Recent Advances in the Understanding and Treatment of Health Anxiety.

PURPOSE OF REVIEW: To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. RECENT FINDINGS: Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.

Personality and coronary heart disease.

Three MMPI variables--HsK + Hy, neuroticism, and somatic complaints--were positively associated with incidence of uncomplicated angina pectoris and not significantly associated with incidence of myocardial infarction and coronary death in a 10-year cohort study of 2003 employed middle-aged men. All three were negatively associated with risk of coronary death after the diagnosis of uncomplicated angina had been established. These results support the hypothesis that tendencies to report somatic complaints or to experience negative, distressing emotions chronically are not related to incidence of coronary heart disease but are associated with incidence of a relative benign, nonatherosclerotic condition that is similar clinically to angina pectoris. Also, HsK + Hy and somatic complaints were positively associated with risk of coronary death in men who had survived an initial myocardial infarction. This result does not indicate an association with coronary hearth disease itself because all of these men already had coronary heart disease. This result may indicate that the tendency to report somatic complaints is related to increased susceptibility to acute emotional stressors that can trigger arrhythmias in an ischemic myocardium.