Health anxiety symptoms in children and adolescents diagnosed with OCD

Abstract

Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30 % presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.

Annual Research Review: Health anxiety in children and adolescents—developmental aspects and cross‐generational influences

“…Recent studies show that health anxiety is commonly reported in children and adolescents diagnosed with OCD (Duholm et al., 2021; Villadsen et al., 2017). Villadsen et al.…”

“…(2017) found that 30% of a pediatric OCD sample presented with high health anxiety symptoms and that the majority (67%) of these children and adolescents were categorized with moderate to severe OCD, indicating that the presence of concurrent health anxiety was associated with greater OCD impairment. Furthermore, children with both OCD and health anxiety symptoms presented with significantly more comorbid anxiety disorders and anxiety symptoms in both studies (Duholm et al., 2021; Villadsen et al., 2017). Overall, these associations may therefore to some degree be explained by the previously mentioned substantial phenomenological overlap between health anxiety and OCD with significant cognitive and behavioral similarities involving intrusive, distressing thoughts, and related repetitive behaviors (Barsky, 1992; Deacon & Abramowitz, 2008; Starcevic, 2014).…”

“…Research in adults exhibits comorbidity between health anxiety and other disorders, especially with anxiety disorders, depression, and obsessive‐compulsive disorder (Abramowitz, Olatunji, & Deacon, 2007; Barsky, 1992; Deacon & Abramowitz, 2008; Greeven, Van Balkom, Van Rood, Van Oppen, & Spinhoven, 2006; Hedman et al., 2017; van den Heuvel, Veale, & Stein, 2014; Lee, Lam, Kwok, & Leung, 2014; Noyes, 1999; Olatunji, Deacon, & Abramowitz, 2009; Scarella, Laferton, Ahern, Fallon, & Barsky, 2016; Sunderland, Newby, & Andrews, 2013; Weck, Bleichhardt, Witthöft, & Hiller, 2011). In children and adolescents, cross‐sectional studies have also demonstrated that health anxiety co‐occurs with other psychopathology such as various types of anxiety symptoms (Williams & Hollis, 1999), functional somatic symptoms and OCD as well as psychotic experiences and behavioral disturbances (Duholm, Højgaard, Skarphedinsson, Thomsen, & Rask, 2021; Köteles et al., 2015; Rask et al., 2012, 2016; Rimvall et al., 2019; Selles et al., 2021; Villadsen et al., 2017; Wright et al., 2016; Wu et al., 2017; See Figure 1).…”

“…Recent studies show that health anxiety is commonly reported in children and adolescents diagnosed with OCD (Duholm et al, 2021;Villadsen et al, 2017). Villadsen et al (2017) found that 30% of a pediatric OCD sample presented with high health anxiety symptoms and that the majority (67%) of these children and adolescents were categorized with moderate to severe OCD, indicating that the presence of concurrent health anxiety was associated with greater OCD impairment. Furthermore, children with both OCD and health anxiety symptoms presented with significantly more comorbid anxiety disorders and anxiety symptoms in both studies (Duholm et al, 2021;Villadsen et al, 2017).…”

“…Health anxiety and obsessive-compulsive disorder. Recent studies show that health anxiety is commonly reported in children and adolescents diagnosed with OCD (Duholm et al, 2021;Villadsen et al, 2017). Villadsen et al (2017) found that 30% of a pediatric OCD sample presented with high health anxiety symptoms and that the majority (67%) of these children and adolescents were categorized with moderate to severe OCD, indicating that the presence of concurrent health anxiety was associated with greater OCD impairment.…”