Somatosensory amplification, health anxiety, and alexithymia in generalized anxiety disorder vijaya kumar 1, ajit avasthi 2, sandeep grover 2 1 department of psychiatry, national institute of mental health and neurosciences, bengaluru, karnataka, india 2 department of psychiatry, postgraduate institute of medical education and research, chandigarh, india. Anxiety sensitivity index please rate each item by selecting one of the five answers for each question. Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of dsmiv hypochondriasis represents a cutoff where the health anxiety becomes clinically significant. Somatosensory amplification, health anxiety, and alexithymia. Moving past the dichotomous response option of the original whiteley index. Cadat is a leader in both research and clinical treatment of anxiety disorders in the uk. Apr 07, 2015 optimal cutoff points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety article pdf available in plos one 104. The number of consultations in primary care was obtained from medical records for 1 year before and after questionnaire assessment, and negative binomial regression analyses identified predictors of consultation. Comparison of unitary and multidimensional models of the whiteley index in a nonclinical sample. Whiteley index is a widely used test to assess hypochondria.
To assess convergent validity, baseline hybocsm scores for the 195 participants were compared to other measures of hypochondriasis andor somatization administered at the same visitthe whiteley index, heightened illness concernseverity scale hicseverity, patient health questionnaire15 phq15, and somatosensory amplification scale. Material and methods this research was a cross sectional study. Implications for understanding and assessing health anxiety article pdf available june 2008. Background health anexity affects the doctorpatient relationship and also causes unnecessary further procedures. This will be administered in the first and last treatment session week 1 and week 12 by the study investigators, and once at 6 months follow up following treatment completion. The economic effects of hypochondriasis are tremendous. Please answer each statement by circling the number that best applies to you. The mediating effect of health anxiety in the relationship. Implications for understanding and assessing health anxiety article pdf. Moreover, factorial investigations of the wi persist in the original truefalse response format despite criticisms of. Associations were examined with the cox proportional regression models. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in.
Lifetime and measures of health anxiety and fear of bodily sensations subscale disease phobia of the whiteley index, and total score of the body sensations questionnaire. Change in health anxiety levels over 12weeks of treatment measured by the whiteley index 7 wi7 time frame. Clinicianadministered measures to assess severity of illness anxiety and response to treatment are few. Optimal cutoff points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety erik hedman, mats lekander, brjann ljotsson, nils lindefors, christian ruck, gerhard andersson and erik andersson linkoping university post print n. Kellner, 1986, 1987 may prove highly useful for the screening of hypochondriasis. Are premenstrual symptoms associated with health anxiety in. Health anxiety and fear of fear in panic disorder and.
As with all tests the result must be interpreted cautiously. The whiteley7 employs a fivepoint likert scale from 1,not at all to 5,a lot with a scale range from 7 to 35. A randomized controlled trial of medication and cognitive. Wi was developed by pilowsky and colleagues in the mid1960s 12. Pdf psychometric properties of the persian version of. Several studies explored the structural validity of the wi obtaining contrary results concerning the number of factors as well as the. Health anxiety may play a role in this relationship, but few studies have examined it. A taxometric analysis of health anxiety volume 39 issue 2 e.
Identifying the optimal cutoffs for classification of presence of a diagnosis of severe health anxiety. The whiteley index is a 14item selfreport questionnaire with scores ranging from 0 almost never to 4 almost always. Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Anxiety and illness behaviours laboratory, university of regina, regina, sk the whiteley index wi. Young women, aged between 18 and 24 years, were investigated at baseline and, 17 months later, using the anxiety disorders interview schedule. The whiteley index wi is a widely used instrument for measuring hypochondriacal worries and beliefs.
Lifetime prevalence rates are 6% in the population and as high as 20% in hospital outpatients, leading to greater costs to health. Metacognitive therapy for health anxiety full text view. Aug 27, 2019 the present study recruited 323 hospitalized patients with depression to complete the patient health questionnaire15, whiteley index 7, and scale for the assessment of illness behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior. British journal of psychiatry, 1, 8993 is a widely used selfreport measure of health anxiety, hypochondriasis, and illness phobia. Health anxiety and risk of ischaemic heart disease. The primary analysis assessed outcome at week 24 among the intenttotreat sample, with responders defined as having a 25% or greater improvement over baseline on both the whiteley index and a modified version of the yalebrown obsessive. Behaviour questionnaire, illness attitude scales, whiteley index, and. Examining the whiteley index6 as a screener for dsm5. Objectives the aim of this study was to evaluate psychometric properties of the persian version of 14item whiteley index. One commonly used health anxiety measure is fear, which is supported by a recent taxometric evaluation the whiteley index wi.
Therefore, early diagnosis of it with a valid instrument is very important. Symptoms of hypochondriasis in obsessivecompulsive. The authors evaluated a modified version of the hypochondriasisybocs hybocsm, a 19item, semistructured, clinicianadministered instrument designed to rate severity of illnessrelated thoughts, behaviors, and avoidance. The boundary between hypochondriasis and obsessivecompulsive. Af ter women who were amenorrheic for any reason were excluded, a final sample of 410 women aged 25 to 52 years was obtained. Optimal cutoff points on the health anxiety inventory. The present study recruited 323 hospitalized patients with depression to complete the patient health questionnaire15, whiteleyindex7, and scale for the assessment of illness behavior, then constructed a structural equation model to examine whether health anxiety mediated the relationship between functional somatic symptoms and illness behavior. Pdf comparison of unitary and multidimensional models of. The whiteley index 7 was devised in order to clarify the symptom clusters that are seen in clinical hypochondriasis by using factor analysis. Hypochondriasis is a relatively prevalent disorder in primary care, with prevalence estimates of between 3% and 6. At the time, severe health anxiety was regarded to respond rather badly to psychotherapy 3, and a widespread idea was that a pathological fear of severe disease is always secondary to another psychiatric condition 4.
