Anxiety sensitivity,anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses

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.     

Are dysfunctional beliefs about illness unique to hypochondriasis?

Objective: There is evidence that individuals high in hypochondriasis overestimate the likelihood of ambiguous symptoms being indicative of serious illness. However, it is not known whether this tendency is unique to hypochondriasis or whether it can be attributed to high negative affectivity or other anxiety symptoms often found to be comorbid with hypochondriasis. Method: College students (N=133) completed measures of hypochondriasis, depression, anxiety, worry, avoidance and estimated the likelihood of various symptoms indicating catastrophic and minor illnesses. Results: Even after entering the other self-report variables, hypochondriasis was the only variable to predict estimates of the likelihood of serious illness. Conversely, being female, high levels of negative affect, agoraphobic avoidance when accompanied by others and higher estimates about the likelihood of symptoms leading to catastrophic illnesses best predicted hypochondriasis scores. Conclusion: Dysfunctional beliefs about illness appear to be unique to hypochondriasis and to uniquely contribute to the prediction of hypochondriasis.     

Health anxiety, rumination, and negative affect: a mediational analysis

OBJECTIVE: A ruminative cognitive style has been associated with a variety of mood and anxiety disorders. This study examined whether a ruminative cognitive style is associated with health anxiety, even when controlling for negative affect. METHOD: College students (N=198) completed measures of health anxiety, rumination, and negative affect and estimated the likelihood that ambiguous symptoms were indicative of catastrophic illnesses. These data were analyzed using structural equation modeling. RESULTS: A ruminative cognitive style was both indirectly associated with health anxiety via its strong relationship with negative affect and was also directly associated with health anxiety. Furthermore, catastrophizing ambiguous symptoms was also directly related to health anxiety. CONCLUSION: High health anxiety individuals not only hold dysfunctional beliefs about health and illness but they also think about their distress in a ruminative manner. A more complete cognitive-behavioral model of health anxiety should include not only cognitive contents ("what") but also cognitive style ("how").     

Life events and hypochondriacal concerns

In a study of 165 employees of a retail firm, life events were associated with several hypochondriacal concerns and with most of the self-rating distress scales. Life events related to illness and death were associated with fear of disease and showed weak associations with somatic symptoms and anxiety. Life events unrelated to illness and death were associated with hypochondriacal beliefs, bodily preoccupations, fear of death, and most of the distress scales. Illness and death do not appear to be common recent precipitants of hypochondriacal concerns in a normal population. One of the reasons for the observed associations appears to be that preoccupation with illness and death can occur at times of distress, regardless of the nature of the recent stressful life events.     

Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood

OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.     

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.     

Negative beliefs about self and illness: a comparison of individuals with psychosis with or without comorbid social anxiety disorder

OBJECTIVE: This study set out to investigate whether socially anxious individuals with psychosis will perceive more loss, entrapment, shame and humiliation, will blame themselves more for their illness and have lower self-esteem than non-socially anxious individuals with psychosis. METHOD: Two groups of participants with psychosis with (n=19) and without (n=19) social anxiety disorder were matched on the basis of gender and diagnosis. RESULTS: There were no differences between the two groups in terms of positive and negative symptoms. Participants with social anxiety had significantly higher levels of self-blame, entrapment, shame and lower self-esteem. Differences in entrapment, shame and self-esteem remained significant after controlling for depression. CONCLUSIONS: Negative beliefs about self and psychosis may be associated with the development of concurrent social anxiety disorder. The clinical and research implications of the findings are discussed.     

