The current study uses data from a large nonclinical college student sample (N = 503) to examine a structural model of hypochondriasis (HC). This model predicts the distinctiveness of two dimensions (disease phobia and disease conviction) purported to underlie the disorder, and that these two dimensions are differentially related to variables important to health anxiety and somatoform disorders, respectively. Results were generally consistent with the hypothesized model. Specifically, (a) body perception variables (somatosensory amplification and anxiety sensitivity – physical) emerged as significant predictors of disease phobia, but not disease conviction; (b) emotion dysregulation variables (cognitive avoidance and cognitive reappraisal) emerged as significant predictors of disease conviction, but not disease phobia; and (c) both disease phobia and disease conviction independently predicted medical utilization. Further, collapsing disease phobia and disease conviction onto a single latent factor provided an inadequate fit to the data. Conceptual and therapeutic implications of these results are discussed.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychiatric Association [APA], 2000) places hypochondriasis (HC) with the somatoform disorders, but contemporary conceptualizations of HC suggest it is better represented as an extreme form of health anxiety ( Abramowitz, Schwartz, & Whiteside, 2002) and belongs to the anxiety disorders domain ( Olatunji, Deacon, & Abramowitz, 2009). Consistent with this position, some cognitive variables hypothesized to underlie anxiety conditions are relevant to HC as well (e.g., anxiety sensitivity, body vigilance; Deacon & Abramowitz, 2008).
However, the ability for the reconceptualization of HC as health anxiety to capture the full HC domain was recently put into some doubt. In particular, Fergus and Valentiner (2009) found that the disease phobia (i.e., fear of having a serious disease) dimension of HC shared significantly stronger relations with health anxiety than did the disease conviction (i.e., the idea that one has a serious disease) dimension. Further, whereas the disease conviction dimension predicted unique variance over an index of health anxiety in medical utilization scores, the disease phobia dimension did not. Based on these results, Fergus and Valentiner postulated that the view of HC as health anxiety may be more consistent with disease phobia and the view of HC as a somatoform disorder may be more consistent with disease conviction.
Whereas dimensions other than disease phobia and disease conviction underlie HC, researchers have pointed to the specific importance of these two dimensions. For example, Barsky (1992) suggested that disease phobia and disease conviction subgroups characterize HC. The diagnostic definition of HC (APA, 2000) defines the disorder as consisting of two beliefs that correspond to disease phobia and disease conviction (i.e., “fears of having, or the idea that one has, a serious disease; ” p. 507); however, HC is still conceptualized as a unidimensional construct within the DSM-IV-TR. Although the issue surrounding the suitability of subgroups is not directly examined in the present study, finding disease phobia and disease conviction to be distinct dimensions would give further credence to Barsky’s notion that utility can be gained in defining HC as a multidimensional construct. Further, if disease phobia and disease conviction are distinct, these dimensions may be associated with different mechanisms (Olatunji, 2008). With the above issues in mind, the present study sought to explicate whether disease phobia and disease conviction represent meaningfully distinct dimensions of HC.
Limitations notwithstanding, the present study indicates that disease phobia and disease conviction are two distinct dimensions of HC. Considering the debate as to whether HC is part of the anxiety disorders domain (Olatunji et al., 2009), separately examining disease phobia and disease conviction appears most promising for understanding how HC relates to other psychological disorders. Although many questions still surround HC, and its dimensions, conceptualizing disease phobia and disease conviction as separate constructs in future applications may help provide clarity as to its conceptualization and treatment.
