Hypochondriacal fears and beliefs in medical and law students

We administered two validated scales of hypochondriacal concerns (the Illness Behavior Questionnaire and the Illness Attitude Scales) to 60 medical students and matched law students. Medical students took more precautions about their health and attended more to somatic symptoms, but the prevalence of hypochondriacal fears, beliefs, and attitudes did not differ significantly between the two groups. Five students (8.3%) in each group scored in the range of patients with hypochondriacal neurosis. Most of the students were free of these concerns. The prevalence of hypochondriacal concerns in medical students was substantially lower than the previously reported incidence over four years of study; this supports the previous observation that most of these reactions are short lived.     

Health attitudes and psychological distress in patients attending a lithium clinic

ABSTRACT– Health attitudes and psychological distress were investigated in 50 patients attending a lithium clinic and in 50 normal controls. Patients receiving lithium treatment did not report more worry about illness, hypochondriacal attitudes, concern about pain, disease phobia and bodily preoccupations than normals, even though they took fewer precautions about their health and exhibited more self-rated psychological distress. Since most of the psychiatric patients were found to display more fears about illness and death than controls in other studies, this preliminary report may suggest that normal health attitudes are associated with lithium compliance in affective illness.     

Hypochondriacal concerns and somatic symptoms in patients with chronic airflow obstruction

In order to explore hypochondriacal concerns in patients with Chronic Airflow Obstruction (CAO) the authors administered the Illness Attitude Scales and the somatization, anxiety, depression and anger-hostility scales of the Hopkins Symptom Checklist to 50 patients with CAO and to matched family practice patients. Somatic symptoms were significantly correlated with fears of disease and hypochondriacal concerns in family practice patients, but were unrelated in CAO. Patients with CAO, although more anxious, depressed and with more severe somatic symptoms than family practice patients, had fewer hypochondriacal concerns. In this respect patients with CAO were unlike any other group previously studied.     

The relation between hypochondriasis and age

OBJECTIVE: This study examined the relation between hypochondriasis and age while controlling for the possible confounding influences of medical morbidity, social isolation, and other psychiatric disorder. METHOD: Consecutive patients attending a general medical clinic on randomly selected days were screened with a hypochondriasis self-report questionnaire. Those whose scores exceeded a preestablished cutoff level and a random sample of those who scored below it completed a research battery consisting of self-report questionnaires and structured interviews for DSM-III-R diagnoses of hypochondriasis and other axis I disorders. The patients' medical records were audited, and their physicians completed questionnaires about them. The 60 patients who met the DSM-III-R criteria for hypochondriasis at interview constituted the study group, and 100 patients randomly chosen from among those who scored below the cutoff for hypochondriasis constituted the comparison group. RESULTS: The hypochondriacal group was not older than the comparison group. Hypochondriacal patients aged 65 years and over did not differ significantly from younger hypochondriacal patients in hypochondriacal attitudes, somatization, tendency to amplify bodily sensation, or global assessment of their overall health, even though their aggregate medical morbidity was greater. The elderly hypochondriacal patients had higher levels of disability, but this appeared to be attributable to their medical status rather than to any increase in hypochondriasis. Within the comparison sample, subjects aged 65 years and over were not more hypochondriacal than those under 65 years of age. CONCLUSIONS: Hypochondriasis is found to some degree in all patients and appears to be unrelated to age.     

Hypochondriacal concerns and attitudes toward illness in males and females.

OBJECTIVE: To review the published studies on the sex distribution of hypochondriasis, and to examine sex differences in hypochondriacal concerns and in attitudes toward illness. METHOD: The Illness Attitude Scales, Factors 2 and 3 of the Whiteley Index and the Symptom Checklist-90 (SCL-90) were administered to fifty randomly-selected female family practice patients ages eighteen to sixty-five, and to male patients matched by age in decades. From a pool of 130 consecutive nonpsychotic psychiatric outpatients, fifty females and fifty males were matched with the family practice patients. RESULTS: Although females rated themselves as more depressed than males in both groups, there were no significant differences between the sexes in hypochondriacal fears and beliefs. Psychiatric male patients reported the most adverse effects of bodily symptoms on work and leisure. There were no other significant differences between the sexes in any of the other attitudes toward illness or symptoms. Hypochondriacal concerns were more common in the psychiatric patients than in the family practice patients of both sexes. CONCLUSION: The review of published studies on the sex distribution of hypochondriasis suggests that disease phobia is more common in females, except for the cardiophobic syndrome, which is more common in males. The other reported differences are inconsistent and appear to be caused by referral biases, varying diagnostic criteria, and cultural factors. In our study, we found no substantial differences between males and females in hypochondriacal concerns and attitudes toward illness.     

