Exploring cyberchondria and worry about health among individuals with no diagnosed medical condition.

OBJECTIVE: To study the phenomenon of cyberchondria and related worries about health among individuals without any diagnosed medical condition. . METHODS: The survey-based, cross-sectional study was conducted from January to July 2018 in the twin cities of Rawalpindi and Islamabad, Pakistan, and comprised graduates of either gender aged at least 35 years with access to internet and means of use, and with no current diagnosed medical condition. The self-reporting Cyberchondria Severity Scale was used data-collection along with a demographic sheet. SPSS 21 was used for data analysis. RESULTS: Of the 150 subjects, 90(60%) were men and 60(40%) were women. A total of 40(26.6%) subjects had low level of cyberchondria, while 35(23.3%) experienced a higher level of it. Mean scores of men on total CSS were slightly higher than those of women (p>0.05). Men also scored higher on compulsion, distress, excessiveness and reassurance subsclaes (p>0.05 each), whereas women scored slightly higherthan men on 'mistrust of medical profession' subscale (p>0.05). No significant gender differences werefound on cyberchondria and its subscales (p>0.05 each). CONCLUSIONS: Doctors / health professionals may benefit from the findings by focussing on their patients who use internet as a major source of medical information.

Scary symptoms? Functional magnetic resonance imaging evidence for symptom interpretation bias in pathological health anxiety.

Patients with pathological health anxiety (PHA) tend to automatically interpret bodily sensations as sign of a severe illness. To elucidate the neural correlates of this cognitive bias, we applied an functional magnetic resonance imaging adaption of a body-symptom implicit association test with symptom words in patients with PHA (n = 32) in comparison to patients with depression (n = 29) and healthy participants (n = 35). On the behavioral level, patients with PHA did not significantly differ from the control groups. However, on the neural-level patients with PHA in comparison to the control groups showed hyperactivation independent of condition in bilateral amygdala, right parietal lobe, and left nucleus accumbens. Moreover, patients with PHA, again in comparison to the control groups, showed hyperactivation in bilateral posterior parietal cortex and left dorsolateral prefrontal cortex during incongruent (i.e., harmless) versus congruent (i.e., dangerous) categorizations of body symptoms. Thus, body-symptom cues seem to trigger hyperactivity in salience and emotion processing brain regions in PHA. In addition, hyperactivity in brain regions involved in cognitive control and conflict resolution during incongruent categorization emphasizes enhanced neural effort to cope with negative implicit associations to body-symptom-related information in PHA. These results suggest increased neural responding in key structures for the processing of both emotional and cognitive aspects of body-symptom information in PHA, reflecting potential neural correlates of a negative somatic symptom interpretation bias.

The Influence of Trauma on Autobiographical Memory in the Assessment of Somatoform Disorders According to DSM IV Criteria.

Recalling an event impairs an individual's later ability to recall related knowledge. Impairment in this retrieval-induced forgetting (RIF) produces a dysfunction in autobiographical memory. This, like somatic symptoms, has been documented in trauma and sexual abuse survivors. To investigate the relationship between past trauma and somatoform disorders, and the role of memory recall dysfunction in this relationship, three sex-matched groups were constituted using DSM IV criteria: Somatoform (SD) (n. 22) other Psychiatric Disorders (PD) (n. 26) and Healthy Subjects (HS) (n. 35). Responses to Stressful Life Events Screening Questionnaire revised (SLESQ-R); Direct Forgetting paradigm (DF) for autobiographical memory; Deese-Roediger-McDermott (DRM) paradigm for false memory; Stanford Scale type A for Post-Hypnotic Amnesia (PHA); Stroop Colour Word test and a digit-span for cognitive assessment; and Somatosensory Amplification Scale (SSAS), Somatic Dissociation Questionnaire (SDQ-20), and Toronto Alexithymia Scale (TAS 20) for somatic discomfort were compared among groups. SSAS, SDQ-20 and TAS F1 were correlated with SLESQ-R scores; subjects with higher numbers of traumatic events (NSE) showed greater capacity to remember items-to-be-forgotten (DFF) and higher SDQ-20 scores. Although the SD group showed higher NSE, their autobiographical memory scores were no different to those of other DSM-IV groups. The somatic-trauma-autobiographical memory impairment relationship is identified by DSM V but not DSM IV criteria for somatoform disorder. Higher NSE appears to correlate with both the presence of somatic discomfort and impaired autobiographical memory, suggesting autonoetic consciousness dysfunction in subjects with past trauma and current somatic symptom disorders.

