Abstract
This paper reviews the relevant cognitive research on health anxiety and hypochondriasis, as well as research examining temperament/personality and social developmental factors relevant to health and illness cognition and associated negative emotional states. A cognitive developmental model is proposed which integrates individual difference variables, selective attention/cognitive factors, and social learning processes that may serve as vulnerability and maintenance factors in the etiology of health anxiety and hypochondriasis. Future directions for the study of cognition and hypochondriasis are suggested.
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REFERENCES
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders(4th ed., text rev.). Washington, DC: Author.
Barsky, A. J., Coeytaux, Remy R., Sarnie, M. K., & Cleary, P. D. (1993). Hypochondriacal patients' beliefs about good health. American Journal of Psychiatry, 150, 1085-1089.
Barsky, A. J., Ahern, D. K., Bailey, E. D., Saintfort, R., Liu, E. B., & Peekna, H. M. (2001). Hypochondriacal patients' appraisal of health and physical risks. American Journal of Psychiatry, 158, 783-787.
Barsky, A. J., Barnett, M. C., & Cleary, P. D. (1994). Hypochondriasis and panic disorder: Boundary and overlap. Archives of General Psychiatry, 51, 918-925.
Barsky, A. J., & Klerman, G. L. (1983). Overview: Hypochondriasis, bodily complaints, and somatic styles. American Journal of Psychiatry, 140, 273-283.
Barsky, A. J., Wool, C., Barnett, M. C., & Cleary, P. D. (1994). Histories of childhood trauma in adult hypochondriacal patients. American Journal of Psychiatry, 151, 397-401.
Barsky, A. J., Wyshek, G., & Klerman, G. L. (1990). Transient hypochondriasis. Archives of General Psychiatry, 47, 746-752.
Barsky, A. J., Wyshek, G., Klerman, G. L., & Latham, K. S. (1990). The prevalence of hypochondriasis in medical outpatients. Social Psychiatry and Psychiatric Epidemiology, 25, 89-94.
Barsky, A. J., Wyshek, G., Latham, K. S., & Klerman, G. L. (1990). The Somatosensory Amplification Scale and its relationship to hypochondriasis. Journal of Psychiatry Research, 24, 323-334.
Brown, H. D., Kosslyn, S. M., Delamater, B., Fama, J., & Barsky, A. J. (1999). Perceptual and memory biases for health-related information in hypochondriacal individuals. Journal of Psychosomatic Research, 47, 67-78.
Cioffi, D. (1991). Beyond attentional strategies: A cognitive-perceptual model of somatic interpretation. Psychological Bulletin, 109, 25-41.
Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100, 316-336.
Cloninger, C. R., Sigvardsson, S., von Knorring, A., & Behman, M. (1984). An adoption study of somato-form disorders. Archives of General Psychiatry, 44, 573-588.
Cox, B. J., Borger, S. C., Asmundson, G. J. G., & Taylor, S. (2000). Dimensions of hypochondriasis and the five-factor model of personality. Personality and Individual Differences, 29, 99-108.
Escobar, J. I., Gara, M., Waitzkin, H., Cohen Silver, R., Holman, A., & Comptom, W. (1998). DSM-IV hypochondriasis in primary care. General Hospital Psychiatry, 20, 155-159.
Fava, G. A., Grandi, S., Saviotti, F. M., & Conti, S. (1990). Hypochondriasis with panic attacks. Psychosomatics, 31, 351-353.
Ferguson, E. (2000). Hypochondriacal concerns and the five factor model of personality. Journal of Personality, 68, 705-724.
Frick, P. J., Kuper, K., Silverthorn, P., & Cotter, M. (1995). Antisocial behavior, somatization, and sensation-seeking behavior in mothers of clinic-referred children. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 805-812.
Gray, J. A. (1982). The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. New York: Oxford University Press.
Gray, J. A. (1987). The psychology of fear and stress. New York: Cambridge University Press.
Hadjistavropoulos, H. D., Craig, K. D., & Hadjistavropoulos, T. (1998). Cognitive and behavioral responses to illness information: The role of health anxiety. Behaviour Research and Therapy, 36, 149-164.
