New Directions in Health Anxiety: Introduction to the Special Issue
Abramowitz, Jonathan S., Journal of Cognitive Psychotherapy
Health concerns are universal-why shouldn't they be? Good health is vital to our survival, and threats to physical well-being are virtuously ubiquitous. We can hardly turn on the evening news or peruse the cable TV lineup without finding accounts of new disease epidemics and information about the latest food or product recalls. Health concern can also be highly adaptive. If we were not at least sometimes concerned about our health, we would probably not take good enough care of ourselves to survive as a species. Empirical research bears this out. In one study, 61% of college students reported intrusive thoughts about their own health (Freeston et al., 1994). Among most people, these health worries and intrusions are short lived and either dismissed as illogical or simply replaced by other more pressing, mundane thoughts.
Clinically severe levels of health anxiety, however, are another matter. Excessive and inappropriate health-related fears and preoccupation can interfere with functioning and cause undue distress. To resolve this distress, individuals might seek out information about the feared illness, compare their apparent "symptoms" to descriptions of serious illnesses (e.g., on the Internet), and seek unnecessary medical evaluations. As we are learning, these types of behaviors are not rare by any means (Taylor & Asmundson, 2004). Mental health professionals have traditionally used the label hypochondriasis to refer to what contemporary researchers (myself included) identify as severe health anxiety. This is likely because hypochondriasis is the psychiatric disorder that most closely corresponds to the psychological and behavioral experiences observed among people with this set of difficulties.
The main feature of hypochondriasis as defined in the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV-TR; American Psychiatric Association, 2000) is a preoccupation with fears of having-or the idea that one has-a serious medical condition such as a chronic, life-threatening (or life-altering) sickness. This belief, or "disease conviction," which is based on a misinterpretation of bodily sensations, persists in spite of appropriate medical evaluation and reassurance of good health. That is, a thorough medical evaluation does not identify a medical condition that can account for the individual's health-related concerns. Moreover, it causes clinically significant personal distress or interferes with important areas of functioning, such as social, occupational, and family life.
For people with this disorder, the health-related preoccupation might concern specific bodily functions, such as breathing or urination; slight physical perturbations, such as an occasional cough; or vague and ambiguous physical sensations, such as "a bad prostate" or "weak spine." These individuals are often highly concerned with the cause, meaning, and authenticity of the feared bodily sensations and disease state. In some instances, they describe a preoccupation with a specific organ (e.g., stomach, brain) or disease (e.g., cancer). Despite these perceptions of illness, repeated medical tests for such complaints consistently turn up negative (i.e., no organic basis) yet provide only short-lived reassurance, if any at all.
Whereas some individuals with hypochondriasis may recognize that their health-related fears and preoccupations are excessive, many with this do not. The diagnostic specifier with poor insight is reserved for those with hypochondriasis who, for most of the time during the current episode of symptoms, do not realize that their concerns about serious illnesses are unreasonable. Nevertheless, despite their sometimes all-consuming health worries, people with hypochondriasis generally have no better health habits (e.g., diet, exercise, smoking, seat-belt use) than those without this disorder.
Although it is perplexing to me that such universal (and potentially very distressing) phenomena as hypochondriasis and other forms of health anxiety have only recently begun to receive the research attention they deserve, the prospect of acquiring new information and adding to the growing literature on the clinical presentation of this continuum of problems is very exciting. …