The global economic burden of health anxiety/hypochondriasis- a systematic review.

BACKGROUND: Recent studies have shown a lifetime prevalence of 5.7% for health anxiety/hypochondriasis resulting in increased healthcare service utilisation and disability as consequences. To the best of our knowledge, there has been no systematic review examining the global costs of hypochondriasis, encompassing both direct and indirect costs. Our objective was to synthesize the available evidence on the economic burden of health anxiety and hypochondriasis to identify research gaps and provide guidance and insights for policymakers and future research. METHODS: A systematic literature search was conducted using PubMed, Web of Science, PsycInfo, EconLit, IBSS and Google Scholar without any time limit, up until April 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in this search and the following article selection process. The included studies were systematically analysed and summarized using a predefined data extraction sheet. RESULTS: Of the 3044 articles identified; 10 publications met our inclusion criteria. The results displayed significant variance in the overall costs listed among the studies. The reported economic burden of hypochondriasis ranged from 857.19 to 21137.55 US$ per capita per year. Most of the investigated costs were direct costs, whereas the assessment of indirect costs was strongly underrepresented. CONCLUSION: This systematic review suggests that existing studies underestimate the costs of hypochondriasis due to missing information on indirect costs. Furthermore, there is no uniform data collection of the costs and definition of the disease, so that the few existing data are not comparable and difficult to evaluate. There is a need for standardised data collection and definition of hypochondriasis in future studies to identify major cost drivers as potential target point for interventions.

Understanding cyberchondria in pregnant women: longitudinal assessment of risk factors, triggers, and outcomes.

Pregnancy often triggers anxiety and health concerns in women, leading many to search for health information online. Excessive, compulsive, and repetitive online health research, accompanied by heightened anxiety, can result in cyberchondria. This study aimed to explore the risk factors, triggers, and outcomes of cyberchondria in pregnant women. A total of 149 participants completed an online questionnaire longitudinally across three stages of pregnancy: early (14-19 weeks), mid (24-29 weeks), and late pregnancy (34-39 weeks). The findings revealed that health anxiety and the cognitive component of anxiety sensitivity are risk factors for cyberchondria during pregnancy. Pregnancy concerns related to motherhood emerged as triggers for cyberchondria. While a connection between cyberchondria and fear of birth was observed, fear of birth did not appear to be a direct outcome of cyberchondria. These results highlight the importance of addressing health anxiety, cognitive anxiety sensitivity and motherhood concerns in prenatal care and support interventions. Understanding the factors contributing to cyberchondria in pregnant women can assist healthcare professionals in providing targeted support and resources to mitigate excessive online health searching behaviors and alleviate anxiety during pregnancy.

Cyberchondria among information technology professionals of Bhubaneswar by using cyberchondria severity scale (CSS-15).

Background: Internet can act as an excellent resource for gaining valuable health related information. However, excessive online research and investigation about health-related issues may impose a negative impact. The term cyberchondria is used to describe a clinical condition in which frequent internet searches for health-related information leads to exaggerated anxieties about physical well-being. Objectives: To determine the prevalence of cyberchondria and associated factors among the information technology professionals of Bhubaneswar in India. Materials and methods: A cross-sectional study was carried out among 243 software professionals in Bhubaneswar using a previously validated Cyberchondria Severity Scale (CSS-15) questionnaire. Descriptive statistics in terms of number, percentage, mean and standard deviation were presented. Independent t-test and one-way analysis of variance was applied to compare the cyberchondria score between two and more than two independent variables respectively. Results: From 243 individuals 130 (53.5%) were males and 113 (46.5%) were females with mean age 29.82±6.67 years. The prevalence of cyberchondria severity was found to be 46.5%. The mean cyberchondria score of all study subjects was 43.80±10.62. It was significantly higher among those who spend more than 1 hour in the internet during night, feel fear and anxiety in visiting the doctor or dentist, interested in gaining the health-related information from other resources and agreed that gaining health related information has increased after COVID-19 pandemic (p˂0.05). Conclusion: Cyberchondria is a growing issue with regard to mental health in developing countries and has the ability to cause anxiety and distress. Appropriate actions must be taken to prevent it on a societal level.

Evaluation of Relationship Between Cyberchondria and Obsessive Beliefs in Adults.