Haenen, M. A., de Jong, P. J., Schmidt, A. J. M., Stevens, S., & Visser, L. (2000). Hypochondriacs' estimation of negative outcomes: Domain-specificity and responsiveness to reassuring and alarming information. Behaviour Research and Therapy, 38, 819-833.
Hazen, R. A., Vasey, M. W., & Schmidt, N. B. (2001, November). Attentional retraining for chronic worry. Poster presented at the 35th annual meeting of the Association for the Advancement of Behavior Therapy, Philadelphia.
Hitchcock, P. B., & Mathews, A. (1992). Interpretation of bodily symptoms in hypochondriasis. Behaviour Research and Therapy, 30, 223-234.
Idler, E. L., & Benyamini, Y. (1997). Self-rated health and mortality: Areview of twenty-seven community studies. Journal of Health and Social Behavior, 38, 21-37.
Karoly, P., & Lecci, L. (1993). Hypochondriasis and somatization in college women: A personal projects analysis. Health Psychology, 12, 103-109.
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.
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.
Lecci, L., & Cohen, D. J. (2002). Perceptual consequences of an illness-concern induction and its relation to hypochondriacal tendencies. Health Psychology, 21, 147-156.
Lecci, L., Karoly, P., Ruehlman, L. S., & Lanyon, R. I. (1996). Goal-relevant dimensions of hypochondriacal tendencies and their relation to symptom manifestations and psychological distress. Journal of Abnormal Psychology, 105, 42-52.
Leventhal, H., Meyer, D., & Nerenz, D. (1980). The common sense representation of illness danger. In S. Rachman (Ed.), Medical psychology(pp. 7-30). New York: Pergamon.
Lewinsohn, P. M., Seeley, J. R., Hibbard, J., Rohde, P., & Sack, W. H. (1996). Cross-sectional and prospective relationships between physical morbidity and depression in older adolescents. Journal of the Academy of Child and Adolescent Psychiatry, 35, 1120-1129.
Lilienfeld, S. O., Van Valkenburg, C., Larntz, K., & Akiskal, H. S. (1986). The relationship of histrionic personality disorder to antisocial personality and somatization disorders. American Journal of Psychiatry, 143, 718-722.
Lonigan, C. J., Vasey, M. W., Phillips, B. M., & Hazen, R. A. (2004). Temperament, anxiety, and the processing of threat-relevant stimuli. Journal of Clinical Child and Adolescent Psychology, 33, 8-20.
Looper, K. J., & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psycho-logical Medicine, 31, 577-584.
Looper, K. J., & Kirmayer, L. J. (2002). Behavioral medicine approaches to somatoform disorders. Journal of Consulting and Clinical Psychology, 70, 810-827.
Lucock, M. P., White, C., Peake, M. D., & Morley, S. (1998). Biased perception and recall of reassurance in medical patients. British Journal of Health Psychology, 3, 237-243.
MacLeod, C., & Mathews, A. (1988). Anxiety and the allocation of attention to threat. Quarterly Journal of Experimental Psychology: Human Experimental Psychology, 38, 659-670.
MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95, 15-20.
MacLeod, C., & Rutherford, E. (1992). Anxiety and the selective processing of emotional information: Mediating roles of awareness, trait and state variable, and personal relevance of stimulus materials. Behaviour Research and Therapy, 30, 479-491.
MacLeod, C., Rutherford, E., Campbell, L., Ebsworthy, G., & Holker, L. (2002). Selective attention and emotional vulnerability: Assessing the causal basis of their association through the experimental manipulation of attentional bias. Journal of Abnormal Psychology, 11, 107-123.
Marcus, D. K. (1999). The cognitive-behavioral model of hypochondriasis: Misinformation and triggers. Journal of Psychosomatic Research, 47, 79-91.
Marcus, D. K., & Church, S. E. (2003). Are dysfunctional beliefs about illness unique to hypochondriasis? Journal of Psychosomatic Research, 54, 543-547.
Mathews, A., & MacLeod, C. (1985). Selective processing of threat cues in anxiety states. Behaviour Research and Therapy, 23, 563-569.
Mathews, A., & MacLeod, C. (1994). Cognitive approaches to emotion and emotional disorders. Annual Review of Psychology, 45, 25-50.
Mathews, A., & Sabastian, S. (1993). Suppression of emotional Stroop effects by fear arousal. Cognition and Emotion, 7, 517-530.