[CLINICAL AND PSYCHOLOGICAL CORRELATIONS IN FIBROMYALGIA PATIENTS].

The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.

The Role of Emotion Reactivity in Health Anxiety.

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.

Hypochondriasis Differs From Panic Disorder and Social Phobia: Specific Processes Identified Within Patient Groups.

Studies of the comorbidity of hypochondriasis have indicated high rates of cooccurrence with other anxiety disorders. In this study, the contrast among hypochondriasis, panic disorder, and social phobia was investigated using specific processes drawing on cognitive-perceptual models of hypochondriasis. Affective, behavioral, cognitive, and perceptual processes specific to hypochondriasis were assessed with 130 diagnosed participants based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (66 with hypochondriasis, 32 with panic disorder, and 32 with social phobia). All processes specific to hypochondriasis were more intense for patients with hypochondriasis in contrast to those with panic disorder or social phobia (0.61 < d < 2.67). No differences were found between those with hypochondriasis with comorbid disorders and those without comorbid disorders. Perceptual processes were shown to best discriminate between patients with hypochondriasis and those with panic disorder.

[Schizophrenia spectrum disorders in general medical practice].

Based on the conception of correlations between independent endogenous factors (positive and negative disorders), the author present a psychopathological model of psychosomatic (hypochondriac) symptoms in deficit disturbances, comorbid with the changes of «verschroben¼ type, observed in general medical practice. The psychosomatic symptoms are represented by a wide range of symptom complexes (from idiopathic pain and conversions to restricted hypochondria, organ neuroses, encapsulated organ psychosis) and defined as a syndrome of endoform of somaticized disorders. The syndrome is interpreted beyond schizophrenia as «the second disease¼, a type of schizophrenia spectrum disorders, in which negative process changes have stopped while the other component (positive psychopathological symptoms) continues to develop.

Somatic symptoms scale: Psychometric properties in clinical and normal sample.

OBJECTIVE: To develop a Somatic Symptoms Scale based on the criteria of standard symptoms, and to examine its psychometric properties through exploratory factor analysis. METHODS: The study was conducted from January, 2010 to May, 2011 at two teaching hospitals in Lahore city and comprised female adolescents with somatic symptoms diagnosed by a psychiatrist, and an equal number of adolescents with minor physical disability. All patients were recruited from psychiatric out-door units of different hospitals. All subjects were unmarried. Translated Urdu version of the Somatic Symptoms Scale was administered to each participant individually. They were instructed to read the scale carefully and select the response that was most appropriate. The assessment procedure was done in a separate room on the hospital premises. RESULTS: There were 150 female adolescents with somatic symptoms and equal number of females with minor disability. The overall mean age was 15.50+/-1.67 years (range: 14-17 years).Exploratory factor analysis showed that the two groups were significantly different on conversion motor symptoms (p<0.001), conversion sensory symptoms (p<0.001), pain symptoms (p<0.001), hypochondriacal symptoms (p<0.001) and body dysmorphic symptoms (p<0.001). CONCLUSIONS: The Somatic Symptoms Scale was found to be a valid and reliable measure which can be used as screening instrument for non-clinical population and as a diagnostic measure in clinical population.

THE PSYCHO-PHYSIOLOGICAL STATUS IN CELIAC DISEASE.

