Article

Anxious attachment and emotional instability interact to predict health anxiety: An extension of the interpersonal model of health anxiety

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

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.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... This elevated health-related vulnerability is likely rooted in maladaptive physiological processes (e.g., increased stress reaction) (Pietromonaco et al., 2013a(Pietromonaco et al., , 2013b and adverse relationship experiences (Feeney & Fitzgerald, 2019;Feeney & Karantzas, 2017;Pepping et al., 2018), which are more prevalent among insecurely compared to securely attached individuals. Further, more anxious individuals tend to be more sensitive to and concerned with their health status (Noyes et al., 2003;Sherry et al., 2014). Together, these factors might contribute to lower health satisfaction among insecurely-and particularly anxiously-attached individuals. ...
... Regarding anxiety, more anxiously attached individuals reported lower health satisfaction: either concurrently, as in the case of partnered individuals, or longitudinally, as observed for singles. This result is in keeping with the previous studies showing that anxious attachment is linked to worse physical health (Stanton & Campbell, 2014), which could be explained through disruptive relationship processes and adverse physiological responses (e.g., Feeney & Karantzas, 2017;Pietromonaco & Collins, 2017), as well as more anxious individuals' heightened sensitivity and concern with their health status (Noyes et al., 2003;Sherry et al., 2014). For singles, the maladaptive potential of anxiety rather unfolded in the long term. ...
... Based on research suggesting that more anxious individuals hold a greater fear of being single (Spielmann et al., 2013) and want more intimacy and closeness (e.g., Hudson & Fraley, 2017), their current single status might reflect a source of distress, that cumulates into long-term detriments in health satisfaction. In contrast, partnered individuals might display a concurrent link between anxiety and health satisfaction due to their ongoing maladaptive relationship processes (Pietromonaco et al., 2013a(Pietromonaco et al., , 2013b and health status concerns (Noyes et al., 2003;Sherry et al., 2014). However, these are only possible speculations on why these effects emerged for partnered individuals cross-sectionally and for single individuals longitudinally. ...
Article
Full-text available
Attachment has previously been linked to people’s health. However, less is known about how romantic attachment in currently partnered and single people predicts their health. The present study examines the association between romantic attachment and health outcomes at different timescales (i.e., cross-sectional and across 2 years) while considering individuals’ relationship status (i.e., partnered and single). The concurrent results based on 516 partnered individuals suggest that more anxious partnered individuals experience lower health satisfaction while more avoidant partnered individuals place less importance to their health. Our results suggest no long-term prediction of partnered individuals’ romantic attachment on their health satisfaction and health goal importance. For the results based on a sample of 173 singles, the picture was painted differently regarding the role of romantic attachment in their health: Avoidance was concurrently negatively linked to health satisfaction and health goal importance; yet, longitudinally, it emerged as a positive predictor for health satisfaction and health goal importance.
... This elevated health-related vulnerability is likely rooted in maladaptive physiological processes (e.g., increased stress reaction) (Pietromonaco et al., 2013a(Pietromonaco et al., , 2013b and adverse relationship experiences (Feeney & Fitzgerald, 2019;Feeney & Karantzas, 2017;Pepping et al., 2018), which are more prevalent among insecurely compared to securely attached individuals. Further, more anxious individuals tend to be more sensitive to and concerned with their health status (Noyes et al., 2003;Sherry et al., 2014). Together, these factors might contribute to lower health satisfaction among insecurely-and particularly anxiously-attached individuals. ...
... Regarding anxiety, more anxiously attached individuals reported lower health satisfaction: either concurrently, as in the case of partnered individuals, or longitudinally, as observed for singles. This result is in keeping with the previous studies showing that anxious attachment is linked to worse physical health (Stanton & Campbell, 2014), which could be explained through disruptive relationship processes and adverse physiological responses (e.g., Feeney & Karantzas, 2017;Pietromonaco & Collins, 2017), as well as more anxious individuals' heightened sensitivity and concern with their health status (Noyes et al., 2003;Sherry et al., 2014). For singles, the maladaptive potential of anxiety rather unfolded in the long term. ...
... Based on research suggesting that more anxious individuals hold a greater fear of being single (Spielmann et al., 2013) and want more intimacy and closeness (e.g., Hudson & Fraley, 2017), their current single status might reflect a source of distress, that cumulates into long-term detriments in health satisfaction. In contrast, partnered individuals might display a concurrent link between anxiety and health satisfaction due to their ongoing maladaptive relationship processes (Pietromonaco et al., 2013a(Pietromonaco et al., , 2013b and health status concerns (Noyes et al., 2003;Sherry et al., 2014). However, these are only possible speculations on why these effects emerged for partnered individuals cross-sectionally and for single individuals longitudinally. ...
Preprint
Attachment has previously been linked to people’s health. However, less is known about how romantic attachment in currently partnered and single people predicts their health. The present study examines the association between romantic attachment and health outcomes at different timescales (i.e., cross-sectional and across 2 years) while considering individuals' relationship status (i.e., partnered and single). The concurrent results based on 516 partnered individuals suggest that more anxious partnered individuals experience lower health satisfaction while more avoidant partnered individuals place less importance to their health. Our results suggest no long-term prediction of partnered individuals' romantic attachment on their health satisfaction and health goal importance. For the results based on a sample of 173 singles, the picture was painted differently regarding the role of romantic attachment in their health: Avoidance was concurrently negatively linked to health satisfaction and health goal importance; yet, longitudinally, it emerged as a positive predictor for health satisfaction and health goal importance.
... In a 32-year longitudinal study, anxious-resistant attachment during infancy was associated with adult endorsement of common syndromes involving physical symptoms (28). Adult attachment patterns characterized by high attachment anxiety have also been associated with health anxiety (29,30) and with symptoms (31,32). In a representative community sample, headache and back pain were endorsed more frequently by persons with dismissing attachment (i.e., high attachment avoidance and low attachment anxiety) (33). ...
... The second condition is that the mediating variable (e.g., attachment insecurity) influences the outcome variable (e.g., somatization) (40). Several studies report associations of insecure attachment to increased reporting of physical symptoms (28,31,32) or to health anxiety (29,30). ...
... Associations between adult insecure attachment, particularly attachment anxiety, and two aspects of somatization (physical symptoms and health anxiety) were found in both clinical and nonclinical cohorts. This corroborates and extends previous studies of clinical cohorts (29)(30)(31)(32). ...
