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Transient and persistent hypochondriacal worry in primary care

Published online by Cambridge University Press:  09 July 2009

James M. Robbins  and
Laurence J. Kirmayer
James M. Robbins*
Affiliation:
Departments of Pediatrics and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
Laurence J. Kirmayer
Affiliation:
Departments of Pediatrics and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA; Institute of Community and Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital and Department of Psychiatry, McGill University, Montreal, Quebec, Canada
*
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.
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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.

Type
Original Articles
Information
Psychological Medicine , Volume 26 , Issue 3 , May 1996 , pp. 575 - 589
Copyright
Copyright © Cambridge University Press 1996

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References

REFERENCES

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association: Washington, DC.Google Scholar
Barsky, A. J. & Klerman, G. L. (1983). Overview: hypochondriasis, bodily complaints and somatic styles. American Journal of Psychiatry 140, 273–283.Google ScholarPubMed
Barsky, A. J. & Wyshak, G. (1989). Hypochondriasis and related health attitudes. Psychosomatics 30, 412–420.CrossRefGoogle ScholarPubMed
Barsky, A. J. & Wyshak, G. (1990). Hypochondriasis and somatosensory amplification. British Journal of Psychiatry 157, 404–409.CrossRefGoogle ScholarPubMed
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, 493–500.CrossRefGoogle ScholarPubMed
Barsky, A. J., Geringer, E. & Wool, C. A. (1988). A cognitive-educational treatment for hypochondriasis. General Hospital Psychiatry 10, 322–327.CrossRefGoogle ScholarPubMed
Barsky, A. J., Wyshak, G. & Klerman, G. L. (1990 a). Transient hypochondriasis. Archives of General Psychiatry 47, 746–753.CrossRefGoogle ScholarPubMed
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, 89–94.CrossRefGoogle ScholarPubMed
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, 20–27.CrossRefGoogle ScholarPubMed
Barsky, A. J., Clary, P. D., Sarnie, M. K. & Klerman, G. L. (1993). The course of transient hypochondriasis. American Journal of Psychiatry 150, 484–488.Google ScholarPubMed
Baur, S. (1988). Hypochondria: Woeful Imaginings. University of California Press: Berkeley.Google Scholar
Beaber, R. J. & Rodney, W. M. (1984). Underdiagnosis of hypochondriasis in family practice. Psychosomatics 25, 39–45.CrossRefGoogle ScholarPubMed
Costa, P. T. Jr. & McCrae, R. R. (1985). Hypochondriasis, neuroticism, and aging: when are somatic complaints unfounded? American Psychologist 40, 19–28.CrossRefGoogle ScholarPubMed
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, 1–15.CrossRefGoogle Scholar
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, 140–146.CrossRefGoogle ScholarPubMed
Ford, C. V. (1986). The somatizing disorders. Psychosomatics 27, 327–337.CrossRefGoogle ScholarPubMed
Goldberg, D. P., Gask, L. & O'Dowd, T. (1989). The treatment of somatization: teaching techniques of reattribution. Journal of Psychosomatic Research 33, 689–695.CrossRefGoogle ScholarPubMed
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, 1069–1077.CrossRefGoogle ScholarPubMed
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, 328–339.CrossRefGoogle ScholarPubMed
Kellner, R. (1985). Functional somatic symptoms and hypochondriasis. Archives of General Psychiatry 42, 821–833.CrossRefGoogle ScholarPubMed
Kellner, R. (1986). Somatization and Hypochondriasis. Praeger: New York.Google Scholar
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. 159–179. American Psychiatric Press: Washington, DC.Google Scholar
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, 127–139.CrossRefGoogle ScholarPubMed
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, 20–25.CrossRefGoogle ScholarPubMed
Kenyon, F. E. (1976). Hypochondriacal states. British Journal of Psychiatry 129, 1–14.CrossRefGoogle ScholarPubMed
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. 111–133. Plenum Press: New York.CrossRefGoogle Scholar
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, 647–655.CrossRefGoogle ScholarPubMed
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).CrossRefGoogle ScholarPubMed
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, 143–163.CrossRefGoogle Scholar
Mabe, P. A., Hobson, D. P., Jones, L. R. & Jarvis, R. G. (1988). Hypochondriacal traits in medical patients. General Hospital Psychiatry 10, 236–244.CrossRefGoogle Scholar
Miller, L. C., Murphy, R. & Buss, A. H. (1981). Consciousness of body: public and private. Journal of Personality and Social Psychology 41, 397–406.CrossRefGoogle Scholar
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, 961–970.CrossRefGoogle ScholarPubMed
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, 533–545.CrossRefGoogle ScholarPubMed
Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry 113, 89–93.CrossRefGoogle ScholarPubMed
Pilowsky, I. & Spence, N. D. (1983). Manual for the Illness Behaviour Questionnaire (IBQ). University of Adelaide, Adelaide, South Australia.Google Scholar
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
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. 283–302. Plenum Press: New York.CrossRefGoogle Scholar
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. 107–141. American Psychiatric Press: Washington.Google Scholar
Robbins, J. M. & Kirmayer, L. J. (1991 b). Attributions of common somatic symptoms. Psychological Medicine 21, 1029–1045.CrossRefGoogle ScholarPubMed
Robbins, J. M., Kirmayer, L. J. & Kapusta, M. A. (1990). Illness worry and disability in fibromyalgia syndrome. International Journal of Psychiatry in Medicine 20, 49–63.CrossRefGoogle ScholarPubMed
Robins, L. N. & Regier, D. (1991). Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. Free Press: New York.Google Scholar
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, 381–389.CrossRefGoogle ScholarPubMed
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, 85–92.CrossRefGoogle ScholarPubMed
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, 710–717.Google Scholar
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, 1164–1170.CrossRefGoogle ScholarPubMed
Starcevic, V. (1990). Role of reassurance and psychopathology in hypochondriasis. Psychiatry 53, 383–395.CrossRefGoogle ScholarPubMed
Starcevic, V. (1991). Reassurance and treatment of hypochondriasis. General Hospital Psychiatry 13, 122–127.CrossRefGoogle ScholarPubMed
Thoits, P. A. (1986). Social support as coping assistance. Journal of Consulting and Clinical Psychology 54, 416–423.CrossRefGoogle ScholarPubMed
Wagner, P. J. & Curran, P. (1984). Health beliefs and physician identified worried well. Health Psychology 3, 459–474.CrossRefGoogle ScholarPubMed
Wickramasekera, I. (1989). Enabling the somatizing patient to exit the somatic closet: a high-risk model. Psychotherapy 26, 530–544.CrossRefGoogle Scholar