Based on the results of a comprehensive study of 35 people aged from 19 to 52 years, among them 20 women and 15 men with celiac disease features of their physiological status were studied, reflecting the severity of the disease and quality of life. The diagnosis was based on the clinical and anamnestic data, endoscopy, histomorphological, immunological and genetic exams. Psychophysiological analysis showed that in celiac disease is characterized by the formation reactions with anxiety, anxiety-phobic, neurotic, affective, and hypochondriacal symptoms. The results of the study emphasized the importance of adaptive physiological capacity of the body to build tolerance to the development of psycho-vegetative, hypochondriacaldepressive and other disorders.

Treatment of mental hypochondriasis: a case report.

Hypochondriasis is characterized by intensive fears of serious disease. Most patients with hypochondriasis worry about physical diseases like cancer, although in rare cases, patients report severe fears of mental disorders (e.g., schizophrenia), a phenomenon described in the literature as mental hypochondriasis. However, little is known about this rare subtype of hypochondriasis and experts have questioned whether mental hypochondriasis has much in common with the type of hypochondriasis in which somatic diseases are the focus of preoccupation. This paper presents, a case report of a woman with a fear of schizophrenia, which was treated with cognitive therapy. This patient fulfills the DSM-IV criteria of hypochondriasis and exhibits many characteristics (e.g., selective attention, safety behavior) considered to be maintaining factors in well-established cognitive-behavioral models of hypochondriasis. Cognitive treatment strategies for hypochondriasis (e.g., attention training, behavioral experiments) also proved effective in this case of mental hypochondriasis.

Diagnostic criteria for psychosomatic research and somatic symptom disorders.

The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.

Specificity and modifiability of cognitive biases in hypochondriasis.

OBJECTIVE: According to cognitive-behavioral models of hypochondriasis (HYP), biased attentional and memory processes related to health threat stimuli are crucial for the development and maintenance of severe health anxiety. Little is known about the specificity, temporal stability, and modifiability of these biases via psychotherapy. METHOD: In an emotional Stroop and subsequent recognition task, the authors compared attention and memory processes for health-related words (illnesses, bodily complaints, and panic-related words) in patients with HYP (n = 32), other somatoform disorders (SFD; n = 27), and panic disorder (PD; n = 25). A control group consisted of 31 healthy participants (CG). All patients were reexamined after 4 months of cognitive-behavioral therapy (CBT). RESULTS: Patients with HYP showed a significant attentional bias toward all 3 target word categories. Evidence for a specific bias was found only for the PD group. General recognition performance for health threat and neutral words was best in the HYP group. After therapy, attentional bias had clearly decreased in the HYP and SFD patients. CONCLUSIONS: Patients with HYP can be characterized by attentional bias and more elaborate verbal processing. These irregularities tend to disappear after psychotherapy.

Hypochondriacal attitudes comprise heterogeneous non-illness-related cognitions.

BACKGROUND: Hypochondriacal attitudes were associated with cognitions not related to illness: Social fears, low self-esteem, and reduced warm glow effect, i.e. less positive appraisal of familiar stimuli. Only a single study had investigated the correlation of hypochondriacal attitudes with the warm glow effect so far and the present study aimed to corroborate this association. Particularly, the present investigation tested for the first time whether social fears, low self-esteem, and reduced warm glow effect represent distinct or related biases in hypochondriacal attitudes. METHODS: Fifty-five volunteers filled in the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales, two scales enquiring social fears of criticism and intimacy, and the Rosenberg Self-Esteem Scale. The interaction of valence and spontaneous familiarity ratings of Chinese characters indicated the warm glow effect. RESULTS: A stepwise regression model revealed specific covariance of social fears and warm glow with hypochondriacal attitudes independent from the respective other variable. The correlation between low self-esteem and hypochondriacal attitudes missed significance. CONCLUSIONS: Hypochondriacal attitudes are embedded in a heterogeneous cluster of non-illness-related cognitions. Each social fears and a reduced cognitive capacity to associate two features--positive appraisal and familiarity--could diminish the susceptibility to safety signals such as medical reassurance. To compensate for reduced susceptibility to safety signals, multifocal treatment and repeated consultations appear advisable.