Article
Full-text available
Objective: An attachment model was used to understand how maternal sensitivity and adverse childhood experiences are related to somatization. Methods: We examined maternal sensitivity at 6 and 18 months and somatization at 5 years in 292 children in a longitudinal cohort study. We next examined attachment insecurity and somatization (health anxiety, physical symptoms) in four adult cohorts: healthy primary care patients (AC1, n=67), ulcerative colitis in remission (AC2, n = 100), hospital workers (AC3, n=157), and paramedics (AC4, n=188). Recall of childhood adversity was measured in AC3 and AC4. Attachment insecurity was tested as a possible mediator between childhood adversity and somatization in AC3 and AC4. Results: In children, there was a significant negative relationship between maternal sensitivity at 18 months and age 5 somatization (B= -3.52, SE=1.16, t=-3.02, p=.003) while maternal sensitivity at 6-months had no significant relationship. In adults, there were consistent, significant relationships between attachment insecurity and somatization, with the strongest findings for attachment anxiety and health anxiety (AC1, Beta = .51; AC2, Beta = .43). There was a significant indirect effect of childhood adversity on physical symptoms mediated by attachment anxiety in AC3 and AC4. Conclusions: Deficits in maternal sensitivity at 18 months of age are related to the emergence of somatization by age five. Adult attachment insecurity is related to somatization. Insecure attachment may partially mediate the relationship between early adversity and somatization.
... Thus, avoidant patients would be expected to direct interpersonal caution towards physicians, favor autonomy, and avoid vulnerability; whereas anxiously attached patients, would approach the relationship with healthcare providers by seeking proximity and expressing dependence. 23,24 Taking these predictions into account, this study aimed to confirm and extend the aforementioned findings 13 by examining the relationship between patients' predisposed attachment orientations and their attachmentrelated attitudes, along with the link between these constructs and the WA. ...
... Patients' attachment-related attitude of support represents the extent to which patients feel that the patient-physician relationship provides a secure base for exploration and a safe haven to go back to when shelter is needed. [11][12][13]23 Additionally, this mediation also demonstrates the measurability of attachment-related attitudes within the patientoncologist relationship, as this is the first study to use a newly developed measure to do so. 13 These findings reflect another step towards fully exploring whether oncologists can serve as attachment figures for their patients. ...
Article
Objective Accumulating research suggests that the working alliance (WA) is a key component in the patient–oncologist relationship. Attachment theory provides a useful framework for understanding this alliance within the oncological setting, where patients' attachment systems are often activated. This study examined the association between attachment orientations of both dyad members (i.e., patient and oncologist) and patients’ WA experience. It also probed whether this link was mediated by patients’ attachment‐related attitudes towards the oncologist, using a recently developed measure. Method Oncologists and their respective patients (N=113: 103 patients, 10 oncologists) were sampled at oncological clinics. Eligible patients filled out online measures of the WA, attachment‐related attitudes, and attachment orientations. The later was also completed by oncologists. Results Structural equation modeling (SEM) demonstrated that both patients' and oncologists' avoidant attachment orientation inversely predicted patients' WA experience, via patients' experience of feeling unsupported by their oncologists. Conclusions Findings suggest that attributes of both members of the patient–oncologist dyad are related to patients' WA experience, and that attachment‐related attitudes towards oncologists occur within this relationship. Oncologists’ understanding of patients’ unique attachment behaviors, as well as their own such behaviors, could improve cancer patients' quality of care and illness outcomes. Results represent another step forward in fully exploring whether oncologists can serve as attachment figures for their patients. This article is protected by copyright. All rights reserved.
... Persons high in neuroticism tend to express more somatic complaints because they interpret bodily sensations as threats (Williams & Wiebe, 2000), and make negative appraisals, overreact to stress, and are introspective, all of which may contribute to health anxiety (Pennebaker & Watson, 1991). As a result, based on prior research (Longley et al., 2005;Noyes et al., 2003;Sherry et al., 2014), neuroticism was expected to be related to health anxiety dimensions. ...
... Contrary to what was expected, insecure attachment (anxious or avoidant attachment) was not directly related to worry. A study by Sherry et al. (2014) showed that anxious attachment was significantly related to hypochondriacal worry, but avoidant attachment was not. Reiser (2013) found that anxious attachment was not predictive of health anxiety, when additional variables (e.g., childhood abuse, emotion regulation, depression, anxiety sensitivity) were simultaneously included in regression models. ...
Article
Full-text available
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.
... When feeling anxious and agitated, their emotions can negatively influence their behavior and relationships with others (Dangwal & Srivastava, 2016). Emotional instability, also known as neuroticism in the Big Five Personality trait, refers to negative emotions such as anxiety, insecurity, moodiness, nervousness, and depression (Sherry et al., 2014). Numerous studies show that internet addiction causes not only physical and social problems but also creates a psychological disturbance that affects emotional instability and the Big Five Personality trait (Cerniglia et al., 2017). ...
Article
Full-text available
Background: Excessive internet usage has become a significant issue among adolescents and young adults, affecting their physical, mental, social, and emotional well-being. In the Pakistani context, this trend is particularly concerning due to limited digital literacy and awareness of the negative effects of internet overuse. Aim: This study aims to explore the impact of excessive internet usage on the emotional maturity of adolescents in Pakistan, analyzing how limitless internet access contributes to physical, mental, and social challenges among this age group. Methodology: The research adopts a qualitative approach, reviewing existing literature on internet abuse and its repercussions on the physical, mental, and emotional health of Pakistani adolescents. The study analyzes key factors contributing to the decline in emotional maturity due to excessive internet use. Results: The findings indicate that high levels of internet usage are closely associated with reduced emotional maturity among adolescents. This reduction is manifested through various issues, including increased mental stress, decreased physical activity, and deteriorated social relationships. Conclusion: The study concludes that excessive internet usage can significantly impact the emotional development and maturity of adolescents, leading to a range of mental, physical, and social problems. It underscores the need for interventions that promote balanced internet use and enhance emotional resilience among Pakistani youth.
... When feeling anxious and agitated, their emotions can negatively influence their behavior and relationships with others (Dangwal & Srivastava, 2016). Emotional instability, also known as neuroticism in the Big Five Personality trait, refers to negative emotions such as anxiety, insecurity, moodiness, nervousness, and depression (Sherry et al., 2014). Numerous studies show that internet addiction causes not only physical and social problems but also creates a psychological disturbance that affects emotional instability and the Big Five Personality trait (Cerniglia et al., 2017). ...
Article
Background: Excessive Internet usage has become a global issue. Adolescents and young adults use the Internet in an excessive way which significantly affects their physical, mental, social, and emotional health. Emotional maturity in adolescents declines significantly due to exposure to limitless Internet access. Research Aim: The primary aim of this study is to review the influence of the Internet and its physical and mental effects on the emotional maturity of adolescents in the context of Pakistan. Methodology: The study comprises a qualitative research design for analyzing and reviewing the existing literature on the influence of the Internet and its physical and mental effects on the emotional maturity of adolescents in Pakistan’s context. Results: The outcomes of this study revealed that emotional maturity and the factors contributing to it are significantly affected by excessive Internet usage resulting in adolescents facing numerous mental, physical, and social challenges. Conclusion: The study concluded that excessive internet usage negatively influences the mental, physical, and social health of adolescents and also has a significantly negative impact on their emotional development and maturity.
