-making partially mediated its relationship with self-assessed health. When the three individual difference variables were examined simultaneously, medical excuse-making partially mediated the relationship of TA and H with self-assessed health, but AA was no longer related to self-assessed health. All effects remained after statistically controlling reported medical conditions. Results suggest medical excuse-making substantially contributes to self-evaluations of health, particularly among anxiety-prone individuals.
Article
The number of studies using a modified Stroop task in the examination of health anxiety-related cognitive biases is limited, and their results are divergent. The use of research methods that preclude conscious processes is, however, essential. The purpose of the present two studies was to examine whether health anxiety is associated with information processing biases towards illness-related stimuli, as well as whether health anxiety interacts with perceived physical symptoms regarding such biases. In both studies a modified Stroop task was implemented. Fifty-one healthy university students in the first study, and 69 in the second study completed a modified Stroop task and filled out questionnaires regarding mood, state anxiety, health anxiety and perceived symptoms. According to the results of both studies, after controlling for positive and negative mood and state anxiety, individuals with higher levels of health anxiety displayed greater information biases towards illness-related words. Moreover, health anxiety did not interact with perceived physical symptoms, as shown in the second study. The implications of these findings are significant, not only as far as health anxiety is concerned, but also for everyday health-related behaviour.
Article
The present study investigated the contribution of demographic characteristics (age, gender, socioeconomic status [SES]) and symptom-perception variables to unexplained physical symptoms and health care utilization. In addition, the consequences of the use of four frequently applied symptom-detection methods for relations among study variables were examined. A group of 101 men and women were administered a standardized interview and several questionnaires. Their general practitioners (GPs) rated (un)explained symptoms and consultations over the previous year. Path analyses showed that direct and indirect effects on symptoms and GP consultations depend on method of symptom detection, the largest difference being between self-reported symptoms and registered symptoms. The model including self-reported common symptoms demonstrated the direct and indirect effects of the symptom-perception variables: chronic disease, negative affectivity, selective attention to bodily sensations, and somatic attribution. In the model including registered symptoms, only chronic disease and SES showed effects on symptoms and GP consultations. This study demonstrates the usefulness of a symptom-perception approach to the experience of unexplained symptoms, the importance of selection of a symptom-detection method, and the need for different models for the explanation of daily experienced symptoms and their presentation in health care.
Article
Although fear of death has been linked to hypochondriasis, the relationship of this fear to the disorder has received little study. To address this deficiency, we administered a fear of death scale along with measures of hypochondriasis, including the Whiteley Index and Somatic Symptom Inventory, to 162 general medical outpatients. Partial correlations, controlling for age, between the fear of death scale and both the Whiteley Index and Somatic Symptom Inventory were strongly positive. A factor analysis of the fear of death scale yielded three dimensions-fear of dying, loss of meaning, and fear of separation-that were also highly correlated with hypochondriasis. Fear of death and hypochondriasis showed comparable relationships to age and gender as well as to personality dimensions measured by the NEO Five-Factor Inventory. Fear of death appears to be an integral part of hypochondriasis. Its presence lends support to three models of hypochondriasis-the perceptual, existential, and interpersonal-that correspond to the dimensions of fear of death.
Article
The aim of this study was to test the interpersonal model of hypochondriasis proposed by Stuart and Noyes. According to this model, hypochondriasis is associated with insecure attachment that in adults gives rise to abnormal care-seeking behavior. Such behavior is associated with interpersonal difficulties and strained patient-physician relationships. One hundred sixty-two patients attending a general medicine clinic were interviewed and asked to complete self-report measures. Instruments included the Whiteley Index of Hypochondriasis, Somatic Symptom Inventory, Relationship Scales Questionnaire, Inventory of Interpersonal Problems, NEO Five-Factor Index, and measures of physician-patient interaction. The Structured Diagnostic Interview for DSM-III-R Hypochondriasis was also administered. Hypochondriacal and somatic symptoms were positively correlated with all of the insecure attachment styles, especially the fearful style. These same symptoms were positively correlated with self-reported interpersonal problems and negatively correlated with patient ratings of satisfaction with, and reassurance from, medical care. Hypochondriacal and somatic symptoms were also positively correlated with neuroticism. The findings indicate that hypochondriacal patients are insecurely attached and have interpersonal problems that extend to and include the patient-physician relationship. These data support the proposed interpersonal model of hypochondriasis.
Article
There is evidence that individuals high in hypochondriasis overestimate the likelihood of ambiguous symptoms being indicative of serious illness. However, it is not known whether this tendency is unique to hypochondriasis or whether it can be attributed to high negative affectivity or other anxiety symptoms often found to be comorbid with hypochondriasis. College students (N=133) completed measures of hypochondriasis, depression, anxiety, worry, avoidance and estimated the likelihood of various symptoms indicating catastrophic and minor illnesses. Even after entering the other self-report variables, hypochondriasis was the only variable to predict estimates of the likelihood of serious illness. Conversely, being female, high levels of negative affect, agoraphobic avoidance when accompanied by others and higher estimates about the likelihood of symptoms leading to catastrophic illnesses best predicted hypochondriasis scores. Dysfunctional beliefs about illness appear to be unique to hypochondriasis and to uniquely contribute to the prediction of hypochondriasis.
