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Psychometric evaluation of the Multidimensional Inventory of Hypochondriacal Traits: Factor structure and relationship to anxiety sensitivity

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Abstract

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

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... To heed those calls, it is of course necessary to have psychometrically sound, comprehensive, measures of health anxiety to aid in screening, case conceptualization, treatment planning, and outcome research (Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). Among existing psychological interventions, cognitive-behavioral therapy seems particularly efficacious in the treatment of health anxiety (Olatunji et al., 2014). ...
... Based on this rationale, Stewart et al. (2008) used CFA to examine the factor structure of the MIHT in an undergraduate sample (n = 535). Both the hierarchical and correlated four-factor models provided adequate fit to the data. ...
... An examination of the model comparison statistics indicated that neither model evidenced superior fit. Stewart et al. (2008) suggested retention of the hierarchical model due to its "superior parsimony." Of note, three of the four domain-specific factors evidenced loadings on the higher order health anxiety construct that supported the hypothesis that these factors are related, but distinct (i.e., Perceptual = .49, ...
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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.
... The three AS dimensions in- clude the fear of arousal-related sensations as a result of cognitive (i.e., mental incapacitation), physical (i.e., physical calamity), or social (i.e., public embarrassment) concerns (Taylor et al., 2007). Among the AS dimensions, the physical dimension is the only one that uniquely relates to health anxiety ( Olatunji et al., 2009;Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). Based on these findings, it is important to use a multidimen- sional conceptualization of AS in health anxiety research. ...
... Consistent with prior research (Boelen & Carleton, 2012;Olatunji et al., 2009;Stewart et al., 2008), we predicted that all AS (cog- nitive, physical, and social) and IU (prospective and inhibitory) dimensions would significantly correlate with health anxiety. Incremental specificity was investigated by examining whether the AS and IU dimensions shared unique relations with health anx- iety after controlling for negative affect and the other set of dimen- sions (AS or IU). ...
... This prediction was based on the following considerations. Given that previous re- search has indicated that physical AS is the AS dimension of partic- ular relevance to health anxiety ( Olatunji et al., 2009;Stewart et al., 2008), we expected robust relations between this AS dimen- sion and health anxiety. McEvoy and Mahoney (2011) suggested that prospective IU is particularly relevant to both generalized anx- iety and obsessive-compulsive symptoms, whereas inhibitory IU is particularly relevant to panic symptoms. ...
Article
Anxiety sensitivity (AS) reflects the fear of arousal-related sensations and intolerance of uncertainty (IU) represents the dispositional fear of the unknown. Within cognitive–behavioral models, AS and IU are individual difference variables considered central to the phenomenology of health anxiety. However, prior studies have cast doubt on whether both variables incrementally contribute to our understanding of health anxiety. Addressing limitations of these prior studies, the present study examined the incremental specificity of AS and IU as these two variables relate to health anxiety in a large medically healthy sample of community adults (N = 474). Both AS and IU incrementally contributed to the concurrent prediction of health anxiety beyond both negative affect and one another. However, within these analyses, the physical dimension of AS and the inhibitory dimension of IU were the only AS and IU dimensions to evidence incremental specificity in relation to health anxiety.
... Higher scores signify higher levels. Coefficients alpha for MIHT subscales are usually P.75 (Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). Evidence supports the predictive, incremental, and convergent validity of the MIHT (Longley et al., 2005). ...
... Evidence suggests the MIHT factor structure may be optimally represented by a second-order factor structure involving four lower-order factors loading into a single higher-order factor (Stewart et al., 2008). Multigroup confirmatory factor analyses tested if factor loadings for the second-order factor structure of the MIHT varied across gender. ...
... All coefficients alpha were >.75, suggesting the items of a given MIHT subscale adequately cohere together with a relatively small amount of measurement error. Our study thus joins Longley et al. (2005) and Stewart et al. (2008) in suggesting the MIHT subscales display adequate internal consistency. ...
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.
... There seems to be a close relationship between anxiety sensitivity and health anxiety for patients suffering from panic disorder (Otto, Pollack, Sachs, & Rosenbaum, 1992, p. 98) and depression (Otto, Demopulos, McLean, Pollack, & Fava, 1998). Stewart, Sherry, Watt, Grant, & Hadjistavropoulos (2008) studied the relationship between anxiety sensitivity and health anxiety in a student sample and also reported large correlations between both constructs. Nevertheless, they concluded that both constructs are better represented by two correlated but distinct traits compared to one single construct. ...
... The cognitive and affective scales of the MIHT show convergent correlations (r > .50) to the corresponding subscales of the WI and IAS while the perceptual scale is theoretically and empirically strongly related to the somatosensory amplification scale (Barsky et al., 1990;Longley et al., 2005). The MIHT yielded good internal consistencies and structural validity (Longley et al., 2005;Stewart et al., 2008). We applied the German version of the MIHT (Witthöft, Haaf, Rist, & Bailer, 2010) that demonstrated similar psychometric characteristics. ...
... Thus, it seems to be impossible to distinguish the effects of health anxiety and anxiety sensitivity in our study. It is well known that these constructs share a lot of common variance (Stewart et al., 2008) which is also the case in our dataset. We observed the largest correlations between the ASI physical subscale and the MIHT facets (all r > .50, ...
Article
Cognitive-behavioral models of health anxiety stress the importance of selective attention not only towards internal but also towards external health threat related stimuli. Yet, little is known about the time course of this attentional bias. The current study investigates threat related attentional bias in participants with varying degrees of health anxiety. Attentional bias was assessed using a visual dot-probe task with health-threat and neutral pictures at two exposure durations, 175ms and 500ms. A baseline condition was added to the dot-probe task to dissociate indices of vigilance towards threat and difficulties to disengage from threat. Substantial positive correlations of health anxiety, anxiety sensitivity, and absorption with difficulties to disengage from threat were detected at 500ms exposure time. At an early stage (i.e., at 175ms exposure time), we found significant positive correlations of health anxiety and absorption with orientation towards threat. Results suggest a vigilance avoidance pattern of selective attention associated with pictorial illness related stimuli in health anxiety.
... The third is the behavioral factor corresponding to the way the person proceeds between avoidance or need for re-assurance. The fourth is perceptual referring to hypersensitivity to somatic symptoms (Bardeen and Fergus 2017;Longley et al. 2005;Stewart & al., 2008;Witthöft et al. 2010;Witthöft et al. 2015). ...
... 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. ...
Article
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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.
... Extant data indicate that anxiety sensitivity is related to greater vigilance toward body sensations (e.g., Olatunji et al. 2007;Schmidt et al. 1997), somatic symptom severity (e.g., Hensley and Varela 2008;Jakupcak et al. 2006;Osman et al. 2010), and physical discomfort (Asmundson et al. 2000). In addition to sharing relations with health anxiety (e.g., Stewart et al. 2008), an emerging line of research indicates that anxiety sensitivity may play a role in obesity. For example, anxiety sensitivity may relate to greater calorie consumption, lowered exercise tolerance, and decreased physical activity (Farris et al. 2016;Hearon et al. 2014;Smits et al. 2010). ...
... Following from the importance of health anxiety to conceptual models of somatic symptoms (Rief and Broadbent 2007), we predicted that health anxiety would account for unique variance in somatic symptom severity scores. Given extant research indicating that anxiety sensitivity, discomfort intolerance, and health anxiety are distinct, albeit related, variables Fergus et al. 2015;Stewart et al. 2008), we further predicted that anxiety sensitivity and discomfort intolerance would account for additional unique variance in somatic symptom severity scores. Multivariate analyses controlled for the effects of other covariates relevant to somatic symptoms, including sociodemographic variables and BMI (e.g., Hilbert et al. 2014), medical morbidity (e.g., Doll et al. 2000), and depression severity (e.g., Luppino et al. 2010). ...
Article
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Prior research indicates the common presentation of somatic symptoms and obesity in primary care settings, as well as links between obesity and somatic symptoms. Anxiety sensitivity, discomfort intolerance, and health anxiety are three variables relevant to somatic symptoms. How those three variables relate to somatic symptom severity among individuals who are obese and the unique variance accounted for by each variable in somatic symptom severity remains unexamined. Among a large sample of primary care patients who are obese (N = 342), anxiety sensitivity, discomfort intolerance, and health anxiety collectively accounted for 35% of variance in somatic symptom severity beyond the effects of sociodemographic variables, body mass index, medical morbidity, and depression severity. Health anxiety accounted for the largest amount of unique variance in somatic symptom severity, potentially supporting the relevance of health anxiety to the presentation of increased somatic symptoms among patients who are obese.