OBJECTIVE: The aim of this study was to evaluate the relationship between cyberchondria and obsessive beliefs and determine the potential risk of the former. METHODS: This was a cross-sectional study conducted with 777 individuals. The Cyberchondria Severity Scale and the Obsessive Beliefs Questionnaire were applied to the participants. Univariate and hierarchical multiple linear regression analyses were used to analyze the data. RESULTS: Of the study group 382 (49.2%) were male, 395 (50.8%), female. Their ages ranged from 18 to 63 years, with an average of 32.6 (± 9.6) years. Multiple linear regression analysis found that the frequency of internet use (several times a day; n = 670), using the internet as a source of health-related information (n = 320), using the internet to research a doctor before making and/or attending an appointment with same (n = 363), halting the use of prescribed medication based on information obtained on the internet (n = 177), and obsessive beliefs were factors linked to cyberchondria. Cyberchondria and obsessive beliefs were positively related and in the final model were found to be the strongest determinants of cyberchondria. CONCLUSION: Obsessive beliefs may be a potential risk factor for cyberchondria. Since cyberchondria affects people's health related behaviors, it is important to ensure the safety of health-related information on the internet. The results of this study may guide future ones that thoroughly investigate the factors associated with cyberchondria. More comprehensive studies are needed to reveal the relationship between cyberchondria and obsessive beliefs.

Latency to treatment seeking in patients with obsessive-compulsive disorder: Results from a large multicenter clinical sample.

This study aimed to identify the factors associated with a delay in treatment-seeking among patients with obsessive-compulsive disorder (OCD), a disabling neuropsychiatric disorder. To achieve this purpose, we conducted a cross-sectional study examining latency to treatment (LTT) and its associated correlates in 863 patients with OCD. We defined LTT as the time lag between the awareness of discomfort and/or impairment caused by symptoms and the beginning of OCD-specific treatment. To determine the socio-demographic and clinical characteristics associated with LTT, we built an interval-censored survival model to simultaneously assess the relationship between all variables, representing the best fit to our data format. The results of our study showed that approximately one-third of OCD patients sought treatment within two years of symptom awareness, one-third between two and nine years, and one-third after ten or more years. Median LTT was 4.0 years (mean = 7.96, SD = 9.54). Longer LTT was associated with older age, early onset of OCD symptoms, presence of contamination/cleaning symptoms and full-time employment. Shorter LTT was associated with the presence of aggression symptoms and comorbidity with hypochondriasis. The results of our study confirm the understanding that LTT in OCD is influenced by several interdependent variables - some of which are modifiable. Strategies for reducing LTT should focus on older patients, who work in a full-time job, and on individuals with early onset of OCD and contamination/cleaning symptoms.

The Portrait of Cyberchondria-A Cross-Sectional Online Study on Factors Related to Health Anxiety and Cyberchondria in Polish Population during SARS-CoV-2 Pandemic.

The SARS-CoV-2 pandemic has served as a magnifying glass for cyberchondria, while the internet emerged as one of the main sources of medical information and support. The core ambition of this study was to estimate the level of cyberchondria and describe the socio-demographic, clinical and pandemic-related factors affecting its severity amid the SARS-CoV-2 pandemic. A cross-sectional study was performed between 16 May 2020 and 29 December 2020 in Poland within a sample of 538 adult internet users. The online survey tool included a Polish adaptation of the Cyberchondria Severity Scale (CSS-PL) and the Short Health Anxiety Inventory (SHAI), complemented with a set of questions covering sociodemographic, clinical and pandemic-related factors. Participants were clustered according to severity of health anxiety and cyberchondria symptoms. The performed binary logistic regression indicated professional inactivity, having a chronic mental disorder and subjectively limited access to healthcare due to COVID-19 to be key determinants of severe health anxiety and cyberchondria. Cyberchondria might be a remarkable public health issue as large proportion of respondents from the analyzed sample population of internet users met the criteria for severe symptoms. Key determinants of intense cyberchondria corresponded with employment stability, mental resilience and accessibility of healthcare services, which could be greatly challenged amid the pandemic.

Cyberchondria in the age of COVID-19.