Article
This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples. A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings. In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders. On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.
Article
To test the effect of psychological intervention on multiple medically unexplained physical symptoms, psychological symptoms, and health care utilization in addition to medical care as usual. To identify patient-related predictors of change in symptoms and care utilization. In a randomized controlled trial, subjects were assigned to one of two conditions: psychological intervention by a qualified therapist plus care as usual by a general practitioner (GP) or care as usual only. Participants (N=98) were administered a standardized interview and several outcome measures at intake and after 6 months and 12 months after intake. GPs rated medically unexplained and explained symptoms and consultations over a period of 1 1/2 years. ANOVAs for repeated measures showed that self-reported and GP-registered unexplained physical symptoms decreased from pretest to posttest to follow-up. Psychological symptoms and consultations decreased from pretest to posttest. GP-registered explained symptoms did not decrease. However, intervention and control groups did not differ in symptom reduction. Path analysis revealed two paths to a decrease in self-reported unexplained physical symptoms: from more negative affectivity via more psychological attribution and more pretreatment anxiety, and from more somatic attribution via more psychological attribution and more pretreatment anxiety. Intervention and control groups did not differ in symptom reduction. Reduction of self-reported medically unexplained symptoms was well predicted by patient-related symptom perception variables, whereas the prediction of change in registered symptoms and consultations requires a different model.
Article
Unlabelled: The purpose of this study was to evaluate whether personality traits, as assessed by the Minnesota Multiphasic Personality Inventory (MMPI), at time of college entry can predict the number of reported pain conditions at an approximate 30-year follow-up for 2332 subjects, 1834 men and 498 women, who were administered the MMPI on entry to the University of North Carolina (Chapel Hill) between 1964 and 1966. In 1997, a follow-up was conducted in which subjects were administered a self-report questionnaire regarding whether they had experienced 1 or more chronic pain conditions. Analyses of the relationship between the MMPI clinical scales at college entrance and the report of number of chronic pain conditions at follow-up were conducted. Among male participants, elevations of Scales 1 (Hypochondriasis), 3 (Hysteria), and 5 (Masculinity/Femininity) predicted increases in number of chronic pain conditions at follow-up. For female participants, elevations in Scales 1, 3, and 6 (Paranoia) predicted increases in number of chronic pain conditions at follow-up. The current study suggests that a statistically significant relationship exists between MMPI responses at college entry and reports of chronic pain conditions at mid-life. Perspective: This study found a small, but significant relationship between elevations on MMPI scales measuring hypochondriasis and hysteria and the report of chronic pain conditions at follow-up. The study is important because it is the first to examine how personality assessed in younger adults relates to the number of chronic pain conditions reported 30 years later.
Article
Although hypochondriasis is associated with the costly use of unnecessary medical resources, this mental health problem remains largely neglected. A lack of clear conceptual models and valid measures has impeded accurate assessment and hindered progress. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) addresses these deficiencies with scales that correspond to a 4-factor model. The MIHT was built with construct validity as a guiding principle and began with an item pool that broadly assessed dimensions identified in the literature. The items were administered to large samples; factor analyses of the responses led to item pool revisions and scale refinements. Multiple studies validated the final MIHT scales and 4-factor model; these findings suggest that the MIHT will contribute to theory and research.
Medical excuse making and individual differences in self-assessed health
  • Fortenberry
Fortenberry, K., & Wiebe, D. (2007). Medical excuse making and individual differences in self-assessed health. Personality and Individual Differences, 43(1), 83-94.
Sex differences in coping behavior
  • L Tamres
  • D Janicki
  • V Helgeson
Tamres, L., Janicki, D., & Helgeson, V. (2002). Sex differences in coping behavior. Personality and Social Psychology Review, 6(1), 2-30.
Health anxiety and cognitive interference
  • E Karademas
  • S Christopoulou
  • A Dimostheni
  • F Pavlu
Karademas, E., Christopoulou, S., Dimostheni, A., & Pavlu, F. (2008). Health anxiety and cognitive interference. Personality and Individual Differences, 44, 1138–1150.
Treating health anxiety
  • S Taylor
  • G Asmundson
Taylor, S., & Asmundson, G. (2004). Treating health anxiety. New York: Guilford Press.
Health anxiety and cognitive interference
  • Karademas
Women and anxiety disorders
  • Ginsberg
Sex differences in coping behavior
  • Tamres
Hypochondriasis and fear of death
  • Noyes