... The structure of the MIHT was investigated using a sample of 535 university students (Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). 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. ...
... According to Stewart et al. (2008), the former conceptualization is consistent with the interpersonal model of health anxiety (e.g., Noyes et al., 2003), whereas the latter is more consistent with a cognitive-behavioral conceptualization (e.g., Warwick & Salkovskis, 1990). ...
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.
... Studies that have correlated the ASI with measures of health anxiety have reported medium to large correlations ranging from .47 to .58 [20][21][22]. Although anxiety sensitivity and health anxiety are clearly strongly related, this association may be partly the result of item and domain overlap. ...
... Although diagnostic classification was not the subject of the present review, a number of the studies that were reviewed have implications for the understanding of how health anxiety should be classified. Studies continue to demonstrate the overlap between health anxiety and other anxiety disorders, especially panic disorder [20][21][22] and OCD [32,35]. Therefore, it is unfortunate that the new edition of the DSM is planning to continue to classify hypochondriasis with somatoform disorders and not with the anxiety disorders [40]. ...
Article
The present paper reviewed studies that examined the role of cognitive and perceptual variables in health anxiety and hypochondriasis that have been published since a 2007 meta-analysis of this literature. Specifically the current review examined the associations between hypochondriasis or health anxiety and (1) dysfunctional beliefs, (2) cognitive processes, (3) triggering stimuli, and (4) the perception of bodily sensations. Overall, the findings from the recent research were consistent with those that were included in the earlier meta-analysis, and were generally supportive of cognitivebehavioral approaches to understanding hypochondriasis and health anxiety. In recent years, there has been a shift in emphasis away from empirical studies of dysfunctional beliefs and toward greater attention to cognitive processes in health anxiety. So far, these cognitive process studies have not been especially systematic and have examined a variety of variables, including attentional biases toward potential threats, rumination, and intolerance of uncertainty. Such findings may help inform more comprehensive cognitive models of hypochondriasis and health anxiety. Conversely, attempts to integrate cognitive process variables into cognitive-behavioral models of health anxiety may help generate more systematic research.
... We applied the multidimensional inventory of hypochondriacal traits (MIHT; Longley et al. 2005) and a 5-point Likert scale version of the Whiteley-Index (Hiller and Rief 2004;Pilowsky 1967) as measures of health anxiety. Because of several psychometric flaws and a rather weak theoretical base of this (e.g., Schwarz et al. 2007) and other instruments (e.g., the illness attitude scales; Kellner 1981;Stewart et al. 2008), Longley et al. (2005) developed the MIHT. It consists of 31 items and was applied to assess the affective, cognitive, behavioral, and perceptual components of hypochondriasis. ...
... and r = .20 in two similar student samples. While Stewart et al. (2008) report a latent correlation (assuming a correlated factor model) of r = .43, the relationship between the observed scales in our sample was even higher with r = .53. ...
Article
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A core feature of health anxiety is a negative interpretation of illness related information. Yet, it is unknown if health anxiety also features an implicit component that can be observed with implicit measures of evaluation. In order to assess automatic evaluative processes in the domain of health anxiety, we applied the affect misattribution procedure with health-threatening prime pictures and examined the relationships to questionnaire measures of health anxiety in a student sample (N = 104). Participants rated Chinese characters significantly less often as pleasant after the presentation of health threatening primes compared with conditions featuring neutral primes or no primes. Significant correlations of the affect misattribution procedure were observed with health anxiety as measured by the Multidimensional Inventory of Hypochondriacal Traits but not with the Whiteley-Index as a global screening measure of clinically-relevant hypochondriasis. The relationships between health anxiety and the affect misattribution procedure effect remained stable after the inclusion of maladaptive emotion regulation strategies as further predictors in a hierarchical regression analysis. The findings suggest that health anxiety has an implicit component which is associated with an automatic misattribution of negative affect elicited by illness related pictures. This effect might represent a crucial component of health anxiety that fosters the automatic interpretation of illness related information in a more negative manner.
... and worry (r = .45) subscales were significantly correlated with anxiety sensitivity (Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). ...
... Means for all measures (see Table 1) were within one standard deviation of means from studies using comparable samples (Fairchild & Finney, 2006;Stewart et al., 2008). Alpha reliabilities (see Table 1) were also acceptable (P.75) and congruent with previous research reported above. ...
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.
... Research has shown that AS is elevated in clinical and analogue clinical samples of severe health anxiety (Bailer et al., 2016;Deacon & Abramowitz, 2008;. Moreover, greater levels of AS are associated with greater health anxiety above and beyond other theoretically relevant factors in both clinical (Abramowitz, Olatunji, & Deacon, 2007;Hedman et al., 2015) and non-clinical samples (Fergus & Bardeen, 2013;Fergus & Valentiner, 2010;Fetzner et al., 2014;O'Bryan & McLeish, 2017;Sexton, Norton, Walker, & Norton, 2003;Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008;Wheaton, Berman, Franklin, & Abramowitz, 2010). ...
Article
It is estimated that individuals with severe health anxiety (HA) utilize 41%-78% more healthcare resources than individuals with identified medical diagnoses. Thus, identifying targets for intervention and prevention efforts for HA that are appropriate for primary care or specialty clinic settings is imperative. The aim of the present investigation was to evaluate the effect of a single-session, computerized anxiety sensitivity (AS) intervention on AS and HA. Participants were 68 university students (79.4% female; Mage = 19.68) with elevated levels of AS and HA. Participants were randomized to either the AS intervention condition or an active control condition and completed self-report and behavioral follow-up assessments at post-intervention, 1-week follow-up, and 1-month follow-up. Results indicated a significant Time x Condition interaction for ASI-3 at each follow-up assessment (all p’s < .001), such that individuals in the active condition exhibited greater reductions in AS compared to the control condition. There was no significant Time x Condition interaction for HA at any follow-up. Mediation analyses revealed a significant indirect effect of Condition on changes in HA through changes in AS. No significant effects were observed for behavioral outcomes. Findings suggest that this intervention successfully reduces AS among those who are high in HA and AS and may indirectly contribute to reductions in HA over time through reductions in AS.
... Higher Total Scores represent higher degrees of health anxiety. Some evidence supporting the MIHT has accumulated (Stewart et al., 2008;Witthöft et al., 2015). ...
Article
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The current study utilized an experimental design to investigate the utility of the MMPI-3 Validity Scales for detecting over- and under-reporting and the impact of these response sets on substantive scale scores. College students completed a battery of criterion measures before assignment to a Standard Instructions (SI) Group (n = 288), an Over-reporting Group (n = 250), or an Under-reporting Group (n = 215). t-tests demonstrated that scores on MMPI-3 over-reporting indicators and most substantive scales were higher among the Over-reporting Group relative to the SI group with very large effect sizes, and scores on MMPI-3 under-reporting indicators were higher and most substantive scales scores were lower among the Under-reporting Group relative to the SI group, with moderate to large effects. Classification accuracy estimates documented the effectiveness of MMPI-3 Validity Scales in detecting over- and under-reporting. Bivariate correlations between MMPI-3 substantive scale scores and criterion measures (which were completed under standard instructions for all three groups) were substantially attenuated for both simulation groups relative to the SI Group. Bivariate correlations were also attenuated for groups identified as over- or under-reporting using MMPI-3 Validity Scale scores relative to individuals with valid MMPI-3 protocols, highlighting the need for and importance of appraising threats to protocol validity when assessing personality and psychopathology by self-report.
... Although the first two subscales assess specific facets of the cognitive and behavioral dimensions, they focus on the very aspects of hypochondriasis -namely, beliefs about others being unsupportive (alienation) and reassurance-seeking behaviors. These subscales fail to cover other important features of hypochondriasis emphasized in cognitivebehavioral models of health anxiety, including catastrophic misinterpretation of somatic cues, bodily checking and avoidance of health threat information [16]. Furthermore, most of the previously developed scales contain statements concerning the belief that one is seriously ill (e.g. ...