Matthews, A., & Mackintosh, B. (1998). A cognitive model of selective processing in anxiety. Cognitive Therapy and Research, 22, 539-560.
McClure, E. B., & Lilienfeld, S. O. (2001). Personality traits and health anxiety. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions (pp. 65-91). New York: Wiley.
McCrae, R. R., & Costa, P. T. (1987). Validation of the five factor model across instruments and observers.Journal of Personality and Social Psychology, 49, 710-727.
Mogg, K., Kentish, J., & Bradley, B. P. (1993). Effects of anxiety and awareness on color identification latencies for emotional words. Behaviour Research and Therapy, 31, 559-567.
Mogg, K., Mathews, A., & Eysenck, M.(1992). Attentional bias to threat in clinical anxiety states. Cognition and Emotion, 6, 149-159.
Mogg, K., Mathews, A., & Weinman, J. (1989). Selective processing of threat cues in anxiety states: A replication. Behaviour Research and Therapy, 27, 317-323.
Noyes, R., Jr. (2001). Hypochondriasis: Boundaries and comorbidities. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions(pp. 132-160). New York: Wiley.
Noyes, R., Jr., Kathol, R. G., Fisher, M. M., Phillips, B. M., Suelzer, M. T., & Woodman, C. L. (1994). One-year follow-up of medical outpatients with hypochondriasis. Psychosomatics, 35, 533-545.
Noyes, R., Jr., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., et al. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65, 292-300.
Noyes, R., Jr., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., & Yagla, S. J. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43, 282-289.
Owens, K. M. B., Asmundson, G. J. G., Hadjistavropoulos, T., & Owens, T. J. (2004). Attentional bias toward illness threat in individuals with elevated health anxiety. Cognitive Therapy and Research, 28, 57-66.
Pauli, P., & Alpers, G. W. (2002). Memory bias in patients with hypochondriasis and somatoform pain disorder. Journal of Psychosomatic Research, 52, 45-53.
Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer-Verlag.
Posner, M. R., & Rothbart, M. K. (2000). Developing mechanisms of self-regulation. Development and Psychopathology, 12, 427-441.
Rief, W., Hiller, W., & Margraf, J. (1998). Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology, 107, 587-595.
Salkovskis, P. M., & Warwick, H. M. C. (2001). Making sense of hypochondriasis: A cognitive theory of health anxiety. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.), Health Anxiety: Clinical and research perspectives on hypochondriasis and related conditions(pp. 46-64). New York: Wiley.
Scalzo, C., Williams, P. G., & Holmbeck, G. N. (in press). Maternal self-assessed health and emotionality predict maternal response to child illness. Children's Health Care.
Tellegan, A. (1985). Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In A. H. Tuma & J. D. Maser (Eds.), Anxiety and the anxiety disorders(pp. 681-706). Hillsdale, NJ: Erlbaum.
Warwick, H. M., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105-117.
Watson, D., & Pennebaker, J. W. (1989). Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psychological Review, 96, 234-254.
Watts, M. C., & Stewart, S. H. (2000). Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adults. Journal of Psychosomatic Research, 49, 107-118.
Weinstein, N. D. (1984). Why it won't happen to me: Perceptions of risk factors and susceptibility. Health Psychology, 3, 431-457.
Weinstein, N. D. (1987). Unrealistic optimism about susceptibility to health problems: Conclusions from a community-wide sample. Journal of Behavioral Medicine, 10, 481-500.
Williams, P. G., Colder, C. C., Richards, M. H., & Scalzo, C. A. (2002). The role of self-assessed health in the relationship between gender and depressive symptoms among adolescents. Journal of Pediatric Psychology, 27, 509-517.
Williams, P. G., Wasserman, M. S., & Lotto, A. J. (2003). Individual differences in self-assessed health: An information-processing investigation of health and illness cognition. Health Psychology, 22, 3-11.
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Williams, P.G. The Psychopathology of Self-Assessed Health:A Cognitive Approach to Health Anxiety and Hypochondriasis. Cognitive Therapy and Research 28, 629–644 (2004). https://doi.org/10.1023/B:COTR.0000045569.25096.44
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DOI: https://doi.org/10.1023/B:COTR.0000045569.25096.44