The global epidemic of (mis)information, spreading rapidly via social media platforms and other outlets, can be a risk factor for the development of anxiety disorders among vulnerable individuals. Cyberchondria can be a vulnerability factor for developing anxiety in a pandemic situation, particularly when the Internet is flooded with (mis)information. The aim of our study was to examine how cyberchondria is related to changes in levels of COVID-19 concern and safety behaviours among persons living in Croatia during the period in which the first COVID-19 case was identified and when the country recorded its first fatality. Repeated cross-sectional data collection was conducted during two waves over a period of three weeks (N1 = 888; N2 = 966). The first began on the day of the first confirmed case of COVID-19 in Croatia (February 24th, 2020) and the second wave began three weeks later, on the day the first COVID-19 fatality was recorded in Croatia (March 19th, 2020). Participants completed an online questionnaire regarding various COVID-19 concerns and safety behaviours aimed at disease prevention (information seeking, avoidance and hygiene) and a measure of cyberchondria (Short Cyberchondria Scale, SCS). We analysed whether changes to the epidemiological situation during the period between the two waves of data collection led to an increase in COVID-19 related behaviour directly and indirectly via an increase in COVID-19 concerns. The results indicated that, between the two waves of research, there was a pronounced increase in concerns regarding COVID-19 (b = 1.11, p < .001) as well as significant behavioural changes (b = 1.18-2.34, p < .001). Also, results demonstrated that cyberchondria plays a moderating role in these changes. In the first wave, persons with severe cyberchondria were already intensely concerned with safety behaviours. High cyberchondria and high levels of concern about the COVID-19 are associated with intense avoidance behaviours, R2 = .63, p < .001. A moderated partial mediation model was confirmed, in which the effect of the epidemiological situation was weaker for those with higher results on the SCS (as indicated by index of moderated mediation between -.10 and -.15, p < .05). As such, cyberchondria is a contributing factor to long-term anxiety and its impact during pandemic on the general mental health burden should therefore be further investigated.

Psychological Aspects and Eating Habits during COVID-19 Home Confinement: Results of EHLC-COVID-19 Italian Online Survey.

The COVID-19 pandemic has had a huge impact on the population with consequences on lifestyles. The aim of the study was to analyse the relationship between eating habits, mental and emotional mood. A survey was conducted online during social isolation, from 24 April to 18 May 2020, among the Italian population. A total of 602 interviewees were included in the data analysis. A high percentage of respondents experienced a depressed mood, anxious feelings, hypochondria and insomnia (61.3%, 70.4%, 46.2% and 52.2%). Almost half of the respondents felt anxious due to the fact of their eating habits, consumed comfort food and were inclined to increase food intake to feel better. Age was inversely related to dietary control (OR = 0.971, p = 0.005). Females were more anxious and disposed to comfort food than males (p < 0.001; p < 0.001). A strength of our study was represented by the fact that the survey was conducted quickly during the most critical period of the Italian epidemic lockdown. As the COVID-19 pandemic is still ongoing, our data need to be confirmed and investigated in the future with larger population studies.

Attitudes Associated with Hypochondria and Abnormal Behavior Towards Illness in Health Science Students.

The objective of this study was to evaluate attitudes towards the disease and its association with the presence of hypochondria in students of the health sciences area. The research was developed in 279 students in the health science area, with the application of Short Health Anxiety Inventory (SHAI) test and the Illness Attitude Scale (IAS) test was performed, and the descriptive, comparative and association statistical analyses were carried out. All students answered the previously mention surveys. Values above Cut-off ≥27 were obtained in the SHAI test was 6.8% (n = 19), and the percentage of students with values ≥50 Cut-off in the test of IAS was 15.7% (n = 44). IAS subtests involving an increase in the SHAI value are IAS for the disease (W), hypochondria beliefs (HB), body concerns (BP), treatment experiences (TE), and effect of symptoms (ES) with regression values of S = 3.9 with a square R adjusted to 64.9%. Therefore, according to the surveys used, a considerable sample of students showed abnormal behaviors towards the disease associated with the hypochondria, so it is important to continue monitoring students to reduce these factors.

Exploring cyberchondria and worry about health among individuals with no diagnosed medical condition.

