Elsevier

Behavior Therapy

Volume 41, Issue 4, December 2010, Pages 505-514
Behavior Therapy

A Taxometric Study of Hypochondriasis Symptoms

https://doi.org/10.1016/j.beth.2010.02.002Get rights and content

Abstract

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

Section snippets

Taxometric Analysis of Hypochondriasis

In the only taxometric study using a well-known measure of hypochondriasis, Ferguson (2009) examined the categorical versus dimensional status of hypochondriasis with a shortened version of the Whiteley Index (Barsky et al., 1986, Barsky et al., 1990, Pilowsky, 1967). This author interpreted his findings as suggestive of a latent dimensional structure. Although this study represents an important step in better understanding the nature of hypochondriasis, there were methodological limitations.

Participants

Participants were 1,083 undergraduates from a midwestern university who completed a questionnaire battery in exchange for course credit. Participants ranged in age from 18 to 57 years old (M = 20.8, SD = 4.51). Most of the participants were female (64%) and Caucasian (68.6%), but 14 % were Hispanic, 6.7% were African-American, and 3.2% were Asian. Unmarried participants comprised 87.2% of the sample, with the remainder being married (6.9%), divorced (0.6%), widowed (0.4%), or “other” (4.9%).

Multidimensional Inventory of Hypochondriacal Traits (MIHT; Longley et al., 2005)

The

Data Analytic Strategy

In an effort to generate meaningful indicators that provide comprehensive coverage of the hypochondriasis construct, items from the three measures of hypochondriacal symptoms were combined (i.e., WI, IAS, and MIHT) and subjected to principal axis factoring followed by varimax rotation. We used this type of factor analysis to more easily identify items that loaded significantly on more than one factor. The following criteria were used to judge solutions: (a) the number of markers with primary

Discussion

The present study suggests that hypochondriasis, as assessed by composite hypochondriasis symptom indicators, is dimensional at the latent level. In this regard, it extends previous research, corroborates existing theory, and suggests future directions for research. Contemporary diagnostic classification systems that conceptualize hypochondriasis as a category are at odds with prevailing theory and with observations that it is a heterogeneous condition (Ferguson, 2009, Katon et al., 1991,

References (65)

  • SchmidtA.J.

    Bottlenecks in the diagnosis of hypochondriasis

    Comprehensive Psychiatry

    (1994)
  • SpeckensA.E. et al.

    A validation study of the Whitely Index, Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients

    Journal of Psychosomatic Research

    (1996)
  • TyrerP. et al.

    Long-term outcome of hypochondriacal personality disorder

    Journal of Psychosomatic Research

    (1999)
  • WarwickH.M. et al.

    Hypochondriasis

    Behaviour Research and Therapy

    (1990)
  • Diagnostic and statistical manual of mental disorders

    (2000)
  • BarskyA.J. et al.

    Hypochondriasis and panic disorder: Boundary and overlap

    Archives of General Psychiatry

    (1994)
  • BarskyA.J. et al.

    Overview: Hypochondriasis, bodily complaints, and somatic style

    American Journal of Psychiatry

    (1983)
  • BarskyA.J. et al.

    Hypochondriasis

    Archives of General Psychiatry

    (1986)
  • BarskyA.J. et al.

    Transient hypochondriasis

    Archives of General Psychiatry

    (1990)
  • BarskyA.J. et al.

    Psychiatric comorbidity in DSM-III-R hypochondriasis

    Archives of General Psychiatry

    (1992)
  • BerriosG.E.

    Hypochondriasis: History of the concept

  • BeauchaineT.P. et al.

    A comparison of maximum covariance and k-means cluster analysis in classifying cases into known taxon groups

    Psychological Methods

    (2002)
  • BleichhardtG. et al.

    Hypochondriasis and health anxiety in the German population

    British Journal of Health Psychology

    (2007)
  • ClarkL.A. et al.

    Diagnosis and classification of psychopathology: Challenges to the current system and future directions

    Annual Review of Psychology

    (1995)
  • CohenH.

    The evolution of the concept of disease

  • CostelloA.B. et al.

    Best practices in Exploratory Factor Analysis: Four recommendation for getting the most from your analysis

    Practical Assessment Research and Evaluation

    (2005)
  • CoteG. et al.

    Hypochondriasis

  • FavelliC. et al.

    Epidemiology of somatoform disorders: A community survey in Florence

    Social Psychiatry and Psychiatric Epidemiology

    (1997)
  • FergusonE.

    A taxometric analysis of health anxiety

    Psychological Medicine

    (2009)
  • FinkP. et al.

    A new empirically established hypochondriasis diagnosis

    American Journal of Psychiatry

    (2004)
  • GoodarzD. et al.

    The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle and metabolic factors

    PLOS Medicine

    (2009)
  • HillerW. et al.

    Dimensional and categorical approaches to hypochondriasis

    Psychological Medicine

    (2002)
  • Cited by (81)

    • The Concept of Health Anxiety

      2019, The Clinician's Guide to Treating Health Anxiety: Diagnosis, Mechanisms, and Effective Treatment
    • Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

      2018, Behaviour Research and Therapy
      Citation Excerpt :

      We thus for example consider it unlikely that BIB-CBT had produced as large effects had participants instead, on their own initiative, purchased a self-help book and worked with it outside any form of health care structure. Strengths of the present trial include the randomised group allocation, and the use of validated outcomes; most dimensional in accordance with the modern view of health anxiety (Asmundson, Taylor, Carleton, Weeks, & Hadjstavropoulos, 2012; Ferguson, 2009; Longley et al., 2010). For most assessment points and groups, attrition rates were low, and the study offers a broad exposition of perspectives on cost-effectiveness and cost-utility.

    View all citing articles on Scopus
    View full text