Characteristics predicting successful outcomes of participants with severe mental illness in supported education

OBJECTIVE: The study sought to identify characteristics of participants in a supported education program that were related to a successful outcome. Supported education programs provide rehabilitation and support services to help people attain postsecondary education. METHODS: A total of 147 persons who completed such a program were interviewed six or 12 months later, or at both times, to determine whether they were involved in productive activity, which was defined as engaging in either college or vocational education or in paid employment. Variables examined as predictors of productive activity were demographic characteristics; education and work background; social support; self-perceptions related to self-esteem, empowerment, quality of life, and school self-efficacy; and illness-related variables, including diagnosis, symptoms, and length of illness. RESULTS: Multivariate logistic regression identified the strongest predictor as productive activity at baseline. Marital status was the only significant demographic variable in the model; single participants were less likely to be engaged in productive activity. For participants who reported more frequent contact with their social network, the likelihood of engagement in productive activity was higher, and for those who reported more encouragement for education from their network, the likelihood was lower. A lower level of adjustment in the financial domain decreased the likelihood of productive activity, and a higher level of problems with housework increased the likelihood. No illness-related variable or self-perception was a significant predictor. CONCLUSIONS: Factors related to a successful outcome from a supported education program for persons with severe mental illness are also likely to be important factors for nondisabled populations. Among those with mental illness, social support is a key factor in attaining educational and vocational goals.     

The Impact of Research Participation on Adults with Severe Mental Illness

Experiences of adults with mental illness who participated in a 12-month managed care study are summarized. During exit interviews, participants were asked about consent procedures, study purpose, if questions were intrusive or anxiety producing, and concerns about information disclosure. Respondents rated their experience and likelihood of future participation. Almost 38% did not remember the consent procedures. Among those who did, 22.4% reported they lacked adequate detail about the scope of the study. Nearly 3% felt pressured into participating. Although most participants (96%) reported positive experiences, 8.8% became anxious, 16.8% were afraid responses would be disclosed, and 16.7% indicated questions were invasive. Age, race/ethnicity, and gender were not associated with adverse reactions. Symptomatology and perceived inadequacies in consent procedures were significantly, albeit weakly, associated with adverse reactions. Although most participants experienced no distress, rates of adverse responses among persons with mental illness exceeded those of community-based samples. Strategies for minimizing negative reactions are discussed.     

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.     

The relationship of hypochondriasis to anxiety disorders

There is evidence from the literature of phenomenological overlap between hypochondriasis and several anxiety disorders, including specific phobia, panic disorder with agoraphobia, generalized anxiety disorder, and obsessive-compulsive disorder. Even though the boundaries of these disorders are specifically addressed in the DSM-IV criteria, there is evidence of anxiety and phobic symptoms among hypochondriacal patients and hypochondriacal concerns among patients with these various anxiety disorders. Beyond that there appears to be considerable shared comorbidity. However, the data remain limited and few direct comparisons have been made between hypochondriacal and anxious patients belonging to particular diagnostic categories. Subtypes of hypochondriasis may exist. In fact, the clearest link would seem to be between the illness phobia subtype and other phobic disorders, although this subgroup has had little study. Thus, hypochondriasis is distinct from the anxiety disorders but, because of phenomenological similarities and extensive comorbidity, consideration should be given to classifying it among them.     

The correlates of hypochondriasis in depressed patients

Of 100 inpatients with depressive illness, fifty-three had evidence of depressed mood prior to their hypochondriacal symptoms, sixteen had the opposite sequence of development and thirty-one had no hypochondriacal symptoms. Comparisons of the three groups revealed some differences that would suggest a less severe depressed mood in association with hypochondriacal symptoms. Whether hypochondriasis preceded or followed depressed mood did not make any other difference to the total clinical picture. This should not be taken to imply that treatment and prognosis are the same in hypochondriacal and nonhypochondriacal depressions.     

Discrepant illness perceptions,affect and expressed emotion in people with psychosis and their carers

Background Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed. Method We interviewed 82 carer-patient dyads, after a relapse of psychosis. Carers were assessed for illness perceptions, distress, self-esteem and EE; patients for illness perceptions, depression, anxiety and self-esteem, in a cross sectional study. Results Carers were more pessimistic than patients about illness persistence and consequences, and carers with low mood were particularly pessimistic about persistence and controllability. Discrepant views about illness consequences were related to greater anxiety, depression, and lower self-esteem in patients, while discrepant views on controllability were associated with greater distress, depression, and lower self-esteem in carers. Illness perceptions did not relate directly to EE. Conclusions In this sample, meta-cognitive carer representations of illness in psychosis are related to negative affective reactions in carers, but not to EE. Resolving discrepant illness perceptions between carers and patients might provide a way of improving family reactions to the health threat of psychosis.     

