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Transient and persistent hypochondriacal worry in primary care

  • James M. Robbins (a1) and Laurence J. Kirmayer (a1)

Synopsis

We present a 12-month prospective study of hypochondriacal worry in primary care. Data were obtained from 546 family medicine patients at the time of a physician visit for a new illness and again 1 year later. Patients were divided into four groups based on scores on the Illness Worry Scale: non-hypochondriacal (N = 460), transient hypochondriacal (N = 34); emerging hypochondriacal (N = 21); and persistent hypochondriacal (N = 31). Persistent patients had significantly more serious medical history but no more serious current illness than those low on illness worry. Patients with persistent illness worry were more likely than others to have a diagnosis of major depression or anxiety disorder, were more likely to believe that their most important significant other would pathologize new symptoms, yet were less likely to have been encouraged to see the doctor by them. Patients who became less worried over the year reported corresponding decreases in distress, attentiveness to bodily sensations, emotional vulnerability and pathological symptom attributions. We conclude that depressive or anxiety disorders, fears of emotional instability, pathological symptom attributional styles and interpersonal vulnerability provide the best prognostic evidence for enduring illness worry.

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Corresponding author

1Address for correspondence: Dr James M. Robbins, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital., 800 Marshall Street, Little Rock, Arkansas 72202., USA.