The phenomenon of ‘chronic Lyme’; an observational study

Purposes: To chart clinical, laboratory, and psychometric profiles in patients who attribute their complaints to chronic Lyme disease. Methods: We assessed the patients by clinical examination, laboratory tests, and questionnaires measuring fatigue, depression, anxiety, health‐related quality of life, hypochondriasis, and illness perceptions. Results: We found no evidence of ongoing Borrelia burgdorferi (Bb) infection in any of the 29 included patients using current diagnostic guidelines and an extended array of tests. Eight (28%) had other well‐defined illnesses. Twenty‐one (72%) had symptoms of unknown cause, of those six met the suggested criteria for post‐Lyme disease syndrome. Fourteen (48%) had presence of anti‐Bb antibodies. The patients had more fatigue and poorer health‐related quality of life as compared to normative data, but were not more depressed, anxious, or hypochondriacal. Their beliefs about the illness were characterized by negative expectations. Conclusion: Our patients, who all attributed their symptoms to chronic Lyme disease, were heterogeneous. None had evidences of persistent Bb infection, but whether current diagnostic criteria are functional in patients with longstanding complaints is controversial. Other well‐defined illnesses or sequelae from earlier Lyme disease were probable as main explanatory factor in some cases. The patients were not more depressed, anxious, or hypochondriacal than the normal population, but they had poorer health‐related quality of life, more fatigue, and negative expectations about their illness.     

Illness coping strategies and hypochondriacal traits among medical inpatients

The Illness Coping Strategies scale (ICS) is an 18-Likert-item scale developed to examine illness appraisal and coping by medical patients more comprehensively than instruments which screen for hypochondriacal traits in this population. This study has examined the association of hypochondriacal traits with illness coping strategies addressed by the ICS among 101 randomly selected inpatients drawn from a general medicine unit of a teaching general hospital. Despite the exclusion of patients with substance abuse or organic mental disorder, or referral for psychiatric consultations, hypochondriacal traits were prevalent in this inpatient sample. Five factor-derived subscales of the ICS (disease vigilance, limit activity, overresponsiveness, self-treatment and obsessive worry) were extracted, and internal consistency and test-retest reliabilities were determined. Multiple regression analysis on a composite measure of hypochondriasis revealed that the five ICS factor scales accounted for 26 percent of the variance. Patients with a high hypochondriacal index had associated high scores on symptom vigilance, limit activity and obsessive worry subscales, suggesting that these illness coping strategies may represent an important aspect of hypochondriacal illness presentation. The self-treatment subscale appeared to act as a suppressor variable, contributing to the prediction of the hypochondriacal index by extracting self treatment aspects from the other illness coping factors. Illness coping responses found to be associated with hypochondriacal traits in this study were rather passive strategies which promoted increased vigilance and concern about symptoms while providing few opportunities to reduce uncertainty regarding health status.     

Distress and attitudes in patients perceived as hypochondriacal by medical staff

The aim of this study was to examine the characteristics of patients perceived by general physicians as hypochondriacal. The authors requested physicians at a general hospital to refer patients for a study of hypochondriasis. In order to measure depression, anxiety, and somatic symptoms, the authors administered several rating and self-rating scales, and to measure hypochondriacal attitudes they administered the Illness Attitude Scales (IAS) and the Illness Behavior Questionnaire (IBQ). The referred patients (N = 29) had more psychiatric disorders, were more depressed and more anxious, and had more severe somatic symptoms than matched medical patients who had not been referred. Self-rated hypochondriacal fears and beliefs did not differ significantly between the groups. Five of the referred patients (17%) whose initial diagnosis was hypochondriasis were subsequently found to have physical diseases that accounted for their symptoms. The implications of these findings for treatment are discussed.     

Hyperprolactinemia, distress, and hostility

The scores of 14 women with hyperprolactinemia on the Symptom Rating Test and the Symptom Questionnaire were compared with those of nonpsychotic women attending a psychiatric clinic, women attending a family practice clinic, and female nonpatient employees. The scores of the hyperprolactinemic women were similar to those of the psychiatric patients. Hyperprolactinemic patients were significantly more hostile, depressed, and anxious and had more feelings of inadequacy than family practice patients and nonpatient employees. The authors recommend measuring the serum prolactin levels of women with depression, hostility, anxiety, and symptoms or signs suggestive of hyperprolactinemia.     

The cognitive-behavioral model of hypochondriasis: misinformation and triggers.

According to the cognitive-behavioral model, hypochondriacal individuals hold dysfunctional assumptions about illness, which may be triggered by critical incidents. In this study 1,158 participants completed measures of hypochondriacal concerns and self-esteem, and estimated the likelihood of various symptoms indicating catastrophic and minor illnesses. Participants who were more hypochondriacal believed that catastrophic outcomes were more likely than did the less hypochondriacal participants, but they did not differ in their estimates for minor illnesses. Estimates of the likelihood of catastrophic illness and self-esteem independently contributed to the prediction of hypochondriacal concerns. In this study 2,177 participants completed a measure of hypochondriacal concerns, performed a scrambled-sentences task that included either illness terms or neutral terms, and completed a state anxiety inventory. The illness terms did not trigger higher levels of anxiety in the more hypochondriacal participants; instead, these terms appeared to make the less hypochondriacal participants as anxious as their hypochondriacal counterparts.     