OBJECTIVE: To study the phenomenon of cyberchondria and related worries about health among individuals without any diagnosed medical condition. . METHODS: The survey-based, cross-sectional study was conducted from January to July 2018 in the twin cities of Rawalpindi and Islamabad, Pakistan, and comprised graduates of either gender aged at least 35 years with access to internet and means of use, and with no current diagnosed medical condition. The self-reporting Cyberchondria Severity Scale was used data-collection along with a demographic sheet. SPSS 21 was used for data analysis. RESULTS: Of the 150 subjects, 90(60%) were men and 60(40%) were women. A total of 40(26.6%) subjects had low level of cyberchondria, while 35(23.3%) experienced a higher level of it. Mean scores of men on total CSS were slightly higher than those of women (p>0.05). Men also scored higher on compulsion, distress, excessiveness and reassurance subsclaes (p>0.05 each), whereas women scored slightly higherthan men on 'mistrust of medical profession' subscale (p>0.05). No significant gender differences werefound on cyberchondria and its subscales (p>0.05 each). CONCLUSIONS: Doctors / health professionals may benefit from the findings by focussing on their patients who use internet as a major source of medical information.

Prevalence of hypochondriac symptoms among health science students in China: A systematic review and meta-analysis.

BACKGROUND: Hypochondriac symptoms are commonly reported in health science students. With their incomplete medical knowledge, they may compare their own bodily symptoms with disease symptoms during the process of learning, which can lead to mental distress and the need for repeated medical reassurance. OBJECTIVE: To estimate the prevalence of hypochondriac symptoms in Chinese health science students. METHODS: A systematic literature search was conducted on PubMed, Web of Science, Embase, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Data on July 1, 2018. Additionally, the references of the retrieved papers were searched. Cross-sectional studies published in either English or Chinese that reported the prevalence of hypochondriac symptoms in health science students were included. The selection process was executed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis, and study quality was assessed with the checklist recommended by the Agency for Healthcare Research and Quality for cross-sectional studies. A random-effects model according to the DerSimonian-Laird method was used to calculate the pooled prevalence. RESULTS: Seven cross-sectional studies involving 6,217 Chinese health science students were included. The pooled prevalence of hypochondriac symptoms among health science students was 28.0% (95% CI = 19.0%-38.0%). The symptoms were a little more common in females (30.0%, 95% CI = 19.0%-42.0%) than in males (29.0%, 95% CI = 16.0%-42.0%), but the difference was not significant. No significant differences were found between participants grouped by study year. Only three studies explored the coping styles of students with hypochondriasis, and these revealed a high tendency toward help-seeking behaviors. CONCLUSION: Our systematic review and meta-analysis showed a high prevalence of hypochondriac symptoms among health science students, indicating that it is a noteworthy phenomenon. We suggest that counseling and other support services are necessary for health science students.

Increase in the prevalence of health anxiety in medical clinics: Possible cyberchondria.

BACKGROUND: Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety. AIM: We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker. METHOD: Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King's Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006-2008 period and six in the 2008-2010 period. As a consequence, more data were collected on the second occasion. RESULTS: There was an increase in the prevalence of health anxiety from 14.9% in 2006-2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008-2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones. CONCLUSION: The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily.

Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder.

Checking behavior (CB) occurs in a variety of disorders such as obsessive-compulsive (OCD), body dysmorphic (BDD), illness anxiety (IA), and panic disorder (PD), as well as anorexia (AN) and bulimia nervosa (BN). Etiological models of these disorders - with the exception of those for PD - postulate that CB mainly occurs in situations characterized by negative affect and serves to regulate it. We aimed to test these assumptions: N = 386 individuals with a self-reported diagnosis of one of the disorders rated their affect at baseline, directly before a remembered CB episode, during, immediately afterwards, and 15 and 60 minutes afterwards, and rated their endorsement of different functions of CB. The results show that transdiagnostically negative affect is significantly higher before CB compared to baseline, and is significantly reduced from before CB to all post-CB assessments. Reduction of negative affect and Attainment of certainty were the sole functions predicting the affective course during CB, and most prominently reported transdiagnostically. Assumptions of the etiological models were confirmed, suggesting that exposure and ritual prevention should be examined across disorders. As attainment of certainty seems to be predictive for the course of CB, this might be targeted in cognitive interventions.

Predictors and consequences of health anxiety symptoms: a novel twin modeling study.

OBJECTIVE: The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population. METHOD: Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates. RESULTS: Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001). CONCLUSION: Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.