The boundary between hypochondriasis and obsessive. Even at subclinical levels of severity, hypochondriacal worries significantly increase health care utilization at the level of primary care services, associated pathology testing, and secondary. Are premenstrual symptoms associated with health anxiety. The full 64item scale was used in the present study. Whitely index wi, illness attitude scales, somatosensory amplification scale are examples of these tools 4. Validity and responsiveness of the eq5d in assessing and. Pdf optimal cutoff points on the health anxiety inventory, illness. Factor structure analysis, validity and reliability of the health. Development and validation of scales for the measurement of health anxiety and hypochondriasis article pdf available in psychological medicine 325. The iterative process of the efa osborne, 2008 resulted in. Health anxiety was also assessed using the whiteley index wi. Pilowsk y, 1967 is a 14 item selfreport instrument frequently used by researchers and clinicians as a measure of health anxiety. The number of consultations in primary care was obtained from medical records for 1 year before and after questionnaire assessment, and negative binomial regression analyses identified predictors of consultation rate. Newby, gavin andrews skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites.
Recent advances in the understanding and treatment of. Optimal cutoff points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety. Patients may be identified as potential cases by using, e. We expected the ias subscales to be equally as effective as the 7item short version of the whiteley index whiteley7.
Even at subclinical levels of severity, hypochondriacal worries significantly increase health care utilization at the level of primary care services, associated pathology testing, and secondary care. Results showed that the prevalence of hypochondriasis symptoms was 30. Data from those who were currently healthy n 501 and receiving no medical treatment were examined using three taxometric procedures. Symptoms of hypochondriasis in obsessivecompulsive disorder.
Psychometric properties of the persian version of whiteley index. This study examined the measurement invariance of the wi6 among black n 183, latino n 173, and white n 177 respondents seeking treatment at a u. Moreover, factorial investigations of the wi persist in the original truefalse response format despite. Seven hundred and eleven working adults completed an index of health anxiety the whiteley index wi and indicated their current health status. It has long been known that severe health anxiety is a common psychiatric condition associated with significant distress, functional impairment, and societal costs. Somatization and health anxiety as predictors of health. Pdf optimal cutoff points on the health anxiety inventory. The current study aimed to investigate the role of health anxiety in the relationship between functional somatic symptoms and illness behavior in patients with depression. Identifying the optimal cutoffs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and. Compared patients with versus without dsm5 severe health anxiety. The hai is a 64item scale that has two sections, one main section comprised of 47 items measuring cognitive, affective and behavioural aspects of health anxiety and a 17item negative consequences section tapping into the respondents perception of how awful it would be to be ill. Three of the most reliable and used selfreport measures of health anxiety are the health anxiety inventory hai, the illness attitude scales ias and the whiteley index.
We measured health anxiety severity using a sevenitem version of the whiteley index whiteley7,24 assessing worrying and convictions about illness. To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. The eq5d is a generic questionnaire providing a preferencebased index score applicable to costutility analysis. Methods in a random sample of the adult uk population, questionnaires assessed the number of somatic symptoms somatic symptom inventory, health anxiety whiteley index, anxietydepression. Optimal cutoff points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety article pdf available in plos one 104. Items assess worry about health, awareness of bodily sensations or changes, and feared consequences of having an illness. The primary analysis assessed outcome at week 24 among the intenttotreat sample, with responders defined as having a 25% or greater improvement over baseline on both the whiteley index and a modified version of the yalebrown obsessive compulsive scale for hypochondriasis hybocsm. Health anxiety selfassessment nevada center for behavior. Abstract objective to assess whether the number of somatic symptoms and health anxiety are independent predictors of future health care use after adjusting for confounders. Nevertheless, the results also suggest that the wi7 is not so psychometrically robust that it could be considered in any way diagnostic of clinical health anxiety. Pdf a selfrated measure of health anxiety should be sensitive across the full range of. Background health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of dsmiv hypochondriasis represents a cutoff where the health anxiety becomes clinically significant. Health anxiety 11 items and illness behavior 6 items.
Data of the eq5d descriptive system, the british and the german eq5d index and the eq visual analogue scale, the patient health questionnaire 15, the patient. Pilowsky, 1967 is a 14 item selfreport instrument frequently used by researchers and clinicians as a measure of health anxiety. Open access research health anxiety and risk of ischaemic. It is considered a classic scale for measuring health anxiety and hypochondriasis, and is widely used. This is the first study to validate the eq5d in patients with somatoform disorders. Somatization and health anxiety as predictors of health care. A 14item version of the whiteley index has been developed by pilowsky and has been usedin several studies in original or modified versions, in different. Several studies explored the structural validity of the wi obtaining contrary results concerning the number of factors as well as the item composition. Psychometric properties of the persian version of whiteley. Kings college london health anxiety questionnaires. Scores above 90th centile of the whiteley index defined health anxiety cases.
Developed by pilowsky11 in the 1960s, this widely used selfreport instrument is considered a classic screening tool for health anxiety and hypochondriasis. The whiteley index is an instrument to assess hypochondriasis. A high score is an indication that you could profit from talking this over with your doctor. Prior research has supported a sixitem short form of the whiteley index wi, a commonly used measure of health anxiety, among englishspeaking respondents. Patients assessed for somatic symptom disorder and illness anxiety disorder. The whiteley index 7 was devised in order to clarify the symptom clusters that are. Three of the most reliable and used selfreport measures of health anxiety are the health anxiety inventory hai, the illness attitude scales ias and the whiteley index wi. A study was conducted in order to test psychometric properties of the questionnaire and to obtain norms. A taxometric analysis of health anxiety psychological.
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