An exploratory analysis of behavioral health care use within families

OBJECTIVES: The authors studied enrollees in employer-sponsored managed health plans to determine the extent of multiple behavioral health consumers within families, use of behavioral health services by employees who have another family member using such services, congruence of diagnoses between two family members using behavioral health services, and the effect on covered charge per behavioral health consumer when other family members use behavioral health services. METHODS: Claims data from 911 plans sold or managed by a single managed behavioral health care company were examined. The plans provided coverage for 724,789 employees and covered about 1.7 million lives. Family members of employees were identified by the relationship codes on the claims. Service utilization rates were calculated for employees overall and for employees who had spouses or children who used behavioral health services. Mean and median covered charges were determined and were examined by number and type of consumers in the family. RESULTS: The use of behavioral health services was greater among employees whose children or spouses used behavioral health services. Utilization rates varied by the child's or spouse's diagnoses. More than 50 percent of male employees whose children received treatment for a depressive disorder also received such treatment. Congruence of diagnoses within families was noted. Covered charges per person generally increased with the number of family members who used behavioral health services. CONCLUSION: Greater knowledge about patterns of use of behavioral health services within families may help in improving access to care and developing more effective family interventions.     

精神分裂症患者的家庭照料负担研究

目的调查精神分裂症患者的家庭照料负担。方法采用家庭负担会谈量表（family interview schedule，FIS）和自编量表为工具，调查了男、女精神分裂症各50例家庭照料负担。结果照料者的负担明显，主要涉及家庭经济、家庭娱乐活动、家庭关系、家庭日常生活、照料者的心理和躯体健康；男性患者的照料者其家庭娱乐活动所受影响比女性患者的照料者明显；女性照料者感到负担重，且直接照料时问越多，负担越重；无工作的男性患者的照料者负担高于有工作患者的照料者。结论精神分裂症的患者对家庭照料者的影响和所造成的负担。应该引起社会足够重视。     

Detecting psychological distress among patients attending secondary health care clinics : Self-report and physician rating

A study was conducted to determine the prevalence of psychological distress, as reported by patients and their physicians, in orthopedic, neurology, dermatology, and ophthalmology clinics; to study their accuracy in detecting psychological distress; and to determine if there is any connection among psychological distress, accuracy of detecting distress, and use of mental health and primary health care physicians' prognosis for the somatic complaints. Five hundred and fifty-six patients, ages 18–21, responded to the Psychiatric Epidemiology Research Interview Demoralization Scale (PERI-D), a measure of psychological distress, and to questions about their mental health and use of mental health and primary health services. Physicians, who were blind to patients' responses, were asked to what extent they thought the cause of patients' complaints was physical and to what extent they thought it was psychological in nature, and to prognosticate. Based on the PERI-D, about 25% of patients were distressed, this was less for females than males and varied between clinics. Based on self-reporting, about 14% of patients (males and females) were distressed. Based on physician reporting, about 17% (males less) were distressed. Physicians identified 35% of the PERI-D-distressed cases and 79% of nondistressed cases. About 66% of patients identified their distress and 83% their lack of distress. Increased use of primary health care and mental health care was related to distress. The prognosis was negatively related to distress. Based on this study, there is a need for more attention to psychological distress among secondary health care patients. Patients' ability to identify their distress suggests the importance of involving the patient in the diagnostic process. Correct detection of distress alone does not appear to decrease the use of primary medical and mental health services.     

Interrelationship of hypochondriacal, paranoid, depressive, and suicidal symptoms in Chinese psychiatric patients

Data concerning 150 consecutive adult psychiatric patients treated by the authors in a general hospital psychiatric unit were analyzed. All patients with predominant hypochondriacal or paranoid symptoms were selected. The presence of depressed mood and suicidal ideas and their impact on prognosis were investigated. Finally, characteristics of patients with both hypochondriacal and paranoid symptoms were studied. We found that: (a) 79% of the patients with predominant hypochondriacal symptoms were depressed, but only 27% of these had suicidal ideas. These patients usually revealed a poor response to treatment. (b) Only 27% of the patients with paranoid symptoms only were depressed, but their suicidal risk was high. They usually had a good response to treatment. (c) Only 3% of the total sample exhibited both hypochondriacal and paranoid symptoms. They were all thought-disordered schizophrenics but had better prognosis than expected. The psychodynamic background of the results is discussed.     