Hipocondría en la infancia y adolescencia. Revisión bibliográfica / Hypochondriasis in children and adolescents. A review of the literature

El trastorno hipocondríaco se describe como la preocupación excesiva por padecer una enfermedad. Como ocurre con otros trastornos psiquiátricos, la ausencia de pruebas complementarias analíticas o de imagen para el diagnóstico complica su estudio, y el debate acerca de sus características es constante. En el caso de niños y adolescentes, los estudios son aún más escasos, dificultando la tarea de psiquiatras y pediatras cuando se encuentran ante sintomatología compatible con diagnóstico de hipocondría. Por ello, hemos querido realizar una revisión de las publicaciones más recientes en relación con este trastorno en población infantojuvenil. Tras explorar los artículos publicados en los últimos años, y a pesar de la limitación de estudios en esta población específica, es de relieve la importancia de un abordaje multidisciplinar. Una vez descartadas otras patologías, el objetivo principal es recuperar y mantener la funcionalidad propia de la edad, implicando al grupo primario de apoyo

Hypochondriasis is a condition in which a person is inordinately worried about having a serious illness. As for many other psychiatric disorders, the lack of an objective method for its diagnosis hampers the investigation of this disease, and turns its features into subject of controversy and continuous discussion. These limitations become more relevant when children and adolescents are affected. This, together with the low number of published works covering hypochondriasis in these populations, poses extreme difficulties to pediatricians and child psychiatrists. Here, the most recent studies covering the causes, diagnosis, symptoms, treatment and prevention of hypochondriasis in children and adolescents are reviewed. The systematic revision of the literature suggests that an accurate diagnosis and management requires a multidisciplinary approach. After discarding other pathologies, appropriate managing should involve the main support group and focus in the recovery of the functionality according to the age of the patient

Perfil psicosocial y sobrevaloracion en lumbalgias crónicas. importancia de las pruebas de biomecanica y valoración psiquiátrica / Psychosocial profile and overvaluation in chronic back pain. importance of biomechanic test and psychiatric evaluation

Introducción: La detección de la simulación se fundamenta en distintas fuentes de información (Exploración física, Pruebas médicas, Evaluación psiquiátrica, Pruebas biomecánicas). A mayor inconsistencias más posibilidades de sobrevaloración. Objetivos: Demostrar que los resultados inconsistentes en pruebas biomecánicas y Test de personalidad (SIMS, PAI, MMPI-2, MCMI-III), se corresponden con un perfil de personalidad característico (somatizador, histriónico, hipocondríaco). Material y Métodos: SUJETOS: 70 pacientes valorados en MAZ por lumbalgia crónica. METODO: determinación de fiabilidad en Valoración Biomecánica (Ned Lumbal) + Entrevista Psiquiátrica Estructurada + fiabilidad en Test de personalidad (MMPI-2, MCMI-III, PAI, SIMS). Resultados y Conclusiones:1) Los pacientes poco fiables muestran significativamente más rasgos de personalidad somatizadora, hipocondríaca e histriónica. 2) no diferencias significativas en pacientes con trastornos adaptativos ansioso-depresivos. 3) alta correlación entre pruebas biomecánicas y de personalidad. Conclusiones: Confirmamos un mayor perfil de personalidad premorbida (somatizador, hipocondríaco e histriónico) y sobrevaloración en lumbalgia crónicas empleando pruebas biomecánicas/psiquiátricas (AU)

Introduction: The detection of the simulation is based on different information sources (physical examination, medical tests, psychiatric evaluation, biomechanical tests). To major inconsistencies more possibilities of overvaluation. Objective:To demonstrate that inconsistent results in Biomechanical tests (Ned-Lumbar) and Personality tests (SIMS, PAI, MMPI-2, MCMI-III) correspond to a characteristic personality profile (somatization, histrionic, hypochondriac). Material and Method: SUBJECTS: 70 patients with chronic back pain valued by MAZ. METHOD: To determinate the reliability in Biomechanical Assessment (Ned Lumbal) + Structured Psychiatric Interview + Personality test (MMPI-2, MCMI-III, PAI, SIMS). Results: 1) Patients with few reliability have a personality profile of somatization, hypochondriac or histrionic statistically significant. 2) No significant differences in patients with adaptative anxiety-depressive disorders. 3) High correlation between biomechanical and personality test. Conclusions:It is confirmed a mayor profile of premorbid personality (somatization, hypochondriac and histrionic) and an overvaluation in chronic back pain using biomechanical and psychiatric tests (AU)

Hypochondriasis Differs From Panic Disorder and Social Phobia: Specific Processes Identified Within Patient Groups.