Common limbic and frontal-striatal disturbances in patients with obsessive compulsive disorder, panic disorder and hypochondriasis.

BACKGROUND: Direct comparisons of brain function between obsessive compulsive disorder (OCD) and other anxiety or OCD spectrum disorders are rare. This study aimed to investigate the specificity of altered frontal-striatal and limbic activations during planning in OCD, a prototypical anxiety disorder (panic disorder) and a putative OCD spectrum disorder (hypochondriasis). METHOD: The Tower of London task, a 'frontal-striatal' task, was used during functional magnetic resonance imaging measurements in 50 unmedicated patients, diagnosed with OCD (n=22), panic disorder (n=14) or hypochondriasis (n=14), and in 22 healthy subjects. Blood oxygen level-dependent (BOLD) signal changes were calculated for contrasts of interest (planning versus baseline and task load effects). Moreover, correlations between BOLD responses and both task performance and state anxiety were analysed. RESULTS: Overall, patients showed a decreased recruitment of the precuneus, caudate nucleus, globus pallidus and thalamus, compared with healthy controls. There were no statistically significant differences in brain activation between the three patient groups. State anxiety was negatively correlated with dorsal frontal-striatal activation. Task performance was positively correlated with dorsal frontal-striatal recruitment and negatively correlated with limbic and ventral frontal-striatal recruitment. Multiple regression models showed that adequate task performance was best explained by independent contributions from dorsolateral prefrontal cortex (positive correlation) and amygdala (negative correlation), even after controlling for state anxiety. CONCLUSIONS: Patients with OCD, panic disorder and hypochondriasis share similar alterations in frontal-striatal brain regions during a planning task, presumably partly related to increased limbic activation.

P wave dispersion in patients with hypochondriasis.

P wave dispersion (Pd), defined as the difference between the maximum and the minimum P wave duration, has been associated with anxiety. Thus, we wondered whether Pd in hypochondriasis which is associated with anxiety differed from that in healthy controls. Pd was measured in 30 hypochondriac patients and same number of physically and mentally healthy age- and gender-matched controls. Hamilton Depression Rating (HDRS) and Hamilton Anxiety Rating Scales (HARS) were scored. The heart rate and left atrium (LA) sizes were not significantly different between groups. However, both Pmax and Pmin values of the patients were significantly higher than those of healthy controls. As for the main variable investigated in the present study, the corrected Pd was significantly longer in the patient group compared to control group. On the basis of this study, we can conclude that Pd may be related to hypochondriasis though our sample is too small to allow us to obtain a clear conclusion. Future studies with larger sample evaluating the effects of treatment are required.

Brain dysfunction behind functional symptoms: neuroimaging and somatoform, conversive, and dissociative disorders.

PURPOSE OF REVIEW: Neuroimaging research in psychiatry has been increasing exponentially in recent years, yet many psychiatrists are relatively unfamiliar with this field. This article summarizes the findings of the most relevant research articles on the neuroimaging of somatoform, conversive, and dissociative disorders published from January 2007 through June 2008. RECENT FINDINGS: Neuroimaging findings summarized here include alterations of stress regulation and coping in somatoform pain disorders, the importance of catastrophizing in somatization disorder, and the relevance of a history of physical/sexual abuse in irritable bowel syndrome. Regarding fibromyalgia, three of the most significant advances have been the impossibility of differentiating primary and concomitant fibromyalgia in the presence of quiescent underlying disease, the role of hippocampal dysfunction, and the possibility that fibromyalgia may be characterized as an aging process. In dissociative disorders, the high levels of elaborative memory encoding and the reduced size of the parietal lobe are highlighted. SUMMARY: The most promising clinical consequence of these studies, in addition to improving knowledge about the etiology of these illnesses, is the possibility of using neuroimaging findings to identify subgroups of patients, which could allow treatments to be tailored.

Fixed belief in cognitive dysfunction despite normal neuropsychological scores: neurocognitive hypochondriasis?