Article
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Aim of the study The aim of the study was to adapt english language version of Short Health Anxiety Inventory (SHAI) developed by Salkovskis et all., to Polish conditions and to investigate its psychometric properties and factor structure in clinical and non-clinical samples. Subject or material and methods A total of 296 subjects participated in this study: 172 clinical samples (46% females and 54% males; mean age: 57,29 ± 13,01 years) and 124 non-clinical samples (51% females and 49% males; mean age: 54,45 ± 13,63). They completed the polish language version of an 18-item SHAI and Hamilton Anxiety Rating Scale (HAM-A). To assess psychometric proporties, internal consistency, test-retest reliability, item-total statistics, construct and convergent validity, and analysis of ROC curves were performed. Results The internal consistency (Cronbach's α of 0,91 and 0,92) and the test-retest reliability (r=0,91 and r=0,94) was excellent for both samples. Correlational analysis revealed a significant relationship of anxiety to SHAI total score and to each of two SHAI subscales. Using the factor analysis, two-factors solution were found, which accounted 48% and 49% of the variance, respectively. A cut-off score of 20 was optimal for detecting severe form of health anxiety in clinical and non-clinical samples, considering the best balance between specificity and sensitivity. Discussion Despite the widespread application of SHAI, polish language version was not created to this time. The results of the psychometric properties of the scale, confirmed a high reliability and accuracy of the proposed solutions. Conclusions This findings provide that polish language version of the SHAI is reliable and valid instrument to detect 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.
... 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.
... The MIHT was selected for this study because it conceptualizes health anxiety from both a cognitive and interpersonal perspective and is the only known measure with distinct scales that assess health anxiety dimensionally (Longley et al., 2010). Confirmatory factor analyses indicate that the MIHT can be conceptualised as hierarchical in nature, with four lower-order dimensions loading onto a global health anxiety factor (Stewart, Sherry, Watt, Grant, & Hadjistavropoulos, 2008). The subscales are: (a) affective, or the tendency to worry excessively about illness and health; (b) cognitive, or the tendency to believe one is ill despite disbelief by others; (c) behavioural, or the tendency to seek reassurance for perceived health concerns; and (d) perceptual, or the tendency to focus on bodily sensations. ...
Article
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Health anxiety is a multidimensional construct referring to worry about health, reassurance seeking, hypervigilance to bodily sensations, and beliefs that health concerns are not taken seriously by others. Research suggests health anxiety can be triggered by a diagnosis of a health condition such as breast cancer. Social factors are postulated to be involved in the occurrence and maintenance of health anxiety, but little empirical evidence is available in this area. The present study tested the role of perceived adequacy of social support and unsupportive social interactions in health anxiety relative to general anxiety, depression, and demographic/cancer-related variables. Canadian women diagnosed with early stage breast cancer within the last 10 years ( N = 131) completed a web-based survey. Social factors contributed to significant variance in health anxiety and its 4 dimensions, even after taking other variables into account. The results underscore the importance of social support to health anxiety and highlight a need to assess social factors when assessing and treating health anxiety in this population.
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Bu çalışma yetişkinlerde kaygı duyarlılığı ile sağlık kaygısı arasındaki ilişkiyi ve bu ilişki için aracı olarak öz-şefkat kavramını inceleyerek kavramın aracı rolünü ortaya koymayı hedeflemektedir. Bu hedef doğrultusunda, araştırmaya 18 yaş ve üzeri 290 yetişkin katılımcı dahil edilmiştir. Katılımcıların yaş ortalaması 32.11’dir (S = 15.06). Katılımcılara uygulanan ölçek seti katılımcıların sosyodemografik bilgilerini incelemek amacıyla Sosyodemografik Bilgi Formu, kaygı duyarlılıklarını ölçmek amacıyla Kaygı Duyarlığı İndeksi, sağlık kaygısı düzeylerini değerlendirmek amacıyla Sağlık Anksiyetesi Ölçeği ve öz-şefkat düzeylerini değerlendirmek amacıyla Öz-Duyarlık Ölçeğinden oluşmaktadır. Araştırmanın değişkenleri olan kaygı duyarlılığı, sağlık kaygısı ve öz-şefkat değişkenleri arasındaki ilişkisel sonuçlar istatistiksel olarak anlamlı bulunmuştur. Buradan hareketle gerçekleştirilen kaygı duyarlılığının sağlık kaygısı üzerindeki yordayıcı etkisinde öz-şefkatin aracı rolünün sınandığı hiyerarşik çoklu doğrusal medyatör regresyon analizinin sonucuna göre kaygı duyarlılığının sağlık kaygısı üzerindeki yordayıcı etkisinde öz-şefkatin kısmi aracı etki gösterdiği bulunmuştur. Araştırmanın bulguları literatür kapsamında tartışılmıştır. Son olarak, mevcut çalışmanın literatüre katkısı ile, çalışmanın sınırlılıkları ve ilerideki çalışmalar için öneriler sunulmuştur.
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Le présent article résume notre programme de recherche sur la sensibilité à l’anxiété (SA) – un facteur dispositionnel cognitif et affectif impliquant des craintes de sensations liées à l’anxiété en raison de croyances selon lesquelles ces sensations entraînent des conséquences catastrophiques. La SA et ses dimensions d’ordre inférieur sont considérées comme des facteurs transdiagnostiques de risque ou de maintien des troubles émotionnels et des troubles addictifs. La compréhension des mécanismes par lesquels la SA exerce ses effets peut révéler des cibles d’intervention clés pour les programmes de prévention et de traitement axés sur la SA. Dans le présent article, je passe en revue les recherches fondamentales que nous avons menées pour comprendre les mécanismes qui relient la SA à ces troubles et à leurs symptômes. Je décris également les interventions transdiagnostiques ciblées sur la SA et j’illustre la manière dont la recherche fondamentale a permis d’orienter le contenu de ces interventions. Enfin, je passe en revue les projets en cours dans mon laboratoire et je souligne les orientations futures importantes dans ce domaine. Bien que des progrès considérables aient été réalisés au cours des trois dernières décennies et que la recherche ait considérablement fait avancer notre compréhension de la SA en tant que facteur transdiagnostique, de nombreuses questions restent en suspens. Les réponses devraient nous aider à affiner les interventions afin d’en faire bénéficier au maximum les personnes qui ont une grande peur d’avoir peur.
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Epidemics bring along many pathologies and become a threat for ill individuals because of an outbreak and those exposed to th e outbreak process. Many negative psychological and educational results can be encountered following the COVID-19 process when previous studies were considered together with these threats. In this context, this research aimed to examine the effect of t he COVI D-19 on anxiety sensitivity, death anxiety, and resilience. In addition, examining anxiety sensitivity in terms of some personal variables (gender, physical health, marital status, and working status). The study has been conducted on a relational survey method. Th e participants consisted of 955 individuals aged between 18-68, of which 281 were males, and 662 were females. In this study, Anxiety Sensitivity Index-3, Death Anxiety Scale, and Brief Resilience Scale were used to collect data. The data were analyzed with Pearson correlation coefficient, regression, independent samples t-test, and ANOVA. The result of analyses showed a positive correlation between anxiety sensitivity and death anxiety; however, there is a negative correlation between resilience and anxiety sensit ivity. Furthermore, resilience and anxiety sensitivity differed significantly according to gender, marital status, and working status (student, unemployed, employed, retired); however, the level of death anxiety did not differ according to gender and marital status. An xiety sensitivity, death anxiety, and resilience did not differ significantly in terms of physical health. When considering the finding obtain ed in the present study, individuals with high anxiety sensitivity levels were affected more by the COVID-19 pandemic, but those with high resilience levels were affected less. © IJERE. All rights reserved
Chapter
Health anxiety is a term used to describe a multidimensional presentation of health preoccupation and distress. Major components of health anxiety include health-related worry, the presence and fear of bodily sensations and changes, overestimating the likelihood and cost of illness, and safety behaviors. Health anxiety within the current diagnostic classification system is a criterion for two psychological disorders: illness anxiety disorder and somatic symptom disorder. These two disorders differ in important ways, and the presence of a general medical condition does not necessarily preclude the diagnosis of either. As such, treatment providers need to be attentive to various potential components and presentations of health anxiety. This chapter presents a perspective that health anxiety is the result of nonadaptive attempts to cope with health-related uncertainty. Considerations of this perspective for assessment, case conceptualization, and intervention are discussed. Exposure-based techniques for targeting health-related worry, safety behaviors, and the fear of bodily sensations and changes are emphasized. This chapter concludes with a case example of severe health anxiety.KeywordsExposureHealth anxietyHealth-related uncertaintyIllness anxiety disorderSomatic symptom disorder
Research Proposal
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The study examined relationship between attachment types, experience of traumatic events, alexithymia and the perception of Body Self and hypochondria. The study verifie how combination of the relationship of attachment types, traumatic experiences and alexithymia relates to level of the Body Self and hypochondria. For the research I applied questionnaires for sex differentiation including: Attachment Styles Questionnaire by Plopa, Toronto Alexithymia Scale (TAS-20) by Taylora and team, Traumatic Experiences Checklist (TEC) by Nijenhuis, Van der Hart and Vanderlinden Assen-Amsterdam-Leuven, Self-Body Questionnaire by Sakson-Obada and also a original questionnaire, which examines the hypochondria based on Hs scale from MMPI-2. I examined 47 people (22 man & 22 women) aged from 19 to 63 years, each with different material and social status. The results show a significant relationship between attachment types and perception of the Body Self and between insecure attachment types and alexithymia. Moreover, it also indicated that when avoidant attachment type occurs then hypochondriacal disturbances can be also expect but only in case of of alexithymia. This trend is increasing in people with traumatic experience. It was also found that Hypochondria is associated with reduced threshold of sensations and emotions to body. In case of bodily perception, it was confirmed that increase in threshold of reduced sensation, feelings control and emotion on body is associated with trauma. In addition, extreme anxiety about health may be associated with greater difficulties with describing feelings and may corrupt externally-oriented thinking. The rest of the analysis has not been confirmed. There were no differences observed between genders.
