Assessing Older Adults' Obsessive-Compulsive Disorder Symptoms: Psychometric Characteristics of the Obsessive Compulsive Inventory-Revised.

The lack of Obsessive-Compulsive disorder (OCD) symptom measures validated for use with older adults has hindered research and treatment development for the age group. We evaluated the Obsessive-Compulsive Inventory-Revised (OCI-R; Foa et al., 2002) with participants aged 65 and older (N = 180) to determine if the measure was an effective tool for evaluating obsessional symptoms. Participants completed the OCI-R and a comprehensive assessment battery up to four times over approximately 18 months. Results supported the well-replicated latent structure of the OCI-R (i.e., Washing, Checking, Ordering, Obsessing, Hoarding, and Neutralizing.). OCI-R total score was robustly associated with OCD symptoms assessed 18 months later by clinical interview, while scores on self-report measures of worry, general anxiety, and depression were not. Results indicate the OCI-R is an effective OCD symptom measure for older adults, although replication with additional older adult samples is needed.

Effects of continuity of care and patient dispositional factors on the physician-patient relationship.

BACKGROUND: We developed a questionnaire to examine the influence of physician and patient variables on the quality of the physician-patient relationship. METHODS: More than 300 family medicine patients completed self-report measures of the physician-patient relationship and variables likely to influence it. RESULTS: The quality of relationship was related to continuity of physician care (having a primary physician, duration of that relationship, and frequency of visits) and to patient dispositional variables (neuroticism, positive and negative affectivity) but not to demographic variables. The regression model included having a primary physician, duration of relationship with that physician, and positive affectivity. Relationship quality was, in turn, associated with outcomes (adherence to care, treatment response, satisfaction with care, and commitment to physician). CONCLUSIONS: The quality of physician-patient relationship is influenced by physician continuity and patient dispositional variables. Better understanding of these may contribute to the therapeutic potential of this important relationship.

Anxiety as a context for understanding associations between hypochondriasis, obsessive-compulsive, and panic attack symptoms.

In the context of the integrative model of anxiety and depression, we examined whether the essential problem of hypochondriasis is one of anxiety. When analyzed, data from a large nonclinical sample corresponded to the integrative model's characterization of anxiety as composed of both broad, shared and specific, unique symptom factors. The unique hypochondriasis, obsessive-compulsive, and panic attack symptom factors all had correlational patterns expected of anxiety with the shared, broad factors of negative emotionality and positive emotionality. A confirmatory factor analysis showed a higher-order, bifactor model was the best fit to our data; the shared and the unique hypochondriasis and anxiety symptom factors both contributed substantial variance. This study provides refinements to an empirically based taxonomy and clarifies what hypochondriasis is and, importantly, what it is not.

A taxometric study of hypochondriasis symptoms.

Hypochondriasis has been conceptualized as both a distinct category that is characterized by a disabling illness preoccupation and as a continuum of health concerns. Empirical support for one of these theoretical models will clarify inconsistent assessment approaches and study designs that have impeded theory and research. To facilitate progress, taxometric analyses were conducted to determine whether hypochondriasis is best understood as a discrete category, consistent with the DSM, or as a dimensional entity, consistent with prevailing opinion and most self-report measures. Data from a large undergraduate sample that completed 3 hypochondriasis symptom measures were factor analyzed. The 4 factor analytically derived symptom indicators were then used in these taxometric analyses. Consistent with our hypotheses and existing theory, results supported a dimensional structure for hypochondriasis. Implications for the conceptualization of hypochondriasis and directions for future study are discussed.

Hypochondriacal symptoms associated with a less therapeutic physician-patient relationship.

The purpose of this study was to examine the association between hypochondriacal symptoms and the physician-patient relationship. Family medicine patients (n = 310) completed self-report measures of hypochondriacal symptoms, quality of physician-patient relationship, and variables likely to influence that relationship. These variables included physician relationship factors, such as duration of relationship and frequency of visits, as well as patient characteristics, such as neuroticism and positive and negative affectivity. Hypochondriacal symptoms were negatively correlated (r = -.24) with the quality of physician-patient relationship. In addition to hypochondriacal symptoms, the regression model included having a primary physician, length of relationship with that physician, frequency of physician visits, and the level of positive affectivity in the patient. Hypochondriacal symptoms appear to be associated with a less therapeutic physician-patient relationship. Physicians must recognize symptoms of this kind in order to properly address the relationship needs of their patients.

A dimensional model of psychopathology among homeless adolescents: suicidality, internalizing, and externalizing disorders.

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model.

Panic and phobic anxiety: associations among neuroticism, physiological hyperarousal, anxiety sensitivity, and three phobias.

A dimensional and psychometrically informed taxonomy of anxiety is emerging, but the specific and nonspecific dimensions of panic and phobic anxiety require greater clarification. In this study, confirmatory factor analyses of data from a sample of 438 college students were used to validate a model of panic and phobic anxiety with six content factors; multiple scales from self-report measures were indicators of each model component. The model included a nonspecific component of (1) neuroticism and two specific components of panic attack, (2) physiological hyperarousal, and (3) anxiety sensitivity. The model also included three phobia components of (4) classically defined agoraphobia, (5) social phobia, and (6) blood-injection phobia. In these data, agoraphobia correlated more strongly with both the social phobia and blood phobia components than with either the physiological hyperarousal or the anxiety sensitivity components. These findings suggest that the association between panic attacks and agoraphobia warrants greater attention.