... anxiety and cognitive impairment might be intrapersonal. This finding is in line with a theoretical model related to health anxiety suggesting that anxiously attached individuals tend to experience more worry and anxiety about their health (Noyes et al., 2003;Sherry et al., 2014). The intrapersonal association was also underlined when stress was included: People's anxiety was linked to their heightened stress levels which were associated with their cognitive impairment. ...
Article
This study examined the link between insecure attachment and cognitive functioning in 1,043 middle-aged and older romantic couples (Mage = 64.7 years), and tests whether stress acts as a mediator. Participants were asked about their romantic attachment (anxiety and avoidance), cognitive impairment, their and their partner’s dementia symptoms, and were tested on their memory performance. Findings suggest that anxiously attached individuals experience more stress and report worse cognitive functioning, while partners of avoidantly attached individuals experience more stress, report worse cognitive functioning, and show worse memory performance. Post-hoc robustness analyses suggest that relationship satisfaction accounts for the link between avoidance and stress and serves as a mediator. Insecure attachment reflects a potential risk for worse cognitive health in older couples.
... anxiety and cognitive impairment might be intrapersonal. This finding is in line with a theoretical model related to health anxiety suggesting that anxiously attached individuals tend to experience more worry and anxiety about their health (Noyes et al., 2003;Sherry et al., 2014). The intrapersonal association was also underlined when stress was included: People's anxiety was linked to their heightened stress levels which were associated with their cognitive impairment. ...
Preprint
This study examined the link between insecure attachment and cognitive functioning in 1,043 middle-aged and older romantic couples (Mage = 64.7 years), and tests whether stress acts as a mediator. Participants were asked about their romantic attachment (anxiety and avoidance), cognitive impairment, their and their partner’s dementia symptoms, and were tested on their memory performance. Findings suggest that anxiously attached individuals experience more stress and report worse cognitive functioning, while partners of avoidantly attached individuals experience more stress, report worse cognitive functioning, and show worse memory performance. Post-hoc robustness analyses suggest that relationship satisfaction accounts for the link between avoidance and stress and serves as a mediator. Insecure attachment reflects a potential risk for worse cognitive health in older couples.
... Pain of childbirth is even mediated by attachment dimensions, with more securely attached women experiencing less labor pain than their insecurely attached counterparts(Costa-Martins et al., 2014). Health anxiety was shown to strongly be predicted by high attachment anxiety levels(Sherry et al., 2014). While insecure attachment indirectly corresponded to lower self-assessment of health(Sadava, Busseri, Molnar, Perrier, & DeCourville, 2009). ...
Article
Attachment Theory suggests interaction with caregivers in childhood impacts relationships and health throughout our lives (Bowlby, 1965, 1969, 1971), leaving many who have experienced insecure attachment with an inability to form healthy relationships or cope with stressors throughout their lifespan (Holmberg, Lomore, Takacs, & Price, 2011). Horses have interacted with humans for over 12,000 years (Hintz, 1995), holding multiple roles in human society, most relying on observation by humans of equine behavior, and formation of a human-equine bond (Hamilton, 2011). More securely attached humans tend to more readily decipher non-verbal cues, positively affecting their felt security and internal working model of Attachment (Bachi, 2013). Interacting with horses, who provide significant non-verbal cues, may provide an opportunity to enhance this process, providing useful feedback and insight. This study aimed to evaluate if a single ground-based encounter with a horse could bring about changes in women participants’ reports of Attachment and Emotion Regulation. It was hypothesized that participants would move towards more secure dimensions of Attachment and Emotion Regulations after the encounter with the horse and that behavioral interactions with the horse would differ for those with differing dimensions of Attachment or Emotion Regulation. This study incorporated a repeated measures mixed methods design, one twenty-eight year old Standardbred mare, “Wicky” Long Wick, interacted with 22 female university students with minimal prior equine experience aged 18-30. Participants completing a demographic and screening questionnaire along with the Experiences in Close Relationships –Revised (ECR)(Brennan, Clark, & Shaver, 1998) and Emotion Regulation Questionnaires (ERQ)(Gross & John, 2003) at baseline, then the ECR and ERQ again both immediately prior to and immediately following encounter with the horse. The encounter was videotaped and included meeting, grooming, leading, and goodbye. Statistical analyses were completed using SPSS including paired t-tests and correlations. Videotape was evaluated, coded, and included in both quantitative and qualitative data analyses. Participants were recruited and participated in the study over the period of one calendar year. A significant decrease in Attachment anxiety was shown after encountering the horse (t(21)=2.915, p=.008 (M .237364, SD= .381941)), and significantly less time was spent between the horse and participant at goodbye than at meeting (t (21)=2.751, p=.021 (M 42.045, SD= 71.67)), particularly for those with insecure dimensions of Attachment (t (15)= 2.814, p=.013 (M= 45.75, SD=65.03)). Participants with insecure dimensions of Attachment showed significant increases in cognitive reappraisal after encountering the horse (t(14)= -3.732, p=.002 (M -.411, SD= .4266)), and the greatest decreases in Attachment Anxiety (t(14)=3.364, p=.005 (M .307, SD= .354)). The findings suggest interaction between horses and people differs along Attachment dimensions and show some support for positive changes in humans for both Attachment and Emotion Regulation dimensions after interaction with a horse.
... Anxious attachment style in particular has been identified as being predictive of health anxiety (Sherry et al., 2014), and has been associated with various cardiovascular issues, including stroke, heart attack, and high blood pressure (McWilliams & Bailey, 2010). ...
Article
Full-text available
This study examined the relationship between attachment style and fear of contamination during the COVID-19 pandemic, hypothesizing that anxiously attached participants would be more distressed when their safe space was threatened by someone leaving and returning. During May 2020, n = 355 participants provided demographics, personality, health anxiety scores, attachment styles, political ideology, and attitudes towards the pandemic. In both social media and MTurk subsamples (but not in a subsample from a ListServ of professional psychologists), anxious attachment was a significant predictor of distress above and beyond personality and health anxiety. In addition, political ideology emerged as a consistent predictor of perceptions of the seriousness of COVID-19, even holding the other predictors constant. Understanding an individual's attachment style may be helpful in working with them in their trauma. This research also contributes to early empirical evidence for the impact of political ideology on self-reported attitudes and behaviors during the COVID-19 pandemic.
... 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). ...
Article
Full-text available
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).
... Some of the most prevalent PD criteria found in the present study were low self-esteem, overconscientiousness, rigid orderliness, anxiousness, rigidity in cooperation, and rigid perfectionism. The other HY studies using SCID-II did not report findings of specific PD criteria, but similar traits of avoidance, obsessiveness, and dependency (insecure attachment styles) have also been reported previously in studies of HY (Doherty-Torstrick et al., 2016;Katzenelbogen, 1942;Kenyon, 1964;Noyes et al., 2003;Pilowsky, 1970;Tyrer et al., 1990) and health anxiety (Anagnostopoulos and Botse, 2016;Sherry et al., 2014). Several studies have also found low self-esteem and related features associated with HY (Bianchi, 1971;Rief et al., 1998;Starcevic, 1989Starcevic, , 1990 and health anxiety and related behaviors (Fortenberry and Wiebe, 2007;Monopoli and Vaccaro, 2003;Noyes et al., 2005;Smith et al., 1983). ...
