Hypochondriacal attitudes, pain sensitivity, and attentional bias

Abstract

Abstract-The relation between hypochondriaeal attitudes, thermal pain threshold, and attentional bias toward pain was examined in a non-clinieal population (N = 28). Attentional bias was operationalized with a eoncentration-performance test, which subjects performed while connected to a pain stimulator. Subjects were informed that they would receive a painful stimulus du ring the second part of the test, while the first part was introdueed as pain-free. The pain stimulus was never applied during the test phase. The expeetancy of a forthcoming pain stimulus reduced the performance of high hypochondriaeal subjects in both parts of the test. Low hypochondriacal subjects, on the other hand, displayed significantly better performance in the first, pain-free compared to the seeond, pain-related part of the test. Thermal pain thresholds were assessed at four measuring sites (thenar, neck, collar-bone, abdomen), but no relations with hypochondriasis sum scores and locus of pain stimulation were found. A stepwise multiple regression of pain threshold by individual lllness Attitude Seal es (lAS) led to 66% of the varianee being explained by the scales 'concern about pain', 'worry about iIIness', and 'disease phobia'. Results are discussed in terms of amplifying somatic style, preoccupation with or atlentional bias toward bodily symptoms, and experimental induction of a hypochondriacal state. INTROOUCTIONONE WA Y of understanding hypochondriasis is as an amplifying somatic style [1]. It is assumed that hypochondriacs augment normal body sensations, and for this reason experience normal bodily sensations as more noxious and more intense than non hypochondrial subjects. Studies found that hypochondriasis or disease phobia is associated with lowered thresholds for e1ectrical [2] or ischemic pain [3], heightened perceptual sensitivity [4], increased awareness of cardiac activity [5], somatosensory amplification [6], and enhanced sensitivity to iIIness cues [7, 8]. Other studies indicate that subjects characterized as high monitorers or sensitizers showed more hypochondriacal complaints, reported more physical symptoms, and displayed more abnormal iIIness behavior than low monitorers or repressors [9]. Reinforcement from family members, friends, or care-takers could play an important role in the development and maintenance of an amplifying somatic style and associated ilIness behavior. The family is believed to be particularly important in reinforcing hypochondriacal attitudes and behavior [1].Attention is seen as a factor able to alter the perceived intensity and level of distress associated with several bodily processes including pain [10], and one could assume that hypochondriacal subjects focus more attention on bodily sensations [1,11,12]. However, no studies so far have examined attentional bias towards aversive bodily sensations in hypochondriacal subjects. Ahles er al. [13] tried to investigate the effect of attention on the perception of pain in subjects with high and 10w body Address for eorrespondence: Or Paul Pauli,

The Illness Attitude Scales

“…The worry about illness, concerns about pain and disease phobia scales resulted significant predictors of the psychophysiological measure of pain threshold [98]. …”

The relevance of health anxiety to chronic pain: Research findings and recommendations for assessment and treatment

“…These patients are more likely to focus on negative aspects of physical sensations and engage in catastrophic thinking [29]. In addition, when health-anxious patients expect a painful stimulus, they have a difficult time performing an attention or concentration task [30]. Experimental research has demonstrated that patients who are health-anxious compared with those who have low anxiety show selective attention biases to illness information [Owens et al, unpublished observation].…”

A sensitive body or a sensitive mind? Associations among somatic sensitization, cognitive sensitization, health worry, and subjective health complaints

“…At a higher cognitive level, sensitization is manifested as cognitive bias [9] (i.e., selective processing of information that is of high relevance for individuals [20]). Cognitive biases for information related to complaints, including pain, have been found in several clinical groups that are difficult to diagnose and treat, including somatoform patients, chronic pain patients, fibromyalgia patients, and persons with high health anxiety [21][22][23][24][25][26][27][28], as well as in patients with medically explained conditions that are influenced by stress, such as psoriasis [29] and asthma [30].…”