Disease phobia and disease conviction are separate dimensions underlying hypochondriasis

doi:10.1016/j.jbtep.2010.05.002

Journal of Behavior Therapy and Experimental Psychiatry

Volume 41, Issue 4, December 2010, Pages 438-444

https://doi.org/10.1016/j.jbtep.2010.05.002 Get rights and content

Abstract

The current study uses data from a large nonclinical college student sample (N = 503) to examine a structural model of hypochondriasis (HC). This model predicts the distinctiveness of two dimensions (disease phobia and disease conviction) purported to underlie the disorder, and that these two dimensions are differentially related to variables important to health anxiety and somatoform disorders, respectively. Results were generally consistent with the hypothesized model. Specifically, (a) body perception variables (somatosensory amplification and anxiety sensitivity – physical) emerged as significant predictors of disease phobia, but not disease conviction; (b) emotion dysregulation variables (cognitive avoidance and cognitive reappraisal) emerged as significant predictors of disease conviction, but not disease phobia; and (c) both disease phobia and disease conviction independently predicted medical utilization. Further, collapsing disease phobia and disease conviction onto a single latent factor provided an inadequate fit to the data. Conceptual and therapeutic implications of these results are discussed.

Section snippets

Body perception

Like with many anxiety disorders, the attention one pays to body sensations is believed to be central to the development and maintenance of HC. That is, individuals with HC are believed to feel they need to pay close attention to ambiguous body sensations in an attempt to prevent the sensations from leading to perceived negative consequences (Abramowitz et al., 2002). In an attempt to better understand the misinterpretation of body sensations seen within HC, researchers have turned towards

Emotion dysregulation

Dysfunctions in emotion regulation are believed to be instrumental in the phenomenology of somatoform disorders (e.g., HC), as these disorders purportedly represent the communication of somatic instead of psychological distress (Waller & Scheidt, 2006). Waller and Scheidt noted that the trait of alexithymia characterizes the emotion regulation deficits of individuals suffering from somatoform disorders. Alexithymia is a deficit in an individual’s ability to understand and regulate emotions. It

Present study

A structural model was developed to test the distinctiveness of disease phobia and disease conviction (Fig. 1). The structural model tested whether body perception variables were specific predictors of disease phobia (i.e., controlling for disease conviction and the effects of emotion dysregulation variables) and emotion dysregulation variables were specific predictors of disease conviction (i.e., controlling for disease phobia and the body perception variables). The structural model also

Participants and procedure

The sample consisted of 503 undergraduate college students enrolled in an introductory psychology class at a Midwestern university. The sample had a mean age of 19.1 (SD = 2.3) years, and was predominantly female (67.7%) and Caucasian (69.2%).

Participants completed the fixed-order questionnaire packets in small group sessions in a university classroom. Data were collected anonymously and participants were informed that they were free to withdraw from the study at any time.

Disease phobia and disease conviction

Disease phobia and

Missing data and health status

Twelve participants (2.4% of the total sample) frequently omitted responses (i.e., greater than 15% of possible items) on at least one measure and were removed from subsequent analyses. In an attempt to ensure that current physical health minimally contributed to observed levels of HC (Abramowitz et al., 2007), the 46 participants (n = 491; 9.4%) in the remaining sample that reported having a current diagnosed physical illness were removed from subsequent analyses. The most common physical

Discussion

The present study sought to examine whether disease phobia and disease conviction are separate dimensions of HC or if they should be clustered under a broad category of beliefs about disease. Although the high correlation (r = .63 in the present study) between disease phobia and disease conviction indicates the two dimensions are highly related, three sets of results indicate that disease phobia and disease conviction can be validly distinguished. That is, (a) disease phobia shared specific

Conclusions

Limitations notwithstanding, the present study indicates that disease phobia and disease conviction are two distinct dimensions of HC. Considering the debate as to whether HC is part of the anxiety disorders domain (Olatunji et al., 2009), separately examining disease phobia and disease conviction appears most promising for understanding how HC relates to other psychological disorders. Although many questions still surround HC, and its dimensions, conceptualizing disease phobia and disease

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^☆: This manuscript is based on the Masters Thesis of the first author under the supervision of the second author.

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Disease phobia and disease conviction are separate dimensions underlying hypochondriasis☆

Abstract

Section snippets

Body perception

Emotion dysregulation

Present study

Participants and procedure

Disease phobia and disease conviction

Missing data and health status

Discussion

Conclusions

The short health anxiety. Inventory in an undergraduate sample: implications for a cognitive-behavioral model of hypochondriasis

Cognitive Therapy and Research

A contemporary conceptual model of hypochondriasis

Mayo Clinic Proceedings

Diagnostic and statistical manual of mental disorders

AMOS 17.0 [Computer software]

The twenty-item Toronto Alexithymia Scale – I: item selection and cross-validation of the factor structure

Journal of Psychosomatic Research

Hypochondriasis and obsessive-compulsive disorder

Psychiatric Clinics in North America

A structured diagnostic interview for hypochondriasis: a proposed criterion standard

The Journal of Nervous and Mental Disease

The somatosensory amplification scale and its relation to hypochondriasis

Journal of Psychiatric Research

Influence of imputation and EM methods on factor analysis when item nonresponse in questionnaire data is nonignorable

Multivariate Behavioral Research

Confirmatory factor analysis for applied research

Can suppressor variables enhance criterion-related validity in the personality domain?

Educational and Psychological Measurement

Is hypochondriasis related to obsessive-compulsive disorder, panic disorder, or both? An empirical evaluation

Journal of Cognitive Psychotherapy: An Internal Quarterly

Reexamining the domain of hypochondriasis: comparing the Illness Attitudes Scale to other approaches

Journal of Anxiety Disorders

A taxometric analysis of health anxiety

Psychological Medicine

Emotional processing of fear: exposure to corrective information

Psychological Bulletin

Multiple imputation of item scores in test and questionnaire data, and influence on psychometric results

Multivariate Behavioral Research

Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being

Journal of Personality and Social Psychology

Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample

Behaviour Research and Therapy