Article
Severe health anxiety (SHA)/hypochondriasis (HY) is often associated with personality pathology; however, studies report inconsistent results. In general populations, 12% have a personality disorder (PD). We assessed physician-referred psychiatric outpatients with SHA enrolled for a treatment study (n = 84) with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) axis II (SCID-II), Personality Inventory for DSM-5 (PID-5), Whiteley Index 7, and Short Health Anxiety Inventory, and the healthy controls (n = 84) with PID-5 only. There were 71.4% of the patients who met criteria for PDs: avoidant (22.6%), obsessive-compulsive (16.7%), depressive (16.7%), dependent (7.1%), paranoid (3.6%), borderline (2.4%), and not otherwise specified (32.1%). Severity of personality pathology was associated with severity of health anxiety. In group comparisons, PID-5 trait domains of negative affectivity, detachment, low antagonism, and low disinhibition, and facets of anxiousness, separation insecurity, and low attention seeking emerged as unique predictors of SHA. Personality pathology is common among individuals with SHA/HY. Further research is needed to understand the nature of the relationship between health anxiety and personality pathology and to determine whether treatments that target both SHA/HY and personality pathology will improve short- and long-term outcomes.
... In addition to this, and although the cognitive-behavioral model focuses mostly on previous health-related experiences as predisposing factors of HA, existing literature also describes a range of other developmental and predispositional factors that were linked to high levels of HA. These factors include distressing and traumatic events in childhood, such as childhood maltreatment (Hager & Runtz, 2012;Kim & Cicchetti, 2009;Waldinger, Schulz, Barsky, & Ahern, 2006;Weck et al., 2010), which seems to be related to HA through the mediating role of poor emotion regulation; fearful temperament and behavioral inhibition (Buss & Kiel, 2013); and insecure attachment as proposed by the interpersonal model of HA (Noyes et al., 2003;Sherry et al., 2014;Stuart & Noyes, 1999). ...
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.
... According to the interpersonal model of hypochondriasis as proposed by Noyes et al., [3] hypochondriasis is associated with insecure attachment that in adults gives rise to abnormal care-seeking behavior associated with interpersonal difficulties and strained patient/physician relationship. Sherry et al. state that anxious attachment and emotional instability predispose to health anxiety [4]. The prevalence of the disorder is unknown. ...
Article
Full-text available
Aim of the study To find out the prevalence of illness anxiety disorder (hypochondriasis) in medical outpatients and the risk factors and psychiatric co morbidities associated with it. Subject or material and methods 400 consecutive medical outpatients were asked for socio demographic characteristics and risk factors associated with illness anxiety and were given Short Health anxiety inventory (SHAI). Psychiatric co-morbidities were assessed using Mini International Neuropsychiatric Interview (M.I.N.I). People who scored 18 or above in SHAI, the diagnosis of Illness anxiety disorder was confirmed by using DSM 5 criteria for illness anxiety disorder (IAD). The data was analyzed by using SPSS version 17, Chi square and t test. Results The prevalence of IAD was 7%. Around 18% patients with IAD had positive family history for hypochondriasis. 32.1% of the patients had a history of abuse in the childhood. 71.4% of the patients had psychiatric co morbidities. 25% patients with IAD had co morbid depression and 28.6% had anxiety spectrum disorder. Discussion The range of prevalence of hypochondriasis is 0.4 to 14% in various studies and it is more common in third and fourth decade. Significant risk factors include divorce, family histrory and history of abuse. 65-88% of patients with hypochondriasis have psychiatric comorbidities like depression and anxiety disorders. Managing psychiatric comorbidities and early treatment of both will lead to better prognosis. Conclusions The anxiety of having a serious medical illness is reasonably high in patients attending medical O.P.D. About three fourth of these patients had co morbid psychiatric condition, mostly depression and anxiety disorders.
... Además, estos individuos tienen más probabilidad de tener un diagnóstico del eje I en comparación con individuos con apego seguro (Ciechanowski, Katon, Russo, & Dwight-Johnson, 2002), especialmente depresión o ansiedad en la adultez (Ba'yah et al., 2013;Heuser & Lammers, 2003). Al respecto se ha encontrado que la ansiedad relacionada con el apego se ha asociado con ansiedad sobre la salud, la cual es la base de los cuadros de hipocondría y de otros trastornos relacionados con la salud (Sherry et al., 2014). ...
... Además, estos individuos tienen más probabilidad de tener un diagnóstico del eje I en comparación con individuos con apego seguro (Ciechanowski, Katon, Russo, & Dwight-Johnson, 2002), especialmente depresión o ansiedad en la adultez (Ba'yah et al., 2013;Heuser & Lammers, 2003). Al respecto se ha encontrado que la ansiedad relacionada con el apego se ha asociado con ansiedad sobre la salud, la cual es la base de los cuadros de hipocondría y de otros trastornos relacionados con la salud (Sherry et al., 2014). ...
Article
Full-text available
The attachment bond has been proven to be a vulnerability factor for chronic diseases. This article seeks to clarify this relationship by the theory of allostasis. Allostasis theory refers to the regulation of complex physiological processes by systemic response in the body maintaining physiological stability when a person is confronted by challenges. The insecure attachments confront children from his first years with stressful events, by failing to provide security, fundamental purpose of attachment. In this way insecure attachments could impact the calibration of the stress system in the early age and would be factors that increases the allostatic load by a larger number of stressful life events compare to people with secure attachment, a cognitive appraisal of threat that leads to the development of hypervigilance and the impact on stress regulation systems in the body.
Article
Background Childhood adversity is associated with somatization, including physical symptom burden and health anxiety. Attachment theory offers a developmental framework to understand adult somatization, as attachment phenomena are theoretically and empirically related to physiological regulation, affect regulation, and childhood adversity, all of which are relevant to somatization. Objective The purpose of this study was to identify the pathways by which childhood adversity and attachment insecurity influence physical symptom burden and health anxiety in adults. Participants and setting Three hundred and fifty-one family medicine patients from a teaching hospital in Toronto, Canada. Methods A cross-sectional survey study was conducted to assess adverse childhood experiences, attachment insecurity, health anxiety and physical symptom severity in primary care patients. Path Analysis using structural equation modeling (AMOS V.26, IBM, 2019) was used to test the model in which childhood adversity, attachment anxiety, attachment avoidance, symptom severity interact to influence health anxiety. Results The majority of the participants were white (66%), had completed post-secondary education (68%), and reported themselves to be in very good to excellent health (62%). Childhood adversity, attachment anxiety, attachment avoidance, health anxiety and symptom severity are all significantly correlated (ranges of rs = 0.29 to 0.63). Childhood adversity has a significant indirect effect on health anxiety with attachment anxiety and symptom severity as serial mediators (βindirect = 0.237, p = .001 and βdirect = 0.065, p = .244). Conclusions Overall, this model extends our understanding of the processes underlying adult somatization. Findings support that childhood adversity and attachment anxiety are predictors of symptom severity and health anxiety.