Differentiating hypochondriasis from panic disorder

Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondriacal patients on all subscales of the Whiteley Index (WI) and the Illness Attitude Scales (IAS) except for illness behavior. These differences were independent of somatization. Patients with hypochondriasis plus panic had higher levels of anxiety, more somatization, more general psychopathology and a trend towards increased health care utilization. Clinicians were able to distinguish between patient groups based upon the tendency of hypochondriacal patients to demand unnecessary medical treatments. These results confirm that hypochondriasis and panic disorder are distinguishable clinical conditions, characterized by generally more psychopathology and distress in hypochondriasis.     

Survey of attitudes of nurses working with AIDS patients

This article reports the results of a ten-question anonymous survey given to nurses at Westchester County Medical Center in July 1983 and January 1984 concerning attitudes about caring for AIDS patients. Two-thirds of the responding nurses reported that they had friends or family express concern about associating with hospital personnel who have contact with AIDS patients. Other questions showed that between one fourth and one half of nurses have a fear of caring for homosexual men and male prisoners because of their awareness about AIDS. One half of the nurses believe that AIDS can be transmitted to hospital personnel because of contact with patients despite precautions. The fear of caring for patients with AIDS as compared to caring for patients with hepatitis, a more contagious but less serious disease than AIDS, was highest in the intensive care unit staff. Eighty-five percent of the health care personnel responding believed that pregnant nurses should not care for AIDS patients and one half of the nurses responding indicated that they would ask for a transfer if they had to care for AIDS patients on a regular basis. The implication of these findings for future treatment programs, medical and nursing education and psychologic support for staff are discussed.     

Perceptual and memory biases for health-related information in hypochondriacal individuals.

Problematic health concerns characteristic of hypochondriasis may be better understood with the aid of cognitive, information processing theories. We investigated whether hypochondriacal individuals show perceptual and explicit memory biases favoring health-related information. A clinical sample of hypochondriacs (n=18) and healthy controls (n=22), and a sample of hypochondriacal (n=22) and nonhypochondriacal (n=67) patients referred for Holter monitoring, completed a computerized test of perceiving difficult-to-read words and then an encoding task followed by recall of those words. Contrary to our prediction, hypochondriacal individuals in the clinical sample did not perceive more health-related words than words not related to health. Hypochondriacal individuals in the Holter-monitoring sample showed an unexpected bias against reporting health-related words. Social class may account for some of the group differences in this sample. Hypochondriacal individuals in both samples showed better memory for health-related than nonhealth words.     

Hypochondriasis: the patient's perspective

OBJECTIVE: The purpose of this investigation was to learn how patients with hypochondriasis view their physicians and medical care. METHOD: To accomplish this, we identified 20 patients with DSM-III-R hypochondriasis and 26 nonhypochondriacal patients from a general medicine clinic. Using a semistructured interview, we obtained information from patients about their recent health problems and medical care. The investigators then reviewed transcribed interviews and assigned comments to a series of categories. RESULTS: Hypochondriacal and non-hypochondriacal patients made equal numbers of positive comments, but hypochondriacal patients made significantly more negative comments about physicians' professional characteristics, characteristics of the patients themselves and total negative comments. Many viewed physicians they had seen as unskilled and uncaring. They indicated that, in many instances, their relationships with physicians had suffered from poor communication and collaboration. CONCLUSION: Since successful management of patients with hypochondriasis rests upon positive relationships, ways must be found to improve the frustrating and costly situation that currently exists.     

Clustering patients according to health perceptions: relationships to psychosocial characteristics and medication nonadherence

BACKGROUND: Little is known about how patients rate their health perceptions. Our objectives were to identify systematic multivariate patterns of perceptions using cluster analysis, and to investigate associations among the clusters, psychosocial characteristics and medication nonadherence. METHODS: Demographic, clinical and psychosocial data on 200 patients with inflammatory bowel disease (IBD) were collected prior to the index office visit and health perceptions were collected afterwards. Cluster analysis using a k-means method was used to identify subgroups of patients based on their responses to the Patient-Physician Discordance Scales (PPDS), an instrument that assesses perceptions of health status and of the clinical visit. RESULTS: We identified five different patient groups: a "healthy, not distressed, good communication, low expectation for medication/testing" group; a "healthy, relatively distressed, good communication, high expectation for medication, low expectation for testing" group; a "symptomatic, distressed, good communication, high expectation for medication/testing" group; a "healthy, not distressed, good communication, high expectation for medication/testing" group; and a "relatively healthy, relatively distressed, poor communication, low expectation for medication/testing" group. After adjustment for age, sex, language, form of IBD, and disease activity, statistically significant between-clusters differences were found in psychological distress, social support satisfaction and medication nonadherence. CONCLUSIONS: Distinct patterns of patients' health perceptions correlated with psychological health and adherence to treatment. This categorization may be used to help identify patients at higher risks for ineffective communication and nonadherence to medication.