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.
Chapter
This chapter evaluates the assessment tools currently available for the diagnosis and evaluation of somatoform disorders in the African American (AA) population. A variety of instruments were reviewed, yet the difficulties continuously lie in the expression of symptomatology in the AA client, in comparison to the Caucasian client. Many of the assessment measures were normed on Caucasian samples, therefore poorly lending their usage to the AA population. It is recommended that reliable and well-validated measures be utilized with this population, while being cognizant of the cultural differences in emotional and physical expression.
Article
Intolerance of uncertainty (IU) − difficulty coping with uncertainty and its implications − is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (Mage = 12.7 years, SD = .82, range 11-17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.
Article
Searching for medical information online is a widespread activity that increases distress for many individuals. Researchers have speculated that this phenomenon, referred to as cyberchondria, overlaps substantially with both health anxiety and obsessive-compulsive symptoms. This study sought to examine: (1) the distinguishability of cyberchondria from health anxiety and obsessive-compulsive symptoms and (2) the components of health anxiety and obsessive-compulsive symptoms that cluster most strongly with cyberchondria. The sample consisted of community adults in the United States with no current reported medical problems (N = 375). Results from confirmatory factor analyses (CFAs) support the idea that cyberchondria is distinct from, yet related to, health anxiety and obsessive-compulsive symptoms. Results from zero-order correlations and regression analyses suggest that cyberchondria clusters with the affective (health worry) component of health anxiety. Regression results diverged from prior findings, as obsessive-compulsive symptoms did not share associations with cyberchondria after accounting for negative affect and health anxiety. The present results indicate that cyberchondria is possibly discernible from both health anxiety and obsessive-compulsive symptoms, while also providing insight into areas of potential overlap.
Article
Preliminary findings suggest that anxiety sensitivity (AS) and intolerance of uncertainty (IU) may confer vulnerability for cyberchondria, defined as repeated internet searches for medical information that exacerbates health anxiety. Prior studies are limited because it remains unclear whether specific AS or IU dimensions differentially relate to certain cyberchondria dimensions. The present study examined associations among AS, IU, and cyberchondria dimensions using a sample of community adults (N=578) located in the United States. As predicted, physical AS and inhibitory IU were the only AS or IU dimensions to share unique associations with the distress cyberchondria dimension after controlling for the overlap among the AS dimensions, IU dimensions, and health anxiety. Cognitive AS and social AS unexpectedly evidenced unique associations with cyberchondria dimensions. The results are limited by the cross-sectional study design and use of a community, rather than clinical, sample. This study provides evidence that specific AS and IU dimensions may confer vulnerability to certain cyberchondria dimensions. Further clarifying associations among AS, IU, and cyberchondria may lead to improvements in our conceptualization and, ultimately, treatment of cyberchondria. Copyright © 2015 Elsevier B.V. All rights reserved.
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
A series of confirmatory factor analyses (CFA) were performed on responses from 195 school-age children to the Childhood Illness Attitude Scales (CIAS; Wright & Asmundson, 2003) Three-, modified 3-, 4-and 4-factor higher-order models were examined. Items originally comprising the treatment experience factor in the 4-factor higher-order model were removed resulting in a revised 3-factor model that best fit the data. Initial construct validity was established by observing moderate correlations between revised CIAS subscale and total scores and measures of anxiety-related constructs, and somatization. Suggested revisions to the CIAS warrant future examination. Implications for clinical practice are discussed.
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Researchers have called for examinations of associations between distinct facets of distress tolerance and specific forms of psychopathology. We examined associations between five facets of distress tolerance (intolerance of uncertainty, ambiguity, frustration, negative emotion, and physical discomfort) and health anxiety using a large community sample of adults. Structural equation modeling was used to examine associations. Intolerance of uncertainty, negative emotion, and physical discomfort were the only facets of distress tolerance that shared unique associations with health anxiety after accounting for the overlap among the facets of distress tolerance. Intolerance of physical discomfort shared an especially strong unique association with health anxiety. These results highlight facets of distress tolerance that are particularly relevant to health anxiety. Conceptual and therapeutic implications are discussed.
Article
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.
Article
With the burden of emergency department (ED) use increasing, research examining the factors associated with ED visits among individuals who use the ED most frequently is needed. Given that substance use is strongly linked to ED visits, this study sought to examine the factors associated with greater ED visits among patients with substance use disorders (SUD). More precisely, we examined whether health anxiety incrementally contributes to the prediction of ED visits for medical care among adult patients (N = 118) in a residential substance abuse disorder treatment facility. As predicted, health anxiety was significantly positively correlated with ED visits during the past year. Furthermore, health anxiety remained a significant predictor of ED visits after accounting for sociodemographic variables, frequency of substance use, and physical health status. These results suggest that health anxiety may contribute to increased ED visits for medical care among individuals with SUD.
Article
Using data from a large nonclinical sample (N = 503), the current study examined the convergence and utility of the Short Health Anxiety Inventory (SHAI; Salkovskis et al., in Psychol Med 32:843–853, 2002) and the Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley et al., in Psychol Assess 17: 3–14, 2005). Results from a higher-order measurement model indicated that the SHAI and the MIHT factors were distinguishable and generally shared significant intercorrelations. The affective factor of the SHAI and the MIHT shared the strongest convergence and the MIHT cognitive factor clustered with both affective factors. Further, a higher-order health anxiety factor adequately accounted for SHAI-MIHT factor intercorrelations, with the affective and cognitive factors of the SHAI and the MIHT loading strongest upon the higher-order factor. Finally, only the affective and cognitive SHAI and MIHT scales incrementally contributed—beyond general distress and the other SHAI and MIHT scales—in regression analyses predicting medical utilization and somatic symptoms. Implications for the conceptualization and assessment of health anxiety are discussed.
Article
The present study examines the association between anxiety sensitivity (AS) and symptoms of hypochondriasis (a pattern of intense health anxiety) in a nonclinical sample. Findings from study 1 (n=498) revealed a significant association between AS and health anxiety even after controlling for symptoms of depression and negative affect. However, the association between AS and health anxiety was not moderated by stress levels. Subsequent analysis did reveal a specific association between AS for physical concerns and health anxiety when controlling for other AS dimensions. Contrary to predictions, AS did not significantly predict residual change in symptoms of health anxiety over a 12-week period (n=195) in Study 2. However, exploratory analyses suggest that some AS dimensions (e.g., physical concerns) may be more predictive of some facets of health anxiety (e.g., body vigilance) than others (e.g., illness severity). Findings from this study are discussed in the context of future research on the role of AS in the development of hypochondriasis.
Article
Research in the anxiety disorders has shown that safety behaviors function to maintain pathological anxiety by preventing the disconfirmation of inaccurate threat beliefs. The present study examined if such safety behaviors might also contribute to the development and exacerbation of symptoms of health anxiety. The present study tested this notion in a sample of students that were randomized to a safety-behavior (n = 30) or a control (n = 30) condition. After a week-long baseline period, participants in the safety-behavior condition spent 1 week engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second baseline period. Participants in the control condition were instructed to monitor their normal use of safety behaviors. Subsequent to the manipulation, participants in the safety behavior manipulation evidenced statistically significant increases in health anxiety, contamination fear, disgust sensitivity, and cognitive and avoidant responses to three health-related behavioral avoidance tasks compared to those in the control condition. However, anxiety and depressive symptoms remained stable and did not differ between the two groups. These findings suggest that health-related safety behaviors may cause an increase in health anxiety and related processes. The implications of these findings for a cognitive-behavioral model of hypochondriasis are discussed. Thesis completed in partial fulfillment of the requirements of the Honors Program in Psychological Sciences
Article
This review examined (a) whether hypochondriacal/health-anxious individuals hold distinct assumptions about health and illness, (b) if triggering these assumptions leads to increased hypochondriacal concerns, and (c) whether these individuals perceive their bodily sensations differently from others (i.e., experience greater somatosensory amplification). There was clear evidence that health anxiety is related dysfunctional health-related beliefs. Few studies have examined how hypochondriacal concerns are triggered, and inconsistent results emerged from those that have. Health anxiety is also associated with self-reported higher levels of somatosensory amplification. However, there was little evidence that individuals high in health anxiety are actually more accurate perceivers of the their own autonomic processes. Although the results generally supported the central tenets of the cognitive-behavioral model of hypochondriasis and health anxiety, further research will be necessary to determine whether these beliefs are specific to hypochondriasis and to identify any cognitive processes that may be unique to hypochondriasis.