Studies of the comorbidity of hypochondriasis have indicated high rates of cooccurrence with other anxiety disorders. In this study, the contrast among hypochondriasis, panic disorder, and social phobia was investigated using specific processes drawing on cognitive-perceptual models of hypochondriasis. Affective, behavioral, cognitive, and perceptual processes specific to hypochondriasis were assessed with 130 diagnosed participants based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (66 with hypochondriasis, 32 with panic disorder, and 32 with social phobia). All processes specific to hypochondriasis were more intense for patients with hypochondriasis in contrast to those with panic disorder or social phobia (0.61 < d < 2.67). No differences were found between those with hypochondriasis with comorbid disorders and those without comorbid disorders. Perceptual processes were shown to best discriminate between patients with hypochondriasis and those with panic disorder.

Impact of personality status on the outcomes and cost of cognitive-behavioural therapy for health anxiety.

BACKGROUND: Health anxiety, hypochondriasis and personality disturbance commonly coexist. The impact of personality status was assessed in a secondary analysis of a randomised controlled trial (RCT). AIMS: To test the impact of personality status using ICD-11 criteria on the clinical and cost outcomes of treatment with cognitive-behavioural therapy for health anxiety (CBT-HA) and standard care over 2 years. METHOD: Personality dysfunction was assessed at baseline in 444 patients before randomisation and independent assessment of costs and outcomes made on four occasions over 2 years. RESULTS: In total, 381 patients (86%) had some personality dysfunction with 184 (41%) satisfying the ICD criteria for personality disorder. Those with no personality dysfunction showed no treatment differences (P = 0.90) and worse social function with CBT-HA compared with standard care (P<0.03) whereas all other personality groups showed greater improvement with CBT-HA maintained over 2 years (P<0.001). Less benefit was shown in those with more severe personality disorder (P<0.05). Costs were less with CBT-HA except for non-significant greater differences in those with moderate or severe personality disorder. CONCLUSIONS: The results contradict the hypothesis that personality disorder impairs response to CBT in health anxiety in both the short and medium term.

Determinants and frequency of irritable bowel syndrome in a German sample.

BACKGROUND: To date there is no study that has estimated the prevalence of irritable bowel syndrome (IBS) in Germany according to the current Rome III criteria. The aim of the present study was to investigate the prevalence of IBS in a non-clinical German sample. Furthermore, we investigated the association of IBS with socio-demographic and psychological risk factors. METHODS: Baseline data from a prospective cohort study were analysed, including the IBS Module of the Rome III Diagnostic Questionnaires and validated psychometric scales including the Patient Health Questionnaire-15 (PHQ-15), the Big Five Inventory (BFI), the Perceived Stress Questionnaire (PSQ-5), and the Whiteley-Index (WI-7). The study population was compared to the German general population to appraise its representativeness. Multivariate logistic regression analyses were performed to identify possible risk factors associated with IBS. RESULTS: Between January 2011 and September 2012, 2419 persons participated (female 54.0 %, mean age 37.4 ±â€Š14.9 years). According to the Rome III criteria, 401 participants (16.6 %) suffered from IBS. Five predictors were independently associated with IBS: previous traveller's diarrhoea infection (OR = 1.76; 95 % CI = 1.34 to 2.31), higher somatic symptom burden (OR = 1.15; 95 % CI = 1.07 to 1.23), increased level of hypochondriasis (OR = 2.04; 95 % CI = 1.54 to 2.70), increased vulnerability to diarrhoea under stress (OR = 3.88; 95 % CI = 3.21 to 4.68) and perceived stress (OR = 1.43; 95 % CI = 1.04 to 1.99). CONCLUSIONS: Our analyses yielded a relatively high IBS prevalence estimate, compared to studies published more than ten years ago. This might partially be explained by the fact that the time criterion of the Rome III criteria (at least 3 days/month in last 3 months) is more inclusive compared to the time criterion of the Rome II criteria (at least 12 weeks, which need not be consecutive, in the preceding 12 months).