Article
Full-text available
Background: Somatosensory amplification involves perceptual sensitivity to and cognitive-affective interpretation of bodily sensations and external stimuli, contributing to heightened experiences of somatic symptoms. However, little is known about somatosensory amplification in relation to vulnerabilities such as attachment insecurity. Aims: The present study investigated the link between attachment insecurity and somatosensory amplification, including the mediating role of dysfunctional interpersonal behaviors. Method: A sample of 245 adult community members completed the Somatosensory Amplification Scale, Generalized Anxiety Disorder Scale, and abbreviated versions of the Experiences in Close Relationships scale and Inventory of Interpersonal Problems. Correlational and regression analyses were used to examine relations among study variables, including a hypothesized parallel mediation model. Results: Somatosensory amplification was significantly associated with attachment anxiety, but not attachment avoidance. Regression analyses, controlling for general anxiety symptoms and gender, found that interpersonal sensitivity (but not aggression or ambivalence) mediated the link between attachment anxiety and somatosensory amplification. Limitations: Study limitations include the use of cross-sectional data and a non-clinical sample. Conclusion: The findings indicate that somatosensory amplification may be related to individuals’ attachment anxiety, through the mediating effect of interpersonal sensitivity problems.
Article
Background and Objectives: Military service is a stressful occupation, including increased risk for psychological distress. In order to provide the best care for service members and veterans (SMVs), it is important to understand personality and behavioral patterns associated with negative outcomes. This study examined links between attachment processes, coping styles, problematic alcohol use and psychological distress. Design: Using a cross-sectional, correlational design, a multi-instrument survey was administered to participants either online or in-person. Methods: Veterans and active duty service members (N = 268) completed measures of adult attachment, coping styles, alcohol use, and psychological symptoms. Results: Attachment avoidance was positively associated with avoidant coping, alcohol use, depression, and PTSD symptoms, but negatively related to problem-focused coping. Attachment anxiety was associated with avoidant coping, depression, GAD, and PTSD symptoms. Avoidant coping, but not problem-focused coping, was associated with psychological symptoms, and significant indirect relationships were noted between insecure attachment processes, avoidant coping, and psychological symptoms. Conclusion: Findings highlight personality and behavioral factors that may be important treatment foci when working with SMVs. Future studies should evaluate this model using longitudinal designs.
Article
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.
Article
Full-text available
Bu çalışmada sağlık kaygısı ile ilişkili faktörler özellikle de bağlanma stillerinin sağlık kaygısı ile ilişkisinin incelenmesi amaçlanmıştır. Bu amacı gerçekleştirmek için sağlık kaygısı, hipokondriazis, hastalık kaygısı ve bağlanma anahtar kelimeleri ile değişik veri tabanları kullanılarak (Web of Science, EBSCHOHost, Elsevier Science Direct, PsycARTICLES, PsycINFO, SocINDEX, ULAKBİM Türk Tıp Dizini/Sosyal Bilimler Dizini) son 20 yıl içerisinde yapılan araştırmalar taranmıştır. Taranan araştırmalarda incelenen boyutlar dikkate alınarak, sağlık kaygısı ve bağlanma stilleri arasındaki ilişki sağlık kaygısı ve hipokondriazis, sağlık kaygısının bilişsel ve kişilerarası modeli, sağlık kaygısı ve bağlanma ve onay arayıcılık başlıkları altında ele alınmıştır. Öncelikle, sağlık kaygısı ile ilgili genel bilgilere yer verilmiştir. Sonrasında, sağlık kaygısını daha iyi açıklamak için geliştirilmiş olan bilişsel modele ve kişilerarası modele değinilmiştir. Ardından, kişilerarası modelin temelinde yer alan bağlanma kuramına ve sağlık kaygısı ile bağlanma stilleri ilişkisine dair yapılan araştırmalara yer verilmiştir. Sağlık kaygısının güvensiz bağlanmanın bir yansıması olduğu, özellikle kaygılı bağlanma ile ilişkili olduğu belirtilmiştir. Son olarak, iki model kapsamında da onay arayıcılığa yer verilmiştir. Sonuç bölümünde ise, araştırmalar ile ilgili genel bir özet verilmiş ve gelecek çalışmalar için önerilerde bulunulmuştur.
Article
Health anxiety (HA) is defined as excessive worries focused on one’s health. The cognitive-behavioral and the interpersonal models assume an association between childhood experiences and the development of HA. The aim of this review is to identify studies which have investigated the association between childhood and family factors and HA. The literature search was generated in PUBMED, EMBASE, and PsycINFO. 25 papers were included. The results show a trend toward an association between the presentation of HA in adulthood and intergenerational transmission of HA and illness beliefs, illness experiences during childhood, and an anxious attachment style. However, no strong empirical evidence could be determined for any of these factors. Possible directions for future research are discussed.
Article
Full-text available
Objectives To develop and assess the validity of measures of patients' attachment-related perceptions of experiences with healthcare providers (HCPs). Setting Online survey. Participants 181 people provided consent and 119 completed the survey (66%). Most participants were women (80%). Primary and secondary outcome measures Questions were developed to assess possible attachment functions served by an HCP and patients' attachment-related attitudes towards an HCP. Scales were constructed based on exploratory factor analysis. Measures of adult attachment, therapeutic alliance, perceived HCP characteristics and health utilisation were used to validate scales. Results Possible safe haven and secure base functions served by HCPs were strongly endorsed. A model with good fit (root mean square error of approximation=0.056) yielded 3 factors: ‘HCP experienced as supportive and safe’ (SUPPORT, α=0.94), ‘HCP experienced as aversive’ (AVERSE, α=0.86) and ‘more and closer contact wanted with HCP’ (WANT, α=0.85). SUPPORT was correlated with positive HCP characteristics and not with attachment insecurity. AVERSE was inversely correlated with positive HCP attributes and correlated with attachment insecurity. WANT was unrelated to positive HCP attributes, but correlated with attachment insecurity. Frequency of HCP contact was related to WANT (Kruskal-Wallis=21.9, p<0.001) and SUPPORT (Kruskal-Wallis=13.2, p=0.02), but not to AVERSE (Kruskal-Wallis=1.7, p=0.89). Conclusions Patients attribute attachment functions of secure base and safe haven to HCPs. SUPPORT is related to positive appraisal of HCP characteristics; AVERSE is associated with discomfort in the HCP relationship that is related with perceived HCP characteristics and patients' insecure attachment; WANT is associated with unmet needs for connection with an HCP related to insecure attachment, but not to perceived HCP characteristics. These scales may be useful in studying the application of attachment theory to the HCP–patient relationship.