Article
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Anxiety sensitivity (AS) has been defined as the fear of anxiety and anxiety-related sensations, and evidence suggests that AS plays an important role in the psychopathology of panic. It is entirely unclear whether the relation between AS and panic should be attributed to one (or more) of the AS group factors, the general AS factor, or to factors at both levels of the AS hierarchy. The authors reanalyzed data presented earlier by R. M. Rapee, T. A. Brown, M. A. Antony, and D. H. Barlow (1992) to tease apart the contributions of the different levels of the AS hierarchy to fear responses to hyperventilation and 5.5% carbon dioxide challenges. ne results demonstrated that AS-Physical Concerns is the only one of the three AS group factors that contributes to relations with fear responses to these two challenges. However, AS-Mental Incapacitation Concerns had a stronger positive linear association with depressed mood than did AS-Physical Concerns.
Chapter
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Recent years have seen major advances in the understanding and treatment of health anxiety and hypochondriasis, particulary in relation to the cognitive behavioural approach to anxiety. This volume brings together this knowledge of psychological and pharmacological treatments of health anxiety, and relates it to a conceptual framework which provides a basis for assessment, treatment and ongoing research. "Asmundson, Taylor and Cox have assembled a group of world class scientists and practitioners for this book. The chapters provide a wealth of information on the causes, assessment and treatment of health anxiety related disorders. I believe that their book is the most significant contribution to date to our understanding of health anxiety related disorders. Everyone working in the health field will find something of worth in this book."
Article
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The present study explored psychological predictors of response to a series of three 25 second inhalations of 20% carbon dioxide-enriched air in 60 nonclinical participants. Multiple regression analyses indicated that only anxiety sensitivity physical concerns predicted self-reported fear, whereas both physical anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted affective ratings of emotional arousal. In contrast, the psychological concerns anxiety sensitivity dimension predicted ratings of emotional displeasure (valence), and both psychological anxiety sensitivity concerns and behavioural inhibition sensitivity independently predicted emotional dyscontrol. No variables significantly predicted heart rate. These data are in accord with current models of emotional reactivity that highlight the role of cognitive variables in the production of anxious and fearful responding to somatic perturbation, and help further clarify the particular predictors of anxiety-related responding to biological challenge.
Article
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Mardia's measure of multivariate kurtosis has been implemented in many statistical packages commonly used by social scientists. It provides important information on whether a commonly used multivariate procedure is appropriate for inference. Many statistical packages also have options for missing data. However, there is no procedure for applying Mardia's kurtosis to a data set with missing values. In this article Mardia's kurtosis is extended to a data set with missing values. Based on the complete data counterpart, the behavior of a standardized version of the extended sample kurtosis can be described by the standard normal distribution. Analytical and Monte-Carlo studies imply that the proposed distribution description is as good as its complete data counterpart when missing variables are either missing completely at random or missing at random when observed marginals do not sit in a cluster with a restricted range. Application of this procedure is illustrated with a real data set.
Article
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This paper reviews the relevant cognitive research on health anxiety and hypochondriasis, as well as research examining temperament/personality and social developmental factors relevant to health and illness cognition and associated negative emotional states. A cognitive developmental model is proposed which integrates individual difference variables, selective attention/cognitive factors, and social learning processes that may serve as vulnerability and maintenance factors in the etiology of health anxiety and hypochondriasis. Future directions for the study of cognition and hypochondriasis are suggested.
Article
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Forty-one DSM-III-R hypochondriacs and seventy-five randomly chosen patients were obtained from a medical outpatient clinic, and completed a psychiatric diagnostic interview and a ten-item self-report questionnaire, the Somatosensory Amplification Scale (SSAS); The SSAS asks the respondent how much s/he is bothered by various uncomfortable visceral and somatic sensations, most of which are not the pathological symptoms of serious diseases. SSAS scores were normally distributed, and had acceptable test-retest reliability and internal consistency. They were not related to sociodemographic characteristics, or to aggregate medical morbidity. Amplification was significantly higher in the DSM-III-R hypochondriacs than in the comparison sample, and was significantly correlated with the degree of hypochondriacal symptomatology within each sample. In the comparison sample, it was also significantly associated with depressive and anxiety disorders, but not with antisocial personality or substance abuse. The association between the amplification scale and DSM-III-R hypochondriasis remained highly significant after controlling for these concurrent psychiatric disorders.
Article
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Anxiety sensitivity (AS; the fear of anxiety-related sensations) has been proposed as a risk factor for the development of panic disorder. The present study involved a conceptual replication of Ehlers' (1993, Behaviour Research and Therapy, 31, 269–278) study on childhood learning experiences and panic attacks, but also extended her work by investigating the relationship between early learning experiences and the development of AS, in a non-clinical sample. A sample of 551 university students participated in a retrospective assessment of their childhood and adolescent instrumental and vicarious learning experiences with respect to somatic symptoms (i.e. anxiety and cold symptoms, respectively) using an expanded version of Ehler's (1993) Learning History Questionnaire. AS levels were assessed using the Anxiety Sensitivity Index, and panic history was obtained using the Panic Attack Questionnaire, Revised. Contrary to hypotheses, the learning experiences of high AS individuals were not found to be specific to anxiety symptoms, but involved parental reinforcement of sick-role behavior related to somatic symptoms in general. High AS subjects reported both more anxiety and cold symptoms prior to age 18 than individuals with lower levels of AS. In addition, both cold and anxiety symptoms elicited more special attention and/or instructions from parents for high AS individuals to take special care of themselves. These findings are contrasted with the results for self-reported panickers who reported more learning experiences (modeling and parental reinforcement) specific to anxiety-related symptoms, than the non-panickers. The results suggest that higher-than-normal levels of AS may arise from learning to catastrophize about the occurrence of bodily symptoms in general, rather than anxiety-related symptoms in particular.
Article
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To determine the nosological and phenomenological overlap and boundaries between panic disorder and hypochondriasis, we compared the symptoms, disability, comorbidity, and medical care of primary care patients with each diagnosis. Patients with DSM-III-R panic disorder were recruited by screening consecutive primary care clinic attenders and then administering a structured diagnostic interview for panic disorder. Patients also completed self-report questionnaires, and their primary care physicians completed questionnaires about them. They were then compared with patients with DSM-III-R hypochondriasis from the same setting who had been studied previously. One thousand six hundred thirty-four patients were screened; 135 (71.0% of the 190 eligible patients) completed the research battery; 100 met lifetime panic disorder criteria. Twenty-five of these had comorbid hypochondriasis. Those without comorbid hypochondriasis (n = 75) were then compared with patients with hypochondriasis without comorbid panic disorder (n = 51). Patients with panic disorder were less hypochondriacal (P < .001), somatized less (P < .05), were less disabled (P < .001), were more satisfied with their medical care (P < .001), and were rated by their physicians as less help rejecting (P < .05) and less demanding (P < .01). Major depression was more prevalent in the group with panic disorder (66.7% vs 45.1%; P < .05), as were phobias (76.0% vs 37.3%; P < .001), but somatization disorder symptoms (P < .0001) and generalized anxiety disorder were less prevalent (74.5% vs 16.0%; P < .001) in panic disorder than was hypochondriasis. While hypochondriasis and panic disorder co-occur to some extent in a primary care population, the overlap is by no means complete. These patients are phenomenologically and functionally differentiable and distinct and are viewed differently by their primary care physicians.
Article
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Anxiety sensitivity (AS) has been defined as the fear of anxiety and anxiety-related sensations, and evidence suggests that AS plays an important role in the psychopathology of panic. It is entirely unclear whether the relation between AS and panic should be attributed to one (or more) of the AS group factors, the general AS factor, or to factors at both levels of the AS hierarchy. The authors reanalyzed data presented earlier by R. M. Rapee, T. A. Brown, M. A. Antony, and D. H. Barlow (1992) to tease apart the contributions of the different levels of the AS hierarchy to fear responses to hyperventilation and 5.5% carbon dioxide challenges. The results demonstrated that AS-Physical Concerns is the only one of the three AS group factors that contributes to relations with fear responses to these two challenges. However, AS-Mental Incapacitation Concerns had a stronger positive linear association with depressed mood than did AS-Physical Concerns.