Psychiatric comorbidity in DSM-III-R hypochondriasis.

Forty-two DSM-III-R hypochondriacs from a general medical clinic were compared with a random sample of 76 outpatients from the same setting. Patients completed a research battery that included a structured diagnostic interview (Diagnostic Interview Schedule) and self-report questionnaires to measure personality disorder caseness, functional impairment, and hypochondriacal symptoms. Psychiatric morbidity in the hypochondriacal sample significantly exceeded that of the comparison sample. Hypochondriacs had twice as many lifetime Axis I diagnoses, twice as many Diagnostic Interview Schedule symptoms, and three times the level of personality disorder caseness as the comparison group. Of the hypochondriacal sample, 88% had one or more additional Axis I disorders, the overlap being greatest with depressive and anxiety disorders. One fifth of the hypochondriacs had somatization disorder, but the two conditions appeared to be phenomenologically distinct. Hypochondriacal patients with coexisting anxiety and/or depressive disorder (secondary hypochondriasis) did not differ greatly from hypochondriacal patients without these comorbid conditions (primary hypochondriasis). Because the nature of hypochondriasis remains unclear and requires further study, we suggest that its nosologic status not be altered in DSM-IV.     

Public perceptions of risk in criminality: The effects of mental illness and social disadvantage

We examined how different types of mental illness elicited varying levels of predicted criminality and compared this with factors which might also elicit a negative response, specifically, a criminal history and social disadvantage. A sample of 243 participants undertook an anonymous, online experiment. Each participant was exposed to one of six vignettes: three involved mental illness (schizophrenia, depression/anxiety, or alcohol dependency); two in which socio-economic background was manipulated; and a control. The impact of mental illness, history of criminality and social disadvantage on the likelihood that the character in the vignette would commit future crime, and levels of sympathy, trust and potential for rehabilitation in the character were measured. Age and personal experience of mental illness and/or criminal behaviour in the participants was also examined. The sample were significantly more likely to think that a character would ‘possibly’ commit future crime if he had mental illness in comparison to the control, but crimes were expected to be minor. Significantly more discriminatory behaviour was reported towards the character with no mental illness but a disadvantaged background. Familiarity ameliorated this effect. Prejudice towards those with a criminal past and a disadvantaged background may be stronger than prejudice against those with mental illnesses.     

Self-esteem in adults with Tourette syndrome and chronic tic disorders: The roles of tic severity,treatment, and comorbidity

BackgroundTourette syndrome (TS) and chronic tic disorders (CTD) are stigmatizing disorders that may significantly impact self-esteem. Alternatively, comorbid psychiatric illnesses may affect self-esteem more than tics themselves. Extant research on self-esteem in TS/CTD is limited, has inconsistently examined the effect of comorbidities on self-esteem, and yields mixed findings.MethodThis study aimed to clarify the roles of tics versus comorbid diagnoses on self-esteem in a large, carefully diagnosed sample of adults with TS/CTD (N = 122) receiving 10 weeks of Comprehensive Behavioral Intervention for Tics (CBIT) or Psychoeducation and Supportive Therapy (PST).ResultsBaseline self-esteem did not differ between adults with TS/CTD only and normative means, whereas self-esteem was significantly lower among adults with TS/CTD with a comorbid psychiatric illness. In a multiple regression testing the baseline association between tic severity, presence of comorbid psychiatric illness, and depression severity with self-esteem, comorbidity and depression severity were significantly associated with self-esteem, whereas tic severity was not. Finally, using a generalized linear model, we tested the effects of treatment assignment, comorbidity, and their interaction on changes in self-esteem across treatment, controlling for baseline depression severity. Results showed that for those with a comorbid illness, self-esteem improved significantly more with CBIT than with PST.ConclusionsComorbid illnesses appear to affect self-esteem more so than tics among adults with TS/CTD. Therapeutic attention should be paid to treating comorbid diagnoses alongside tics when treating TS/CTD.     