A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of "neurocognitive hypochondriasis." Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome.

Hypochondriasis and the self-perception of handedness: a critique of the use of hand preference scales.

OBJECTIVE: Previous research reported an association of handedness with a variety of neurologic, psychiatric, and immunologic diseases. Most of these studies assessed handedness via questionnaire. This association might therefore result from response bias. METHODS: Participants (n=422) completed 2 standard questionnaires to assess handedness and hypochondriasis: the Edinburgh Handedness Inventory and the Whiteley Index. Subjects with past or present neurologic, psychiatric, or immunologic disease or any severe disease were excluded. Separate analyses were made for the overall sample and 2 subsamples with and without a reported medical history of nonsevere diseases. RESULTS: The distribution of handedness is different for subjects with lower versus higher hypochondriac traits: higher scores of hypochondriac traits are associated with weaker right or left-handedness. The subsample reporting a history of nonsevere diseases had even stronger hypochondriac traits and less extreme handedness scores compared with the other subsample. CONCLUSIONS: Handedness scores derived from questionnaires are affected by information bias. Future medical and psychologic research on handedness should control for this bias or use empirical methods to assess hand preference.

DSM-IV-TR "pain disorder associated with psychological factors" as a nonhysterical form of somatization.

BACKGROUND: Elevated Minnesota Multiphasic Personality Inventory (MMPI) scores on the hysteria (Hy) scale are reported in several forms of pain. Previous results were possibly biased by diagnostic heterogeneity (psychogenic, somatic and mixed pain syndromes included in the same index sample) or Hy heterogeneity (failure to differentiate Hy scores into clinically meaningful subscales, such as admission of symptoms [Ad] and denial of symptoms [Dn]). METHODS: To overcome this drawback, 48 patients diagnosed as having a Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR) diagnosis of "pain disorder associated with psychological factors" were compared with 48 patients experiencing somatic pain excluding psychological factors, and 42 somatic controls without pain. RESULTS: MMPI Hy and hypochondriasis (Hs) scores were significantly higher in the pain disorder group than in control groups, who scored similarly. MMPI correction (K) scores and Dn scores were similar in the three groups, whereas Ad was significantly higher in the pain disorder group and lower and similar in the two control groups, respectively. In the pain disorder group, Ad and Dn were negatively correlated, whereas in control groups they were unrelated. CONCLUSIONS: These findings suggest that whereas a pattern of high Hs and Hy scores together with a normal K score might characterize patients with a pain disorder associated with psychological factors, elevated Hy scores per se do not indicate hysterical traits. In the pain disorder group, elevated Hy scores reflected the Ad subscale alone, indicating a strikingly high frequency of distressing somatic symptoms. They tend not to repress or deny the emotional malaise linked to symptoms, as the hysterical construct expects. The pain disorder designation should be considered a nonhysterical form of somatization.

[Clinical variants of hypochondriac state in patients with duodenal ulcer].

AIM: To describe some clinical variants of hypochondriac syndrome in patients with duodenal ulcer (DU). MATERIAL AND METHODS: A hypochondriac trend was studied clinically and was confirmed by changes in the first scale of AMPI in 150 DU patients. If the first scale contained a rise over 70 points, the examinee was stated to be much concerned about his/her health. RESULTS: Hypochondriac syndrome in exacerbation was registered in 59 (39.3%) patients. It was accompanied with anxiety in 28.8% cases. Introversion and original attitude to somatic disorders were observed in 25.4% cases. Demonstrative behavior was seen in 23.8% patients. Depressive trends occurred in 13.5% patients. Conception of the disease was confirmed in 5.1% cases. Hypochondriac state with protest reactions and hyperthymic effect occurred least frequently (1 and 1 case, respectively). CONCLUSION: Hypochondriac states aggravate DU, deteriorate quality of life. Early diagnosis of a variant of hypochondriac syndrome enables a directed individual psychotherapy which improves emotional state of the patient and prevent further development of psychopathological traits.