Article
Objective This 2-part study provided the first known examination of an association between cognitive fusion and health anxiety.Method This association was examined using 2 samples of community adults recruited through the Internet (Study 1: N = 252, mean [M] age = 31.2 years, 65.5% male; Study 2: N = 371, M age = 33.1 years, 56.9% male).ResultsIn Study 1, cognitive fusion shared a moderate association with health anxiety that was not attributable to negative affect. Along with replicating Study 1 findings using an alternative measure of health anxiety, the association between cognitive fusion and health anxiety was found to be independent of experiential avoidance and anxiety sensitivity in Study 2. Cognitive fusion was most relevant to the affective and cognitive dimensions of health anxiety.Conclusion The present findings are consistent with the possibility that cognitive fusion contributes to health anxiety. Future multivariate experimental and longitudinal studies are required to establish causality.
Article
Full-text available
The cognitive-behavioral and interpersonal models of health anxiety propose that parental illness could be a contributory factor to the development of health anxiety but through different mechanisms. The cognitive-behavioral model suggests that exposure to parental illness may lead to health beliefs that could increase health anxiety. In contrast, the interpersonal model proposes that parental illness may contribute to the development of an insecure attachment pattern and consequently health anxiety. To assess the additive value of the models, 116 emerging adults (i.e. aged 18-25) who had a parent diagnosed with a serious medical illness (e.g. cancer, multiple sclerosis) completed measures of health anxiety, adult attachment dimensions, and health beliefs. Attachment anxiety, attachment avoidance, health beliefs, and death of the ill parent were statistically significant predictors of health anxiety. The results provide support for both models of health anxiety. Theoretical implications and directions for future research are discussed.
Article
Full-text available
This study investigated 3 broad classes of individual-differences variables (job-search motives, competencies, and constraints) as predictors of job-search intensity among 292 unemployed job seekers. Also assessed was the relationship between job-search intensity and reemployment success in a longitudinal context. Results show significant relationships between the predictors employment commitment, financial hardship, job-search self-efficacy, and motivation control and the outcome job-search intensity. Support was not found for a relationship between perceived job-search constraints and job-search intensity. Motivation control was highlighted as the only lagged predictor of job-search intensity over time for those who were continuously unemployed. Job-search intensity predicted Time 2 reemployment status for the sample as a whole, but not reemployment quality for those who found jobs over the study's duration. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Full-text available
Contemporary conceptualizations of hypochondriasis (HC) as severe health anxiety have led to the development of cognitive-behavioral approaches to understanding, assessing, and treating this problem. The Short Health Anxiety Inventory (SHAI) is a new instrument that measures cognitive factors associated with HC. In the present study, we examined the psychometric properties and factor structure of the SHAI in a large sample of medically healthy university students. We also examined the scale’s convergent, divergent, and predictive validity. Results indicated that the SHAI has good psychometric properties and contains three factors that assess the perceived likelihood and perceived severity of becoming ill, and body vigilance. Facets of health anxiety uniquely predicted increased safety-seeking behavior and medical utilization, behaviors that are commonly observed in HC. Results are discussed in terms of the cognitive-behavioral model of HC.
Article
Full-text available
Questionnaire measures of attachment style and health behavior were completed by 287 university students on 2 occasions, 10 weeks apart. At Time 1, Ss also provided reports of emotionality and early family experiences of illness. Reports of early family illness showed theoretically meaningful relationships with attachment style. Symptom reporting was predicted most strongly by anxious/ambivalent attachment and negative emotionality, with the link between anxious/ambivalent attachment and symptom reporting partially mediated by negative emotionality. Visits to health professionals at Time 2 were directly related to reports of chronic illness in the family but inversely related to paternal illness and avoidant attachment, controlling for symptom reporting. The results are discussed in terms of theories of attachment and affect regulation.
Article
Full-text available
Spanish-language measures of the Big Five personality dimensions are needed for research on Hispanic minority populations. Three studies were conducted to evaluate a Spanish version of the Big Five Inventory (BFI) (O. P. John et al., 1991) and explore the generalizability of the Big Five factor structure in Latin cultural groups. In Study 1, a cross-cultural design was used to compare the Spanish and English BFI in college students from Spain and the United States, to assess factor congruence across languages, and to test convergence with indigenous Spanish Big Five markers. In Study 2, a bilingual design was used to compare the Spanish and English BFI in a college-educated sample of bilingual Hispanics and to test convergent and discriminant validity across the two languages as well as with the NEO Five Factor Inventory in both English and Spanish. Study 3 replicated the BFI findings from Study 2 in a working-class Hispanic bilingual sample. Results show that (a) the Spanish BFI may serve as an efficient, reliable, and factorially valid measure of the Big Five for research on Spanish-speaking individuals and (b) there is little evidence for substantial cultural differences in personality structure at the broad level of abstraction represented by the Big Five dimensions.
Article
Full-text available
Self-report measures of adult attachment are typically scored in ways (e.g., averaging or summing items) that can lead to erroneous inferences about important theoretical issues, such as the degree of continuity in attachment security and the differential stability of insecure attachment patterns. To determine whether existing attachment scales suffer from scaling problems, the authors conducted an item response theory (IRT) analysis of 4 commonly used self-report inventories: Experiences in Close Relationships scales (K. A. Brennan, C. L. Clark, & P. R. Shaver, 1998), Adult Attachment Scales (N. L. Collins & S. J. Read, 1990), Relationship Styles Questionnaire (D. W. Griffin & K. Bartholomew, 1994) and J. Simpson's (1990) attachment scales. Data from 1,085 individuals were analyzed using F. Samejima's (1969) graded response model. The authors' findings indicate that commonly used attachment scales can be improved in a number of important ways. Accordingly, the authors show how IRT techniques can be used to develop new attachment scales with desirable psychometric properties.
Article
Full-text available
Attachment theory proposes that cognitive schemas based on earlier repeated experiences with caregivers influence how individuals perceive and act within interpersonal relationships. We hypothesized that medical patients with two types of insecure attachment-preoccupied and fearful attachment-would have higher physical symptom reporting compared with those with other attachment styles, but that preoccupied attachment would be associated with higher and fearful attachment with lower primary care utilization and costs. In a large sample of adult female primary care health maintenance organization patients (N = 701), we used analysis of covariance and Poisson regressions to determine whether attachment style was significantly associated with 1) symptom reporting based on questions from the somatization section of the Diagnostic Interview Schedule and 2) contemporaneous automated utilization and cost data. Attachment style was significantly associated with symptom reporting (p =.02), with patients with preoccupied (p =.03) and fearful (p =.003) attachment having a significantly greater number of physical symptoms compared with secure patients. There were no significant differences in medical comorbidity between attachment groups. Attachment was also significantly associated with primary care visits and costs. Patients with preoccupied attachment had the highest primary care costs and utilization, whereas patients with fearful attachment had the lowest. These results suggest that attachment style is an important factor in assessing symptom perception and health care utilization. Despite being on opposite ends of the utilization spectrum, patients with preoccupied and fearful attachment have the highest symptom reporting. These data challenge the observation that increased symptom reporting is uniformly associated with increased utilization in medical patients.