Article
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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.
Book
Anxiety sensitivity (AS) is the fear of anxiety sensations which arises from beliefs that these sensations have harmful somatic, social, or psychological consequences. Over the past decade, AS has attracted a great deal of attention from researchers and clinicians with more than 100 peer-reviewed journal articles published. In addition, AS has been the subject of numerous symposia, papers, and posters at professional conventions.© 1999 by Lawrence Erlbaum Associates, Inc. Why this growing interest? Theory and research suggest that AS plays an important role in the etiology and maintenance of many forms of psychopathology, including anxiety disorders, depression, chronic pain, and substance abuse. Bringing together experts from a variety of different areas, this volume offers the first comprehensive state-of-the-art review of AS--its conceptual foundations, assessment, causes, consequences, and treatment--and points new directions for future work. It will prove to be an invaluable resource for clinicians, researchers, students, and trainees in all mental health professions. © 1999 by Lawrence Erlbaum Associates, Inc. All rights reserved.
Article
A FORTRAN 77 program is presented that tests assumptions of multivariate normality in a data set. Violation of the normality assumption, especially excessive kurtosis, suggests that alternative estimation techniques other than maximum likelihood should be used. Even if all the univariate distributions are normal, the joint distribution may depart substantially from multivariate normality. Consequently, testing variables individually may not be sufficient. This program is of use to those engaged in structural equation modeling with latent variables.
Article
The Anxiety Sensitivity Index (ASI) is one of the most widely used measures of the construct of anxiety sensitivity. Until the recent introduction of a hierarchical model of the ASI by S. O. Lilienfeld, S. M. Turner, and R. G. Jacob (1993), the factor structure of the ASI was the subject of debate, with some researchers advocating a unidimensional structure and others proposing multidimensional structures. In the present study, involving 432 outpatients seeking treatment at an anxiety disorders clinic and 32 participants with no mental disorder, the authors tested a hierarchical factor model. The results supported a hierarchical factor structure consisting of 3 lower order factors and 1 higher order factor. It is estimated that the higher order, general factor accounts for 60% of the variance in ASI total scores. The implications of these findings for the conceptualization and assessment of anxiety sensitivity are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
For symmetric unimodal distributions, positive kurtosis indicates heavy tails and peakedness relative to the normal distribution, whereas negative kurtosis indicates light tails and flatness. Many textbooks, however, describe or illustrate kurtosis incompletely or incorrectly. In this article, kurtosis is illustrated with well-known distributions, and aspects of its interpretation and misinterpretation are discussed. The role of kurtosis in testing univariate and multivariate normality; as a measure of departures from normality; in issues of robustness, outliers, and bimodality; in generalized tests and estimators, as well as limitations of and alternatives to the kurtosis measure β2, are discussed.
Article
This study examined the linkages between health status, health perceptions and health locus of control, and three dimensions of anxiety in a group of community-dwelling elders (N=91). Findings show that whereas medical conditions (e.g. high blood pressure, diabetes) did not relate to anxiety, poorer actual and perceived health were related to increased distress and hypochondriacal concerns. Both internal and external (i.e. powerful others, chance) locus of control over health were differentially predictive of anxiety. Loss of internal control and attributions of control to chance increased distress, attribution to powerful others and chance increased anxiety sensitivity, and attributions to powerful others and health perceptions increased hypochondriasis. Findings are discussed in terms of the relative influence of biological (i.e co-morbid) and psychosocial (i.e. reactive) factors in the experience of anxiety in later life. Potential implications with respect to psychosocial interventions are discussed.
Article
SUMMARY Measures of multivariate skewness and kurtosis are developed by extending certain studies on robustness of the t statistic. These measures are shown to possess desirable properties. The asymptotic distributions of the measures for samples from a multivariate normal population are derived and a test of multivariate normality is proposed. The effect of nonnormality on the size of the one-sample Hotelling's T2 test is studied empirically with the help of these measures, and it is found that Hotelling's T2 test is more sensitive to the measure of skewness than to the measure of kurtosis.
Article
A model for the relation between multivariate Fourth-order central moments of a set of variables and the marginal kurtoses and covariances among these variables is used to produce an estimator for covariance structure analysis that is asymptotically efficient and yields an asymptotic X 2 goodness of fit test of the covariance structure while substantially reducing the computations. When the kurtoses of the variables are equal, the method reduces to one based on multivariate elliptical distribution theory, and, when there is no excess kurtosis, to one based on multivariate normal distribution theory.
Article
Despite its high prevalence and implications for health care resources, health anxiety is still a relatively neglected area of research. This paper describes the development of the Health Anxiety Questionnaire (HAQ), a measure based on a cognitive-behavioural analysis of health anxiety. The measure was developed to identify individuals with high levels of concern about their health. Psychiatric and medical samples were used in the reported studies. The HAQ was found to have good internal consistency (coefficient alpha and split-half reliability) and short-term temporal stability (test-retest reliability). Long-term stability (one year) was modest but predictably responsive to external events. Analysis of the structure of the HAQ (cluster and factor analyses) revealed four factors: worry and health preoccupation, fear of illness and death, reassurance-seeking behaviour and the extent to which symptoms interfere with a person's life. Studies of the HAQ's validity indicate that it has appropriate discriminate validity. It is concluded that the HAQ appears to reflect relatively enduring features consistent with the cognitive-behavioural model of health anxiety. It is anticipated that the HAQ should be able to predict response to reassurance following medical examination.
Article
Evaluated a scale for measuring anxiety sensitivity (i.e., the belief that anxiety symptoms have negative consequences), the Child Anxiety Sensitivity Index (CASI), in 76 7th–9th graders and 33 emotionally disturbed children (aged 8–15 yrs). The CASI had sound psychometric properties for both samples. The view that anxiety sensitivity is a separate concept from that of anxiety frequency and that it is a concept applicable with children was supported. The CASI correlated with measures of fear and anxiety and accounted for variance on the Fear Survey Schedule for Children—Revised and the State-Trait Anxiety Inventory for Children (Trait form) that could not be explained by a measure of anxiety frequency. The possible role of anxiety sensitivity as a predisposing factor in the development of anxiety disorder in children is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Book
Readers who want a less mathematical alternative to the EQS manual will find exactly what they're looking for in this practical text. Written specifically for those with little to no knowledge of structural equation modeling (SEM) or EQS, the author's goal is to provide a non-mathematical introduction to the basic concepts of SEM by applying these principles to EQS, Version 6.1. The book clearly demonstrates a wide variety of SEM/EQS applications that include confirmatory factor analytic and full latent variable models.
Article
This study evaluated the sensitivity of maximum likelihood (ML)-, generalized least squares (GLS)-, and asymptotic distribution-free (ADF)-based fit indices to model misspecification, under conditions that varied sample size and distribution. The effect of violating assumptions of asymptotic robustness theory also was examined. Standardized root-mean-square residual (SRMR) was the most sensitive index to models with misspecified factor covariance(s), and Tucker-Lewis Index (1973; TLI), Bollen's fit index (1989; BL89), relative noncentrality index (RNI), comparative fit index (CFI), and the ML- and GLS-based gamma hat, McDonald's centrality index (1989; Mc), and root-mean-square error of approximation (RMSEA) were the most sensitive indices to models with misspecified factor loadings. With ML and GLS methods, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, CFI, gamma hat, Mc, or RMSEA (TLI, Mc, and RMSEA are less preferable at small sample sizes). With the ADF method, we recommend the use of SRMR, supplemented by TLI, BL89, RNI, or CH. Finally, most of the ML-based fit indices outperformed those obtained from GLS and ADF and are preferable for evaluating model fit. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Hypochondriacal concerns ranging from disease phobias to bodily preoccupations are common among patients with panic disorder. In a previous study of patients with panic disorder, we found that, of a number of symptom dimensions examined, anxiety sensitivity was the strongest predictor of hypochondriacal concerns. This finding has been the topic of subsequent debate in the anxiety literature, with concerns raised whether true hypochondriacal concerns were confounded with typical panic-related concerns. To clarify this issue, we now report on the association between anxiety sensitivity and hypochondriacal concerns in 100 patients with major depression and no history of panic disorder. Consistent with our previous study, we found that of the symptoms examined—anxiety sensitivity, depressed mood, anxious mood, somatic symptoms, and anger/hostility—anxiety sensitivity was the strongest predictor of hypochondriacal concerns. Findings are discussed in relation to the role of catastrophic interpretations of somatic symptoms in depression, panic disorder, and hypochondriasis.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related sensations arising from beliefs that these sensations have harmful physical, psychological, or social consequences. AS is measured using the Anxiety Sensitivity Index (ASI), a 16-item self-report questionnaire. Little is known about the origins of AS, although social learning experiences (including sex-role socialization experiences) may be important. The present study examined whether there were gender differences in: (a) the lower- or higher-order factor structure of the ASI; and/or (b) pattern of ASI factor scores. The ASI was completed by 818 university students (290 males; 528 females). Separate principal components analyses on the ASI items of the total sample, males, and females revealed nearly identical lower-order three-factor structures for all groups, with factors pertaining to fears about the anticipated (a) physical, (b) psychological, and (c) social consequences of anxiety. Separate principal components analyses on the lower-order factor scores of the three samples revealed similar unidimensional higher-order solutions for all groups. Gender × AS dimension analyses on ASI lower-order factor scores showed that: females scored higher than males only on the physical concerns factor; females scored higher on the physical concerns factor relative to their scores on the social and psychological concerns factors; and males scored higher on the social and psychological concerns factors relative to their scores on the physical concerns factor. Finally, females scored higher than males on the higher-order factor representing the global AS construct. The present study provides further support for the empirical distinction of the three lower-order dimensions of AS, and additional evidence for the theoretical hierarchical structure of the ASI. Results also suggest that males and females differ on these various AS dimensions in ways consistent with sex role socialization practices.
