Hypochondriacs' estimation of negative outcomes: domain-specificity and responsiveness to reassuring and alarming information.

Based on hypochondriacal patients' tendency to overestimate the seriousness of bodily sensations and health risks [Barsky, A. J., Wyshak, G. & Klerman, G. L. (1990). The Somatosensory Amplification Scale and its relationship to hypochondriasis. Journal of Psychiatric Research, 24, 323-334; Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105-117], we investigated whether hypochondriacal individuals (n = 20) are inclined to report higher estimates of negative outcomes than healthy controls (n = 20) when interpreting ambiguous health-related and nonhealth-related events. In addition, we explored the influence of additional reassuring and alarming information on hypochondriacs' estimates of negative outcomes. Following the cognitive-behavioural model of hypochondriasis [Warwick, H. M. C. & Salkovskis, P. M. (1989). Hypochondriasis. In J. Scott, J. M. G. Williams & A. T. Beck (Eds.), Cognitive therapy in clinical practice: an illustrative casebook. (pp. 78-102). London: Routledge] we hypothesized that hypochondriacal individuals would be more responsive to alarming information and less responsive to reassuring information than healthy controls. Yet, hypochondriacs were neither found to be immune for reassuring information, nor to be hypersensitive to alarming information. Meanwhile, irrespective of the additional alarming or reassuring information, hypochondriacs clearly showed a domain-specific bias towards higher estimates of negative outcomes in ambiguous health-related situations.

Hypochondriasis: the role of fear-confirming reasoning.

We investigated whether hypochondriacal patients are prone to selectively search for danger-confirming information when asked to judge the validity of conditional rules in the context of general and health threats. Therefore, hypochodtriacal patients (n = 27) and a healthy control group (n = 27) were presented with modified Wason Selection Tasks (WSTs) pertaining to general and health threats. The WSTs contained safety rules (If P then safe) and danger rules (If P then danger). Subjects adopted a verificationistic strategy in case of danger rules and tended to look for falsifications in case of safety rules. This danger-confirming reasoning pattern was similar for both types of contexts and not particularly pronounced in hypochondriacal persons. These findings argue against the idea that such a reasoning pattern directly causes hypochondriasis. Yet, in the presence of anxiogenic (hypochondriasis related) convictions such danger-confirming reasoning pattern logically serves to maintain or even enhance hypochondriacal complaints.

Tactual sensitivity in hypochondriasis.

BACKGROUND: In his article on amplification, somatization and somatoform disorders Barsky [Psychosomatics 1992; 33:28-34] pointed out the importance of studying the perception and processing of somatic and visceral symptoms. Subsequently, it was demonstrated that hypochondriacal patients are not more accurately aware of cardiac activity than a group of non-hypochondriacal patients. Authors concluded that hypochondriacal somatic complaints do not result from an unusually fine discriminative ability to detect normal physiological sensations that non-hypochondriacal patients are unable to perceive. The aim of the present study was to investigate tactual sensitivity to non-painful stimuli in hypochondriacal patients and healthy subjects. METHODS: Twenty-seven outpatients with DSM-III-R hypochondriasis and 27 healthy control subjects were compared. In all subjects the two-point discrimination threshold was measured, as well as subjective sensitivity to harmless bodily sensations as measured by the Somatosensory Amplification Scale. RESULTS: It was found that hypochondriacal patients reported more distress and discomfort with benign bodily sensations. The two-point discrimination threshold of hypochondriacal patients was not significantly lower in patients as compared to controls. CONCLUSIONS: Hypochondriacal subjects considered themselves more sensitive to benign bodily sensations without being better able to discriminate between two tactual bodily signals. These findings of the present study correspond quite closely to those reported earlier.

Symptom reporting and interoceptive attention in panic patients.

The present study investigated whether bodily sensations reported by panic-disorder patients can be due to interoceptive attention. The attention of two groups, one of 16 panic patients and one of 17 normal control subjects was manipulated towards and away from bodily sensations. After each manipulation they had to report the sensations experienced. As expected, panic patients did report more sensations than controls in a baseline condition but against the hypothesis that a ceiling effect would occur in the panic group, both panic patients and controls reported more sensations after being instructed to attend to them. However, when their attention was diverted, panic patients showed a decrease in sensations greater than control subjects showed. The findings suggest that interoceptive attention may partly account for the sensations reported by panic patients.

Hypochondriasis and symptom reporting--the effect of attention versus distraction.

BACKGROUND: This study examined symptom perception in hypochondriacal patients without physical stimulation. METHODS: Seventeen outpatients with DSM-III-R hypochondriasis and 16 healthy control subjects were compared. All subjects were asked to report perceived sensations in three conditions: attention, distraction and control. RESULTS: It was found that hypochondriacal subjects showed remarkably higher levels of symptom reporting than healthy subjects in all three conditions. In spite of excessive attention to bodily sensations in a control condition, attention instructions still added significantly to symptom reporting in hypochondriacal patients. The effect of distraction was not significant in either of the groups. Furthermore, group differences in symptom reporting appeared to be related to preoccupation with bodily symptoms rather than to general anxiety level as measured by the STAI. CONCLUSIONS: Hypochondriacal patients report more bodily sensations than healthy controls when no instructions are given. In addition, focussing on bodily sensations seems to cause a significant overall increase of perceived symptoms in hypochondriacal patients, whereas in healthy subjects there is a trend towards an increase in symptom reporting.

A preliminary study of externally and self-ordered task performance in schizophrenia.

Frontal lobe dysfunctions are assumed to be involved in the cognitive problems of schizophrenia. The inability to plan or organize behavior, however, may be the result of an inability to process information (i.e., attention disorder) as well as of an incapacity of information processing (i.e., overstimulation). Wiegersma et al. (1990) described impaired performance in frontal lobe patients on self-ordered tasks (Randomization Span and Sequential Pointing span) but intact performance on externally ordered tasks (Digit Span and Missing Item scan). These four tasks were used in the present study in which ten schizophrenic patients and ten matched controls participated. The schizophrenic patients exhibited significant impairments in the self-ordered as well as in the externally ordered tasks. It was concluded that the impairment of schizophrenic patients may be caused by overstimulation rather than by attention disorders.