The classification of depressive illness continues to be a subject for dispute. Studies in many areas support the view that there are two distinct forms of depression, but until techniques of multivariate analysis became available it was difficult to obtain definite support for either the unitary or the binary view.
The literature on disease phobia is discussed and a controlled study of this variety of hypochondriasis is presented. There were 30 disease phobic and 30 control subjects, in-patients of a general hospital psychiatric unit in Sydney. Controls were defined as lacking the symptoms ‘disease phobia’, ‘disease conviction’, ‘somatic preoccupation’ and ‘psychogenic pain’. Matching was one-for-one and concerned sex, age and occupational prestige. In brief, the disease phobics were more anxious and self-pitying (current mental state). Before the illness they were more prone to inhibition of anger, bodily concern and low selfesteem (personality variables). As children they were more often weak, sickly and overprotected. Fifteen were youngest siblings versus only six of the controls. They gave a history of much family illness, substantiated by the findings of an excess of deaths among the mothers of disease phobics (life history characteristics). They reported an electrical current as a sensation at relatively low voltages and had low tolerance of pain (experimental measures). A logical insight into the origins of disease phobia is provided by inter-relating the data from these four aspects of the investigations (Fig. 1). This matrix is interpreted in terms of the augmentation-reduction theory of Petrie.
This paper develops a structural equation model to assess the effects of mental state on EPI scores. This model is applied to results obtained from a clinical population. The findings show that :(a) the E scale is not influenced by mental state as measured by the Hamilton Anxiety Scale (HAS); (b)) the N scale is influenced by HAS. An attempt to revise the N scale to produce an uncontaminated score is discussed.
Hypochondriasis, though recognized as common and important, has not been accorded the study that its ubiquity and prominence might be thought to require. It is not long since anecdotes and uncontrolled observations masqueraded as knowledge.
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