Attribution of Somatic Symptoms in Hypochondriasis

Abstract

The misinterpretation of bodily symptoms as an indicator of a serious illness is a key feature of the criteria and the cognitive-behavioural models of hypochondriasis. Previous research suggests that individuals suffering from health anxiety endorse attributions of physical disease, whereas persons with elevated general anxiety have the tendency to attribute psychological causes to their symptoms. However, whether a somatic attribution style is specific to patients with hypochondriasis, as opposed to those with anxiety disorders, has not yet been investigated and is therefore part of the present study. Fifty patients with hypochondriasis, 50 patients with a primary anxiety disorder and 50 healthy participants were presented with nine common bodily sensations and had to spontaneously attribute possible causes to the symptoms. Patients with hypochondriasis differed from patients with anxiety disorders and healthy controls in giving significantly fewer normalizing explanations, but attributing more often in terms of moderate or serious diseases. Patients with anxiety disorders also made significantly fewer normalizing attributions and more somatic attributions to a severe illness than healthy controls. There were no differences between the groups in the frequency of psychological attributions and somatic attributions concerning mild diseases. The present study demonstrates that hypochondriasis is associated with a disorder-specific attribution style connecting somatic symptoms primarily with moderate and serious diseases. By contrast, normalizing attributions are largely omitted from consideration by patients with hypochondriasis. The findings conform with the cognitive conception of hypochondriasis and support the strategy of modifying symptom attributions, as practiced in cognitive-behavioural therapy.

Predictors and consequences of health anxiety symptoms: a novel twin modeling study

“…However, there are important differences between the construct of HA and AS in regard to the appraisal/attribution of bodily anxiety symptoms. In HA, patients tend more to attribute such symptoms to a moderate or severe physical disease process and tend to be characterized by long periods of anxiety due to the delayed consequences, whereas for people with high AS, particularly PD patients, somatic symptoms are more commonly attributed to cognitive/psychological factors (e.g., I will get crazy ) and also related to immediate threats . Nevertheless, in the current study, HA and AS (measured by the ASI) were found to be the most strongly correlated measures within individuals, and by contrast the lowest cross‐twin correlation.…”

Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

“…This, in turn, gives rise to behavioural responses (E), which persist because they reduce anxiety and/or fear in the short term, but also contribute to maintaining high levels of health anxiety over time. In accordance with the model (Figure 1), there is experimental evidence to support the claim that individuals with high levels of health anxiety are more prone than others to view healthand illness-related stimuli as threats to their own personal health 17,159 (A-B), and to direct their attention to such stimuli 16, 160-162 (C). Individuals with high levels of health anxiety also tend to have a biased perception of health-related cues, such as their own heart rhythm 163,164 ; a finding which ties in with a large empirical literature on the influence of expectancy over perception 165,166 , including interoceptive awareness 167 .…”

“…Severe health anxiety has a broad set of cognitive, behavioural, and emotional characteristics. For example, individuals with this condition are prone to react to disease-related stimuli 16 , and are more likely than others to interpret bodily symptoms as indicative of disease 17 . On average, individuals with severe health anxiety also utilise more health care than others 18 .…”

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

“…prolonged headache) to participants, who then have one minute per symptom to spontaneously attribute possible causes. Neng and Weck (2015) reported one notable study in which the Attribution Task is used to compare symptom attributions among patients with hypochondriasis, patients with anxiety disorders and healthy controls. In this study, two independent blind raters classified the given attributions into different categories: normalizing, somatic (diseases) and psychological.…”

“…In this study, two independent blind raters classified the given attributions into different categories: normalizing, somatic (diseases) and psychological. By using this instrument, Neng and Weck (2015) showed that hypochondriasis is associated with a disorder-specific attribution style that connects somatic symptoms primarily with moderate (e.g. migraine) and severe (e.g.…”