Hypochondriasis and Symptom Reporting – The Effect of Attention versus Distraction

Abstract

Background: This study examined symptom perception in hypochondriacal patients without physical stimulation. Methods: Seventeen outpatients with DSM-III-R hypochondriasis and 16 healthy control subjects were compared. All subjects were asked to report perceived sensations in three conditions: attention, distraction and control. Results: It was found that hypochondriacal subjects showed remarkably higher levels of symptom reporting than healthy subjects in all three conditions. In spite of excessive attention to bodily sensations in a control condition, attention instructions still added significantly to symptom reporting in hypochondriacal patients. The effect of distraction was not significant in either of the groups. Furthermore, group differences in symptom reporting appeared to be related to preoccupation with bodily symptoms rather than to general anxiety level as measured by the STAI. Conclusions: Hypochondriacal patients report more bodily sensations than healthy controls when no instructions are given. In addition, focussing on bodily sensations seems to cause a significant overall increase of perceived symptoms in hypochondriacal patients, whereas in healthy subjects there is a trend towards an increase in symptom reporting.

Attentional Correlates of Illness Anxiety in a Non-Clinical Sample

“…The results confirm the hypothesis that a selective attentional focus on the body (private body consciousness as well as symptom reporting) is significantly related to illness anxiety. The relation between symptom reporting and illness anxiety has also been demonstrated in hypochondriacal patients [12]. On the other hand, only cognitive failure in everyday life appeared to be related to the other questionnaires, but not to a specific sustained attention task.…”

“…The degree of symptom reporting is assumed to be strongly related to the amount of attention focused on the body [10, 11]. Therefore, symptom reporting can be conceived as an indirect expression of attending to bodily sensations [12]. A second hypothesis states that externally oriented attention decreases as a function of illness anxiety, which may be conceived as a consequence of more inwardly directed attention.…”

Cognitive and Behavioural Treatment of Hypochondriasis

“…For quite a few patients the therapy sessions appeared to be among the rare occasions on which they freely discussed their thoughts and behaviours at length without being ridiculed (‘You’re not playing with your excrements, are you?’), interrupted (‘Why don’t you stop whining, you’re perfectly healthy’) or hastily reassured (‘It’s nothing, I know many people with the same symptoms who are still very much alive’). There is now some experimental evidence that hypochondriacal patients tend to report more bodily symptoms [34] and show greater distress about these symptoms [35] than healthy controls. The overreporting and distress may be reduced by this type of complaint-focused treatment.…”

Serie Onderzoek en Psychotherapie: Cognitieve gedragstherapie bij hypochondrie

“…Verder zijn er aanwijzingen dat hypochondere patie¨nten meer piekeren over hypochondere thema's dan over andere onderwerpen en dat zij daar minder controle over hebben dan over niet-hypochondere thema's (Bouman & Meijer, 1999). Ook aandachtsprocessen spelen een belangrijke rol bij de hypochondere preoccupatie: er is over het algemeen selectieve aandacht voor informatie die de hypochondere preoccupatie ondersteunt (Vervaeke, Bouman & Valmaggia, 1999), ten nadele van tegensprekende informatie (Haenen, Schmidt, Kroeze & Van den Hout, 1996).…”