Intolerance of uncertainty, hypochondriacal concerns, obsessive-compulsive symptoms, and worry

Intolerance of uncertainty (IU) has been found to be involved in several anxiety disorders, including generalized anxiety disorder and obsessive-compulsive disorder (OCD). Few studies have examined the role of IU in health anxiety (HA)/hypochondriacal concerns (HC). We conducted two studies exploring the associations between IU and HA/HC. The first study included undergraduates (n = 114) and indicated an association between IU and several HA/HC indices. When controlling for neuroticism, worry about illness was the single index of HA/HC that remained associated with IU. In the second study among bereaved adults (n = 126), IU was associated with one index of HA/HC but not when neuroticism and anxiety sensitivity were controlled. In both studies, IU was found to be more strongly associated with OCD symptoms and worry than with HA/HC.     

Social anxiety in young gay men

Based on the assumption that sexual minority individuals are particularly sensitive to the possible rejection of others, the present study examined the occurrence and correlates of social anxiety symptomatology in gay and heterosexual men. Eighty-seven heterosexual and 87 gay undergraduate men between the ages of 18 and 24 completed common measures of social anxiety, self-esteem, boyhood gender conformity, and a modified S-R Inventory of Anxiousness. Results reveal that gay men reported greater fear of negative evaluation and social interaction anxiety and lower self-esteem than heterosexual men. Gay men who are less open about their sexual orientation and those who are less comfortable with being gay were more likely to experience anxiety in social interactions. The modified S-R Inventory of Anxiousness was useful in revealing that relatively innocuous situations for heterosexual men can be anxiety-provoking for gay men. The hypothesis that gay men who were gender nonconforming as children would report a higher degree of social interaction anxiety was not supported. Results are discussed in terms of the socialization experiences of gay men and are explicated using a minority stress framework. Implications are offered for the treatment of social anxiety in this population.     

Neural activations are related to body-shape,anxiety, and outcomes in adolescent anorexia nervosa

Anorexia nervosa (AN) is an illness that frequently begins during adolescence and involves weight loss. Two groups of adolescent girls (AN-A, weight-recovered following AN) and (HC-A, healthy comparison) completed a functional magnetic resonance imaging task involving social evaluations, allowing comparison of neural activations during self-evaluations, friend-evaluations, and perspective-taking self-evaluations. Although the two groups were not different in their whole-brain activations, anxiety and body shape concerns were correlated with neural activity in a priori regions of interest. A cluster in medial prefrontal cortex and the dorsal anterior cingulate correlated with the body shape questionnaire; subjects with more body shape concerns used this area less during self than friend evaluations. A cluster in medial prefrontal cortex and the cingulate also correlated with anxiety such that more anxiety was associated with engagement when disagreeing rather than agreeing with social terms during self-evaluations. This data suggests that differences in the utilization of frontal brain regions during social evaluations may contribute to both anxiety and body shape concerns in adolescents with AN. Clinical follow-up was obtained, allowing exploration of whether brain function early in course of disease relates to illness trajectory. The adolescents successful in recovery used the posterior cingulate and precuneus more for friend than self evaluations than the adolescents that remained ill, suggesting that neural differences related to social evaluations may provide clinical predictive value. Utilization of both MPFC and the precuneus during social and self evaluations may be a key biological component for achieving sustained weight-recovery in adolescents with AN.     

Hypochondriacal beliefs and attitudes in family practice and psychiatric patients

Beliefs and attitudes which can be responsible for hypochondriacal behavior were explored by administering the Illness Attitude Scales and two distress scales to patients attending a family practice clinic, nonpsychotic psychiatric outpatients and a random group of employees. Family practice patients were more distressed, had more hypochondriacal concerns and had more bodily preoccupations than employees and took more precautions about their health. Psychiatric patients were more distressed and had more fears about illness and death than family practice patients, yet took fewer precautions about their health. The findings appear to have implications for treatment.