Assessment of the hypochondriasis domain: the multidimensional inventory of hypochondriacal traits (MIHT).

Although hypochondriasis is associated with the costly use of unnecessary medical resources, this mental health problem remains largely neglected. A lack of clear conceptual models and valid measures has impeded accurate assessment and hindered progress. The Multidimensional Inventory of Hypochondriacal Traits (MIHT) addresses these deficiencies with scales that correspond to a 4-factor model. The MIHT was built with construct validity as a guiding principle and began with an item pool that broadly assessed dimensions identified in the literature. The items were administered to large samples; factor analyses of the responses led to item pool revisions and scale refinements. Multiple studies validated the final MIHT scales and 4-factor model; these findings suggest that the MIHT will contribute to theory and research.

Relationship between hypochondriacal concerns and personality dimensions and traits in a military population.

Our aim was to examine the relationship between personality dimensions and hypochondriacal concerns and somatic symptoms in a military population. The Schedule of Nonadaptive and Adaptive Personality along with measures of hypochondriacal concerns and somatic symptoms were administered to 602 military veterans who had been on active duty during the 1991 Gulf War. Factor analyses identified six separable dimensions-two of hypochondriacal concerns, two of somatic symptoms, and two of possible mechanisms of symptom generation-for study. Multiple regression models determined the proportion of variation in these measures of somatic distress explained by personality scales. Personality measures explained between 26% and 38% of the variance in hypochondriacal concerns and somatic symptoms, and Negative Temperament accounted for most of this. Moderately strong positive correlations were observed between trait scales Mistrust, Low Self-Esteem, and Eccentric Perceptions and the various measures of somatic distress. Thus, when Negative Temperament was taken into account, few significant correlations between personality measures and hypochondriacal concerns or somatic symptoms remained. Negative temperament or neuroticism is strongly associated with hypochondriacal concerns. Important features of hypochondriasis and somatic distress appear to lie within the domain of personality. It remains for future research to show whether negative temperament is a vulnerability factor for hypochondriasis or hypochondriasis is itself a personality disorder.

Test of an interpersonal model of hypochondriasis.

OBJECTIVE: The aim of this study was to test the interpersonal model of hypochondriasis proposed by Stuart and Noyes. According to this model, hypochondriasis is associated with insecure attachment that in adults gives rise to abnormal care-seeking behavior. Such behavior is associated with interpersonal difficulties and strained patient-physician relationships. METHODS: One hundred sixty-two patients attending a general medicine clinic were interviewed and asked to complete self-report measures. Instruments included the Whiteley Index of Hypochondriasis, Somatic Symptom Inventory, Relationship Scales Questionnaire, Inventory of Interpersonal Problems, NEO Five-Factor Index, and measures of physician-patient interaction. The Structured Diagnostic Interview for DSM-III-R Hypochondriasis was also administered. RESULTS: Hypochondriacal and somatic symptoms were positively correlated with all of the insecure attachment styles, especially the fearful style. These same symptoms were positively correlated with self-reported interpersonal problems and negatively correlated with patient ratings of satisfaction with, and reassurance from, medical care. Hypochondriacal and somatic symptoms were also positively correlated with neuroticism. CONCLUSIONS: The findings indicate that hypochondriacal patients are insecurely attached and have interpersonal problems that extend to and include the patient-physician relationship. These data support the proposed interpersonal model of hypochondriasis.

Hypochondriasis and fear of death.

Although fear of death has been linked to hypochondriasis, the relationship of this fear to the disorder has received little study. To address this deficiency, we administered a fear of death scale along with measures of hypochondriasis, including the Whiteley Index and Somatic Symptom Inventory, to 162 general medical outpatients. Partial correlations, controlling for age, between the fear of death scale and both the Whiteley Index and Somatic Symptom Inventory were strongly positive. A factor analysis of the fear of death scale yielded three dimensions-fear of dying, loss of meaning, and fear of separation-that were also highly correlated with hypochondriasis. Fear of death and hypochondriasis showed comparable relationships to age and gender as well as to personality dimensions measured by the NEO Five-Factor Inventory. Fear of death appears to be an integral part of hypochondriasis. Its presence lends support to three models of hypochondriasis-the perceptual, existential, and interpersonal-that correspond to the dimensions of fear of death.

Childhood antecedents of hypochondriasis.

According to the interpersonal model of hypochondriasis, early environmental adversity may give rise to attachment insecurity that finds adult expression in care-seeking behavior. To identify antecedents of this disturbance, we interviewed general medicine patients and obtained from them self-reports of traumatic events, adverse circumstances, and symptoms experienced in childhood. Patients who met DSM-III-R criteria for hypochondriasis more often reported traumatic events and circumstances, including serious illness or injury. Among all patients, the level of hypochondriacal symptoms in adulthood was correlated with poor health, hypochondriacal worry, and separation anxiety in childhood. These findings are consistent with a growing literature that links childhood adversity to adult hypochondriasis; they support the interpersonal model.