Article
Many panic disorder patients have significant levels of hypochondriacal concerns. The present study investigated the relationship between specific symptom characteristics and hypochondriacal concerns in a sample of 50 panic disorder patients at different stages of treatment and recovery. Of the symptom characteristics examined — anxious mood, depressed mood, anxiety sensitivity, current number of panic attacks, and degree of phobic avoidance — hypochondriacal concerns were most highly associated with anxiety sensitivity. This finding is discussed in relation to the role of catastrophic interpretations of somatic symptoms in panic disorder and hypochondriasis. Treatment implications are discussed.
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
Two studies were conducted to assess the spontaneous self-focusing tendencies of depressed and nondepressed individuals after success and failure. Based on a self-regulatory perseveration theory of depression, it was expected that depressed individuals would be especially high in self-focus after failure and low in self-focus after success. The results of Experiment 1 suggested that immediately after an outcome, both depressed and nondepressed individuals are more self-focused after failure than after success. This finding led us to hypothesize that differences between depressed and nondepressed individuals in self-focus following success and failure emerge over time. Specifically, immediately following an outcome, both types of individuals self-focus more after failure because of self-regulatory concerns. However, over time, depressed individuals persist in higher levels of self-focus after failure than after success, whereas nondepressed individuals shift to the opposite, more hedonically beneficial pattern. The results of Experiment 2 provided clear support for these hypotheses. Theoretical implications of these results were discussed.
Article
In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.
Article
A distinction is proposed between anxiety (frequency of symptom occurrence) and anxiety sensitivity (beliefs that anxiety experiences have negative implications). In Study 1, a newly-constructed Anxiety Sensitivity Index (ASI) was shown to have sound psychometric properties for each of two samples of college students. The important finding was that people who tend to endorse one negative implication for anxiety also tend to endorse other negative implications. In Study 2, the ASI was found to be especially associated with agoraphobia and generally associated with anxiety disorders. In Study 3, the ASI explained variance on the Fear Survey Schedule—II that was not explained by either the Taylor Manifest Anxiety Scale or a reliable Anxiety Frequency Checklist. In predicting the development of fears, and possibly other anxiety disorders, it may be more important to know what the person thinks will happen as a result of becoming anxious than how often the person actually experiences anxiety. Implications are discussed for competing views of the ‘fear of fear’.
Article
In order to investigate the concept of hypochondriasis a questionnaire has been devised. Evidence of its validity and reliability has been presented. This has been followed by a principal component analysis. Three factors have been identified as reflecting three dimensions of hypochondriasis, viz: Bodily Pre-occupation", "Disease Phobia" and "Conviction of the Presence of Disease with Non-Response to Reassurance". These three factors are discussed in relation to the literature on hypochondriasis. Their nature lends support to those observations which have been based on clinical experience.
Article
Patients with somatization disorder (SD), subthreshold somatization, and somatization that is comorbid with another mental or physical disorder use a remarkably high level of general medical services. Because these patients view themselves as more seriously ill than do patients in the general medical population, their use of health care services may be as high as nine times greater than that of the general population. It is important to understand the course and prevalence of SD because 1) these patients tend to overuse health care resources and services, and 2) the associated costs are enormous. It is vital that expert clinical care and research be directed at this important patient group so that appropriate treatment regimens can be developed to help these patients and control the overutilization of limited health care resources.
Article
To clarify the relationship between panic disorder and the symptoms of hypochondriasis and somatization, we evaluated these symptoms and diagnoses in patients attending an Anxiety Disorders Clinic. Structured clinical interviews, self-report measures, and symptom diaries were used to assess 21 patients with panic disorder, 23 patients with social phobia, and 22 control subjects with no psychiatric disorders. Ten of the patients with panic disorder (48%) also met DSM-IV criteria for hypochondriasis, whereas only one of the patients with social phobia and none of the healthy control subjects met the criteria for this diagnosis. None of the participants met DSM-IV criteria for somatization disorder, even though both anxiety groups reported high levels of somatic symptoms. The panic disorder group reported higher levels of fear about illness and disease conviction and endorsed more somatic symptoms than did the other groups. A higher proportion of panic disorder patients reported previously diagnosed medical conditions (48%) as compared with patients with social phobia (17%) or healthy control subjects (14%). The panic disorder patients with DSM-IV hypochondriasis obtained higher scores on measures of hypochondriacal concerns, somatization, blood-injury phobia, and general anxiety and distress than did the panic disorder patients without hypochondriasis. The results suggest a strong association between panic disorder and hypochondriasis.
Article
The Illness Attitudes Scale (IAS) is a self-report instrument comprising nine subscales designed to assess fears, beliefs and attitudes associated with hypochondriasis and abnormal illness behaviour [Kellner (1986). Somatization and hypochondriasis. New York: Praeger.]. The purpose of the present study was to explore the factor structure of the IAS in a chronic pain sample as a preliminary step toward determining the use of this measure in this sample. Hypochondriacal tendencies have been postulated to play a role in maintaining and exacerbating responses to chronic pain and, therefore, appropriate measurement in this sample is important. In the present study, consecutive chronic pain patients presenting to a pain treatment program (N = 198) were administered the IAS. Principal component analysis with oblique (Oblimin) rotation identified that five factors best explain the measure in this population. These factors were (1) fear of illness, (2) effects of symptoms, (3) health habits, (4) disease phobia and conviction and (5) fear of death. The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986), as well as with the factor structure identified in a non-clinical sample [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences, 18, 463-469.]. There were enough discrepancies, however, to suggest an alternative method for scoring the IAS with chronic pain patients. Implications for the use of the measure with chronic pain patients, as well as future research directions for exploring the utility of this measure with chronic pain patients, are discussed.
Article
Anxiety sensitivity (AS) is the fear of anxiety-related sensations. According to Reiss's (e.g., Reiss, 1991) expectancy theory, AS amplifies fear and anxiety reactions, and plays an important role in the etiology and maintenance of anxiety disorders, particularly panic disorder. Recent evidence suggests that AS has a hierarchical structure, consisting of multiple lower order factors, loading on a single higher order factor. If each factor corresponds to a discrete mechanism (Cattell, 1978), then the results suggest that AS arises from a hierarchic arrangement of mechanisms. A problem with previous studies is that they were based on the 16-item Anxiety Sensitivity Index, which may not contain enough items to reveal the type and number of lower order factors. Also, some of the original ASI items are too general to assess specific, lower order factors. Accordingly, we developed an expanded measure of AS--the ASI-R--which consists of 36 items with subscales assessing each of the major domains of AS suggested by previous studies. The ASI-R was completed by 155 psychiatric outpatients. Factor analyses indicated a four-factor hierarchical solution, consisting of four lower order factors, loading on a single higher factor. The lower order factors were: (1) fear of respiratory symptoms, (2) fear of publicly observable anxiety reactions, (3) fear of cardiovascular symptoms, and (4) fear of cognitive dyscontrol. Each factor was correlated with measures of anxiety and depression, and fear of cognitive dyscontrol was most highly correlated with depression, which is broadly consistent with previous research. At pretreatment, patients with panic disorder tended to scored highest on each of the factors, compared to patients with other anxiety disorders and those with nonanxiety disorders. These findings offer further evidence that Reiss's expectancy theory would benefit from revision, to incorporate the notion of a hierarchic structure of AS.