Article
Full-text available
A self-rated measure of health anxiety should be sensitive across the full range of intensity (from mild concern to frank hypochondriasis) and should differentiate people suffering from health anxiety from those who have actual physical illness but who are not excessively concerned about their health. It should also encompass the full range of clinical symptoms characteristic of clinical hypochondriasis. The development and validation of such a scale is described. Three studies were conducted. First, the questionnaire was validated by comparing the responses of patients suffering from hypochondriasis with those suffering from hypochondriasis and panic disorder, panic disorder, social phobia and non-patient controls. Secondly, a state version of the questionnaire was administered to patients undergoing cognitive-behavioural treatment or wait-list in order to examine the measure's sensitivity to change. In the third study, a shortened version was developed and validated in similar types of sample, and in a range of samples of people seeking medical help for physical illness. The scale was found to be reliable and to have a high internal consistency. Hypochondriacal patients scored significantly higher than anxiety disorder patients, including both social phobic patients and panic disorder patients as well as normal controls. In the second study, a 'state' version of the scale was found to be sensitive to treatment effects, and to correlate very highly with a clinician rating based on an interview of present clinical state. A development and refinement of the scale (intended to reflect more fully the range of symptoms of and reactions to hypochondriasis) was found to be reliable and valid. A very short (14 item) version of the scale was found to have comparable properties to the full length scale. The HAI is a reliable and valid measure of health anxiety. It is likely to be useful as a brief screening instrument, as there is a short form which correlates highly with the longer version.
Article
Full-text available
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.
Article
Full-text available
To examine whether spontaneous causal attributions for blood glucose events were associated with blood glucose control (HbA(1c) [A1C]), self-management, and adjustment to diabetes. A total of 62 adults (31 female) with type 1 diabetes, recruited from a diabetes specialist clinic, with a mean age of 42.3 years and a mean illness duration of 19.6 years, were interviewed about the onset, history, course, and management of their diabetes. Spontaneous causal attributions for fluctuations in blood glucose level were extracted from the interviews and coded in accordance with the Leeds Attributional Coding System. Participants completed questionnaire measures of anxiety, depression, and appraisal of diabetes. Glycemic control (A1C) at the time of interview and 1 year later was extracted from notes. Participants who made proportionally more personal, or idiosyncratic, explanations for blood glucose fluctuations or events (such as hypoglycemic episodes) had higher A1C levels at time 1 and 1 year later and were judged to manage their diabetes less well. Furthermore, the association between personal attributions and A1C was partly accounted for by self-management behavior. Participants who made personal and stable attributions appraised their diabetes more negatively. Clinicians should be sensitive to patients' causal explanations for blood glucose events. Helping patients consider alternative explanations may produce benefits in terms of better management and control of diabetes.
Article
Full-text available
An individual's attachment style can be conceptualized as a working model for interactions with others, developed as result of experiences with childhood caregivers. People with hypochondriacal tendencies are preoccupied with thoughts of having an illness and constantly seek medical reassurance. We hypothesized that students with preoccupied attachment would score highly on a measure of hypochondriasis and investigated whether the association would be explained by the general tendency to seek reassurance in relationships. A total of 117 undergraduate students completed questionnaires measuring attachment style; negative affectivity; reassurance seeking in relationships and hypochondriasis. Participants with preoccupied attachment style (n = 17, 15%) had significantly higher hypochondriasis scores than those with other attachment styles. Hierarchical multiple regression analysis suggested that the association between the preoccupied attachment style and hypochondriasis was explained by the general tendency to seek reassurance in relationships, with negative affectivity, a dispositional variable, also acting as a significant predictor of hypochondriasis.
Article
Full-text available
We developed a 12-item, short form of the Experiences in Close Relationship Scale (ECR; Brennan, Clark, & Shaver, 19985. Brennan , K. A. , Clark , C. L. and Shaver , P. R. 1998. “Self-report measurement of adult attachment: An integrative overview”. In Attachment theory and close relationships, Edited by: Simpson , J. A. and Rholes , W. S. 46–76. New York: Guilford. [CrossRef]View all references) across 6 studies. In Study 1, we examined the reliability and factor structure of the measure. In Studies 2 and 3, we cross-validated the reliability, factor structure, and validity of the short form measure; whereas in Study 4, we examined test-retest reliability over a 1-month period. In Studies 5 and 6, we further assessed the reliability, factor structure, and validity of the short version of the ECR when administered as a stand-alone instrument. Confirmatory factor analyses indicated that 2 factors, labeled Anxiety and Avoidance, provided a good fit to the data after removing the influence of response sets. We found validity to be equivalent for the short and the original versions of the ECR across studies. Finally, the results were comparable when we embedded the short form within the original version of the ECR and when we administered it as a stand-alone measure.
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
The authors review the theory of romantic, or pair-bond, attachment as it was originally formulated by C. Hazan and P. R. Shaver in 1987 and describe how it has evolved over more than a decade. In addition, they discuss 5 issues related to the theory that need further clarification: (a) the nature of attachment relationships, (b) the evolution and function of attachment in adulthood, (c) models of individual differences in attachment, (d) continuity and change in attachment security, and (e) the integration of attachment, sex, and caregiving. In discussing these issues, they provide leads for future research and outline a more complete theory of romantic attachment.
Article
This study examines the relationships between the constructs of depression as measured by the Center for Epidemiological Studies Depression Scale (CES-D) and the revised Beck Depression Inventory (BDI) in a sample of 261 college students. The two scales were found to have a moderately high correlation and a similar pattern of relationships to measures of anxiety, hostility, self-esteem, hypochondriasis, and locus of control. However, the relations between the subscales and the factor structure of the subscales derived from both instruments suggest that the BDI and CES-D measure different aspects of depression despite sharing some symptoms. Therefore, the authors argue that the BDI and CES-D should not be used interchangeably. The results are discussed in terms of the applicability of the two measures of depression for use with nonclinical populations.
Article
The current study utilized a path analytic strategy to examine the relationship between gender, neuroticism (N) and physical symptom reports. Trait self-focused attention and state negative affect (NA) were included as potential mediators. Results indicated that both gender and N have significant direct effects on symptom reports when considered in the same model. State NA partially mediated the relationship between N and symptom reports. Trait self-focused attention partially mediated the effects of N on symptom reports for women but not men. Findings are discussed with respect to the information processing aspects of individual differences in self-assessed health and directions for future research are suggested.