References

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American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association: Washington, DC.
Barsky, A. J. & Klerman, G. L. (1983). Overview: hypochondriasis, bodily complaints and somatic styles. American Journal of Psychiatry 140, 273283.
Barsky, A. J. & Wyshak, G. (1989). Hypochondriasis and related health attitudes. Psychosomatics 30, 412420.
Barsky, A. J. & Wyshak, G. (1990). Hypochondriasis and somatosensory amplification. British Journal of Psychiatry 157, 404409.
Barsky, A. J., Wyshak, G. & Klerman, G. L. (1986). Hypochondriasis: an evaluation of the DSM-III criteria in medical outpatients. Archives of General Psychiatry 43, 493500.
Barsky, A. J., Geringer, E. & Wool, C. A. (1988). A cognitive-educational treatment for hypochondriasis. General Hospital Psychiatry 10, 322327.
Barsky, A. J., Wyshak, G. & Klerman, G. L. (1990 a). Transient hypochondriasis. Archives of General Psychiatry 47, 746753.
Barsky, A. J., Wyshak, G., Klerman, G. L. & Latham, K. S. (1990 b). The prevalence of hypochondriasis in medical outpatients. Social Psychiatry and Psychiatric Epidemiology 25, 8994.
Barsky, A. J., Cleary, P. D., Wyshak, G., Spitzer, R. L., Williams, J. B. W. & Klerman, G. L. (1992). A structured diagnostic interview for hypochondriasis: a proposed criterion standard. Journal of Nervous and Mental Disease 180, 2027.
Barsky, A. J., Clary, P. D., Sarnie, M. K. & Klerman, G. L. (1993). The course of transient hypochondriasis. American Journal of Psychiatry 150, 484488.
Baur, S. (1988). Hypochondria: Woeful Imaginings. University of California Press: Berkeley.
Beaber, R. J. & Rodney, W. M. (1984). Underdiagnosis of hypochondriasis in family practice. Psychosomatics 25, 3945.
Costa, P. T. Jr. & McCrae, R. R. (1985). Hypochondriasis, neuroticism, and aging: when are somatic complaints unfounded? American Psychologist 40, 1928.
Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H. & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): a self-report inventory. Behavioral Science 19, 115.
Escobar, J. L., Rubio-Stipec, M., Canino, G. & Karno, M. (1989). Somatic Symptom Index (SSI): a new and abridged somatization construct. Journal of Nervous and Mental Disease 177, 140146.
Ford, C. V. (1986). The somatizing disorders. Psychosomatics 27, 327337.
Goldberg, D. P., Gask, L. & O'Dowd, T. (1989). The treatment of somatization: teaching techniques of reattribution. Journal of Psychosomatic Research 33, 689695.
Helzer, J. E., Spitznagel, E. L. & McEvoy, L. (1987). The predictive validity of lay Diagnostic Interview Schedule diagnoses in the general population. Archives of General Psychiatry 44, 10691077.
Kasteler, J., Kane, R. L., Olsen, D. M. & Thetford, C. (1976). Issues underlying prevalence of ‘doctor-shopping’ behavior. Journal of Health and Social Behavior 17, 328339.
Kellner, R. (1985). Functional somatic symptoms and hypochondriasis. Archives of General Psychiatry 42, 821833.
Kellner, R. (1986). Somatization and Hypochondriasis. Praeger: New York.
Kellner, R. (1991). Treatment approaches to somatizing and hypochondriacal patients. In Current Concepts of Somatization: Research and Clinical Perspectives (ed. Kirmayer, L. J. and Robbins, J. M.), pp. 159179. American Psychiatric Press: Washington, DC.
Kellner, R., Abbott, P., Pathak, D., Winslow, W. W. & Umland, B. E. (1983). Hypochondriacal beliefs and attitudes in family practice and psychiatric patients. International Journal of Psychiatry in Medicine 13, 127139.
Kellner, R., Abbott, P., Winslow, W. W. & Pathak, D. (1987). Fears, beliefs, and attitudes in DSM-III hypochondriasis. Journal of Nervous and Mental Disease 175, 2025.
Kenyon, F. E. (1976). Hypochondriacal states. British Journal of Psychiatry 129, 114.
Kirmayer, L. J. (1986). Somatization and the social construction of illness experience. In Illness Behavior: A Multidisciplinary Perspective (ed. McHugh, S. and Vallis, T. M.), pp. 111133. Plenum Press: New York.
Kirmayer, L. J. & Robbins, J. M. (1991). Three forms of somatization in primary care: prevalence, co-occurrence and sociodemographic characteristics. Journal of Nervous and Mental Disease 179, 647655.
Kirmayer, L. J. & Robbins, J. M. (1996). Patients who somatize in primary care: a longitudinal study of cognitive and social characteristics. Psychological Medicine 26, (in the press).
Leventhal, H., Diefenbach, M. & Leventhal, E. A. (1992). Illness cognition: using common sense to understand treatment adherence and affect cognition interaction. Cognitive Therapy and Research 16, 143163.
Mabe, P. A., Hobson, D. P., Jones, L. R. & Jarvis, R. G. (1988). Hypochondriacal traits in medical patients. General Hospital Psychiatry 10, 236244.
Miller, L. C., Murphy, R. & Buss, A. H. (1981). Consciousness of body: public and private. Journal of Personality and Social Psychology 41, 397406.
Noyes, R., Kathol, R. G., Fisher, M. M., Phillips, B. M., Suelzer, M. T. & Holt, C. S. (1993). The validity of DSM-III-R hypochondriasis. Archives of General Psychiatry 50, 961970.
Noyes, R., Kathol, R. G., Fisher, M. M., Phillips, B. M., Suelzer, M. T. & Woodman, C. (1994). A one-year follow-up of medical outpatients with hypochondriasis. Psychosomatics 35, 533545.
Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry 113, 8993.
Pilowsky, I. & Spence, N. D. (1983). Manual for the Illness Behaviour Questionnaire (IBQ). University of Adelaide, Adelaide, South Australia.
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.
Robbins, J. M. & Kirmayer, L. J. (1986). Illness cognition, symptom reporting and somatization in primary care. In Illness Behavior: A Multidisciplinary Model (ed. McHugh, S. and Vallis, T. M.), pp. 283302. Plenum Press: New York.
Robbins, J. M. & Kirmayer, L. J. (1991 a). Cognitive and social factors in somatization. In Current Concepts of Somatization: Research and Clinical Perspectives (ed. Kirmayer, L. J. and Robbins, J. M.), pp. 107141. American Psychiatric Press: Washington.
Robbins, J. M. & Kirmayer, L. J. (1991 b). Attributions of common somatic symptoms. Psychological Medicine 21, 10291045.
Robbins, J. M., Kirmayer, L. J. & Kapusta, M. A. (1990). Illness worry and disability in fibromyalgia syndrome. International Journal of Psychiatry in Medicine 20, 4963.
Robins, L. N. & Regier, D. (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press: New York.
Robins, L. N., Helzer, J. E. & Croughan, J. (1981). National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Archives of General Psychiatry 38, 381389.
Rosenberg, S. J., Hayes, J. R. & Peterson, R. A. (1987). Revising the Seriousness of Illness Rating Scale: modernization and restandardization. International Journal of Psychiatry in Medicine 17, 8592.
Safer, M. A., Tharps, Q. J., Jackson, T. C. & Leventhal, H. (1979). Determinants of three stages of delay in seeking care at a medical clinic. Medical Care 14, 710717.
Schulberg, H. C., Saul, M., McClelland, M., Ganguli, M., Christy, W. & Frank, R. (1985). Assessing depression in primary medical and psychiatric practices. Archives of General Psychiatry 42, 11641170.
Starcevic, V. (1990). Role of reassurance and psychopathology in hypochondriasis. Psychiatry 53, 383395.
Starcevic, V. (1991). Reassurance and treatment of hypochondriasis. General Hospital Psychiatry 13, 122127.
Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology 54, 416423.
Wagner, P. J. & Curran, P. (1984). Health beliefs and physician identified worried well. Health Psychology 3, 459474.
Wickramasekera, I. (1989). Enabling the somatizing patient to exit the somatic closet: a high-risk model. Psychotherapy 26, 530544.

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