Article
The Illness Attitudes Scale (IAS) assesses fears, beliefs and attitudes associated with hypochondriasis [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers.]. Recent factor analytic investigations of the IAS in non-clinical samples have suggested a number of different factor solutions. In study 1, we used principal components analysis with both orthogonal and oblique rotation to better explore the structure of this measure. Using a random selection of 390 participants from a larger pool of 780, a five-factor solution was identified: (1) fear of illness, death, disease and pain, (2) effects of symptoms, (3) treatment experiences, (4) disease conviction and (5) health habits. In study 2, confirmatory factor analysis (CFA) of responses from the remaining 390 students evaluated: (a) a single-factor model, (b) Kellner's original nine-factor model, (c) a four-factor model proposed by Ferguson and Daniel [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469.], (d) a different four-factor model proposed by Stewart and Watt [Stewart, S. H. & Watt, M. C. (1998). A psychometric investigation of the Illness Attitudes Scale (IAS) in a nonclinical young adult sample. Submitted for publication.] and (e) the five-factor model derived in study 1. Of these models, greatest support was obtained for our five-factor model. However, it was also clear that this model could be improved. Based on the results of the CFA, as well as previous research and theoretical considerations, we tested a revised model in which the health habits factor was deleted. Analysis of the revised model showed that it received the greatest support and could be conceptualized as either four distinct factors or as hierarchical in nature, with four lower-order factors loading on a single higher-order factor. Future directions for research as well as suggestions for scoring and using the IAS with nonclinical samples are discussed.
Article
The Illness Attitudes Scale (IAS) is a self-rated measure that consists of nine subscales designed to assess fears, attitudes and beliefs associated with hypochondriacal concerns and abnormal illness behavior [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger; Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico]. The purposes of the present study were to explore the hierarchical factor structure of the IAS in a nonclinical sample of young adult volunteers and to examine the relations of each illness attitudes dimension to a set of anxiety-related measures. One-hundred and ninety-seven undergraduate university students (156 F, 41 M; mean age = 21.9 years) completed the IAS as well as measures of anxiety sensitivity, trait anxiety and panic attack history. The results of principal components analyses with oblique (Oblimin) rotation suggested that the IAS is best conceptualized as a four-factor measure at the lower order level (with lower-order dimensions tapping illness-related Fears, Behavior, Beliefs and Effects, respectively), and a unifactorial measure at the higher-order level (i.e. higher-order dimension tapping General Hypochondriacal Concerns). The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986, 1987), as well as with the factor structures identified in previously-tested clinical and nonclinical samples [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469; Hadjistavropoulos, H. D. & Asmundson, G. J. G. (1998). Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behaviour Research and Therapy, 36, 1185-1195; Hadjistavropoulos, H. D., Frombach, I. & Asmundson, G. J. G. (in press). Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample. Behaviour Research and Therapy; Speckens, A. E., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95-104]. The Fears, Beliefs and Effects lower-order factors and the General Hypochondriacal Concerns higher-order factor, were shown to be strongly associated with anxiety sensitivity, even after accounting for trait anxiety and panic history. Implications for understanding the high degree of comorbidity between the diagnoses of panic disorder and hypochondriasis, as well as future research directions for exploring the utility of various IAS dimensions in predicting responses to lab-based bodily symptom-induction procedures, are discussed.
Article
the present study investigated childhood learning experiences potentially associated with the development of elevated hypochondriacal concerns in a non-clinical young adult sample, and examined the possible mediating roles of anxiety sensitivity (i.e., fear of anxiety-related symptoms) and trait anxiety (i.e., frequency of anxiety symptoms) in explaining these relationships. 197 university students participated in a retrospective assessment of their childhood instrumental (i.e., parental reinforcement) and vicarious (i.e., parental modeling) learning experiences with respect to arousal-reactive (e.g., dizziness) and arousal-non-reactive (e.g., lumps) bodily symptoms, respectively. Childhood learning experiences were assessed using a revised version of the Learning History Questionnaire (LHQ), anxiety sensitivity levels with the Anxiety Sensitivity Index (ASI), trait anxiety levels with the State-Trait Anxiety Inventory-Trait (STAI-T) scale, and degree of hypochondriacal concerns with the Illness Attitudes Scale (IAS)-Total score. consistent with earlier findings [Watt MC, Stewart SH, Cox BJ. A retrospective study of the learning history origins of anxiety sensitivity. Behav Res Ther 1998; 36: 505-525.], elevated anxiety sensitivity levels were associated with increased instrumental and vicarious learning experiences related to both arousal-reactive and arousal-non-reactive bodily symptoms. Similarly, individuals with elevated hypochondriacal concerns also reported both more instrumental and vicarious learning experiences around bodily symptoms than did students with lower levels of such concerns. However, contrary to the hypothesis, the childhood learning experiences related to hypochondriacal concerns were not specific to arousal-non-reactive symptoms, but instead involved parental reinforcement and modeling of bodily symptoms in general (arousal-reactive and -non-reactive symptoms alike). Anxiety sensitivity, but not trait anxiety, partially mediated the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. elevated anxiety sensitivity appears to be a risk factor for the development of hypochondriasis when learning experiences have involved both arousal-reactive and arousal-non-reactive bodily symptoms.
Article
We examined the effects of anxiety sensitivity (AS) and arousal induction on heartbeat awareness and heart rate reactivity in a nonclinical undergraduate sample. Students were randomly selected from a larger screening sample to fill two groups (high and low AS; n = 15 per group) based on Anxiety Sensitivity Index (ASI) [Peterson, R. A., & Reiss, S. (1992). Anxiety Sensitivity Index manual (2nd ed. revised). Worthington, OH: International Diagnostic Systems] scores. Participants completed a mental arithmetic/spelling task to induce arousal. At two phases (i.e., baseline vs. stress), participants estimated their heart rates during specified intervals using a mental tracking paradigm. Actual heart rates were simultaneously measured. Although heart rate did increase significantly from baseline to stress phases, high and low AS groups did not differ in terms of heart rate reactivity to the stressor. As hypothesized, high AS individuals were more accurate in estimating their actual heart rate as compared to low AS individuals. Contrary to hypothesis, the AS group differences in accuracy of heartbeat estimations did not vary across baseline vs. stress phases. Interestingly, only low AS individuals provided heart rate estimates which were significantly lower than their actual heart rate readings. Although high and low AS individuals did not differ in actual heart rate, high AS individuals provided significantly higher heart rate estimates than low AS individuals. These results are consistent with the interoceptive sensitivity hypothesis. Implications of the greater heartbeat awareness of high AS individuals are discussed.
Article
This study examined the role of anxiety sensitivity (the fear of anxiety symptoms because such symptoms are believed to have harmful consequences), anxiety, and depression in older adults and their relation to hypochondriacal concerns and medical illnesses. The sample included 53 clinic-referred (M age = 78.8 years), and 53 non-clinic referred (M age = 70.9 years) older adults. It was examined whether (1) anxiety sensitivity was elevated in the clinic-referred group relative to the non-referred group, (2) symptoms of anxiety, anxiety sensitivity and depression were related to number of medical illnesses and/or to hypochondriacal concerns, and (3) anxiety sensitivity was a better predictor of hypochondriacal concerns relative to depression or trait anxiety. The results indicated that anxiety sensitivity was significantly elevated in the clinic-referred group relative to the non-clinic referred group, was negatively associated with history of medical illnesses, was strongly associated with hypochondriacal concerns, and was a better predictor of hypochondriacal concerns than depression and trait anxiety. The findings are discussed in terms of problems facing older adults as they relate to the constructs of anxiety sensitivity and hypochondriacal concerns.
Article
Hypochondriasis (HC), which involves preoccupation with the fear of having a serious illness despite appropriate medical examination, is often encountered in medical settings. The most conspicuous feature of this disorder is seeking excessive reassurance from physicians, medical references, or self-inspection; however, many patients also fear they will receive upsetting information if evaluated and thus avoid consultations and remain preoccupied with physiologic events, believing they are physically ill. Thus, HC causes personal suffering for the patient and practical and cost management problems for professionals across fields of clinical practice. The past 2 decades have seen considerable improvement in the understanding and treatment of HC. In this article, we review a contemporary conceptual model of HC and an effective form of treatment called cognitive-behavioral therapy that is derived from this model. Recommendations for presenting this conceptualization to patients and encouraging proper treatment are also discussed.
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.