Article
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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 authors review the theory of romantic, or pair-bond, attachment as it was originally formulated by C. Hazan and P. R. Shaver in 1987 and describe how it has evolved over more than a decade. In addition, they discuss 5 issues related to the theory that need further clarification: (a) the nature of attachment relationships, (b) the evolution and function of attachment in adulthood, (c) models of individual differences in attachment, (d) continuity and change in attachment security, and (e) the integration of attachment, sex, and caregiving. In discussing these issues, they provide leads for future research and outline a more complete theory of romantic attachment. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Data regarding the treatment of somatoform disorders suggest that the gains associated with current psychopharmacologic or psychotherapeutic treatments are modest at best. There have been a few moderately effective treatments for selected functional somatic syndromes, but patients who present with multi-system symptoms meeting criteria for the DSM-IV somatoform disorders are notoriously unresponsive to treatment. Experts in the field have advocated several approaches, including interpersonally oriented and cognitive-behavioral therapies, and have emphasized the importance of the provision of reassurance within the doctor-patient relationship. While each individual approach has merit, none is likely to be maximally efficacious as a stand-alone treatment. In this article we describe the theoretical underpinnings and technical aspects of a treatment for somatizing patients that integrates these three elements.
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
Mrs. A. presents with a textbook case of hypochondriasis. An additional diagnosis of OCD does not enhance our understanding or treatment of her problems, and is not indicated according to DSM-IV. Cognitive-behavior therapy (CBT) is effective in treating hypochondriasis, although it is necessary to devise a case formulation for each patient to determine which interventions to use and how to best implement them. A detailed cognitive and behavioral assessment is essential to successful treatment. In this commentary, I describe the important assessment areas that need to be covered to better understand Mrs. A.'s problems and the obstacles to assessment that might be encountered. A tentative case formulation is presented, based on the available information, and a tentative CBT protocol is derived. Likely obstacles to successful treatment, such as Mrs. A.'s poor insight into her disorder, need to be more thoroughly assessed in order to devise strategies for circumventing these difficulties.
Article
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.
Article
In the temperament literature, agreeableness has been theoretically linked to effortful control. Further, research in this area has suggested that effortful control may play a broad role in moderating temperament-based tendencies toward negative affect. The present three studies, involving a total of 300 undergraduate participants, sought to extend this perspective to the adult literature by examining potential interactions between agreeableness and neuroticism in predicting reported somatic symptoms. Although such symptoms have been linked to neuroticism, they are not characteristic of the interpersonal concerns linked to agreeableness. Nevertheless, all studies found that agreeableness and neuroticism interacted to predict somatic symptoms such that high levels of agreeableness decoupled the relationship between neuroticism and somatic distress. These findings indicate a broad role for agreeableness in the self-regulation of neuroticism-linked distress.
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
To explore the extent to which the domains of the Big 5 are risk factors for hypochondriacal concerns (HCs). Two longitudinal studies, one using blood donors (over a 16-17-month period) and one using undergraduate students (over a 2.5-month period), were used to collect data on the Big 5 and HCs. Univariate analyses indicated that: (1) emotional stability predicted future levels of HCs once baseline levels of HCs were controlled, and (2) reductions in HCs over time were predicted primarily by increases in conscientiousness and emotional stability scores. Structural modelling of cross-lagged effects indicated that emotional stability was related to future levels of hypochondriacal concerns by contributing to initial levels of HCs. Regression analysis indicated that those who become more conscientious become less health anxious. Emotional stability and conscientiousness have predictive roles with respect to HCs.
Article
Our aim was to examine the relationship between personality dimensions and hypochondriacal concerns and somatic symptoms in a military population. The Schedule of Nonadaptive and Adaptive Personality along with measures of hypochondriacal concerns and somatic symptoms were administered to 602 military veterans who had been on active duty during the 1991 Gulf War. Factor analyses identified six separable dimensions-two of hypochondriacal concerns, two of somatic symptoms, and two of possible mechanisms of symptom generation-for study. Multiple regression models determined the proportion of variation in these measures of somatic distress explained by personality scales. Personality measures explained between 26% and 38% of the variance in hypochondriacal concerns and somatic symptoms, and Negative Temperament accounted for most of this. Moderately strong positive correlations were observed between trait scales Mistrust, Low Self-Esteem, and Eccentric Perceptions and the various measures of somatic distress. Thus, when Negative Temperament was taken into account, few significant correlations between personality measures and hypochondriacal concerns or somatic symptoms remained. Negative temperament or neuroticism is strongly associated with hypochondriacal concerns. Important features of hypochondriasis and somatic distress appear to lie within the domain of personality. It remains for future research to show whether negative temperament is a vulnerability factor for hypochondriasis or hypochondriasis is itself a personality disorder.
Los cinco grandes across cultures and ethnic groups
  • V Benet-Martinez
  • O John
Benet-Martinez, V., & John, O. (1998). Los cinco grandes across cultures and ethnic groups. Journal of Personality and Social Psychology, 75, 729-750.
Multiple regression: Testing and interpreting interactions Thousand Oaks, CA: Sage Los cinco grandes across cultures and ethnic groups
  • L Aiken
  • S West
  • V Benet-Martinez
  • O John
Aiken, L., & West, S. (1991). Multiple regression: Testing and interpreting interactions. Thousand Oaks, CA: Sage. Benet-Martinez, V., & John, O. (1998). Los cinco grandes across cultures and ethnic groups. Journal of Personality and Social Psychology, 75, 729–750.
Attachment style and affect regulation
  • J Feeney
  • S Ryan
Feeney, J., & Ryan, S. (1994). Attachment style and affect regulation. Health Psychology, 13, 334-345.
Agreeableness and the self-regulation of negative affect
  • S Ode
  • M Robinson
Ode, S., & Robinson, M. (2007). Agreeableness and the self-regulation of negative affect. Personality and Individual Differences, 43, 2137-2148.
Assessment of the hypochondriasis domain
  • S Longley
  • D Watson
  • R Noyes
Longley, S., Watson, D., & Noyes, R. (2005). Assessment of the hypochondriasis domain. Psychological Assessment, 17, 3-14.
Hannah and her sisters [Motion picture]. United States: Orion Pictures
  • R Greenhut
  • Producer
  • W Allen
Greenhut, R. (Producer), & Allen, W. (Director) (1986). Hannah and her sisters [Motion picture]. United States: Orion Pictures.
Medical excuse making and individual differences in self-assessed health
  • K Fortenberry
  • D Wiebe
Fortenberry, K., & Wiebe, D. (2007). Medical excuse making and individual differences in self-assessed health. Personality and Individual Differences, 43, 83-94.
The health anxiety approach
  • P Salkovskis
  • K Rimes
  • H Warwick
  • D Clark
Salkovskis, P., Rimes, K., Warwick, H., & Clark, D. (2002). The health anxiety approach. New York, NY: Guilford.
Hannah and her sisters [Motion picture
  • R Greenhut
  • W Allen
Greenhut, R. (Producer), & Allen, W. (Director) (1986). Hannah and her sisters [Motion picture]. United States: Orion Pictures.