Hypochondriasis, now often designated as health anxiety, is important in terms of prevalence, levels of suffering, and health services cost in adults. Whereas the DSM-IV-TR suggests that the condition primarily begins in adulthood, retrospective reports point to a possible origin in childhood with onset as early as preschool age. However, little research has addressed health anxiety in children. In the present study we explored parental-reported health anxiety symptoms (HAS) and their association with physical and mental health in a population-based sample of 5- to 7-year-old children.
Methods
Parents of 1323 children (49.7% boys), recruited from the birth cohort: Copenhagen Child Cohort CCC 2000, completed questionnaires regarding their child's HAS, and physical and mental health. Associations were examined using multiple logistic regression analyses adjusted for concurrent chronic physical disease.
Results
HAS were present in 17.6% and present ‘a lot’ (categorized as considerable HAS) in 2.4% of the children. Children with considerable HAS demonstrated more physical health problems and internalizing disorders than children with no or non-considerable HAS, but in the majority (71.9%) no associated chronic physical disease or other mental disorder was reported. In a subsample of children with functional somatic symptoms (FSS), impairing FSS were more likely among children who reported HAS.
Health anxiety refers to excessive concerns regarding ones health. The core cognitive feature is disease conviction, which may motivate maladaptive coping behaviors with reassurance-seeking and recurrent checking for, e.g., bodily changes.1 Severe health anxiety in adults, most often classified as hypochondriasis or hypochondriacal disorder in the current DSM-IV-TR and ICD-10,2 and 3 has been shown to have significant negative impacts on well-being, social and occupational functioning, and health care resource utilization.4, 5 and 6
Intergenerational transmission of health beliefs may be an important mechanism for the development of health anxiety.7 and 8 Besides the genetic concordance between parent and child, there is increasing evidence that the ways in which parents respond to children's health complaints (reinforcement) and the ways in which they cope with their own illnesses (modeling) influence their children's health attitudes and behavior,9, 10 and 11 and those later in life.12 However, studies dealing directly with the presence of excessive concern or preoccupation with symptoms and illness in children and adolescents are very few.13 and 14 To our knowledge, only two population-based studies, one on schoolage children and one on adolescents, have been performed. Both demonstrated fears, beliefs, and attitudes in youth with similarities to cognitive and behavioral features of health anxiety in adults.15 and 16 The possibility that health anxiety has its roots in childhood is further supported by retrospective reports of adult patients with severe health anxiety. Though prone to recall bias, these reveal that the level of health-related worries in adulthood is positively correlated with similar worries in childhood.17
The research to date in this area leaves a number of questions unanswered. We need to know more about the prevalence, impact, associated factors, and course of health anxiety symptoms (HAS) early in life in order to understand the development of severe health anxiety, and to provide new avenues for prevention and treatment.
The present study is mainly exploratory in order to contribute to the sparse descriptive data on health-related anxiety, especially in young children. As onset of health anxiety in retrospective reports of adults has been reported to be as early as at the age of five,18 we wanted to explore the presence and distribution of parent-reported HAS in a general population-based sample of 1323 children (ages 5- to 7-years old). A secondary aim was to examine the association between these symptoms and parental-reported current physical and mental health problems in the child. We hypothesized that (1) HAS can be demonstrated already at this early age, and (2) the close relationship, repeatedly reported in adults,4 between health anxiety and medically unexplained, i.e., functional somatic symptoms (FSS), and internalizing, disorders, i.e., depression and anxiety, can also be demonstrated in young children.
