Cognitive aspects of hypochondriasis and the somatization syndrome.

Abstract

The aim of this study was to evaluate whether specific cognitive aspects are present in patients suffering from somatoform disorders. With a sample of 493 patients from a center for behavioral medicine, the authors evaluated a questionnaire assessing typical cognitions concerning body perception, illness behavior, and health. The authors further examined 225 participants, including patients with a somatization syndrome, patients with somatization syndrome and additional hypochondriasis, patients with hypochondriasis, patients with other mental disorders (clinical control group), and nonclinical controls. The results showed that not only patients with hypochondriasis but also patients with somatization syndrome had cognitive concerns and assumptions that were specific for the disorder. These patients had a self-concept of being weak and unable to tolerate stress. A catastrophizing interpretation of minor bodily complaints found in hypochondriacal patients in earlier studies was also found for patients with multiple somatization symptoms.

Symptoms and the body: Taking the inferential leap

“…Evidence in line with the (mis)interpretation assumption has been documented for most MUS-related conditions, such as chronic pain, somatoform disorders, fatigue, health anxiety and hypochondriasis (Goedendorp et al, 2013;Marcus et al, 2007;Rief et al, 1998;Rief and Broadbent 2007;Rief and Martin, 2014). These beliefs correlate with various ratings indicating the aversive quality of induced or existent bodily sensations, such as (pain) threshold and unpleasantness.…”

“…Self-report studies indeed show that individuals with MUS report a tendency to scan the body for signs of illness (e.g., Gendolla et al, 2005;Rief et al, 1998). However, objective measures of attention to health-related stimuli have yielded less consistent findings.…”

“…There is evidence that patients with MUS hold more precise priors about "a normal body condition" (Rief et al, 1998) and have lower tolerance for uncertainty, leading to more prediction errors and thereby symptoms, especially when questioned about their somatic state. Also chronic somatic concerns may afford more weight to symptom-related priors, reducing detailed sensoryperceptual processing.…”

Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA

“…The overall internal consistency (Cronbach's alpha) of the CABAH is 0.90, with the five subscales ranging from α =.67 to α = .88 (Rief et al 1998). The measure has demonstrated good convergent and divergent validity (Leibbrand, Hiller & Fichter, 2000).…”

“…It has also demonstrated good to excellent reliability and validity (Greeven et al, 2007;Fink et al, 1999;Stewart & Watt, 2001;;Speckens, 2001). Rief, Hiller, & Margraf, 1998) The CABAH is a self-report measure that captures cognitions, attitudes and behaviours associated with cognitive behavioural theories of health anxiety (Rief et al, 1998;Weck, Bleichhardt & Hiller, 2010;Hiller, Leibbrand, Rief, & Fichter, 2005). The measure consists of five subscales which measure: catastrophizing interpretation of bodily complaints, autonomic sensations, bodily weakness, intolerance of bodily complaints and health habits.…”