Elsevier

Behavior Therapy

Volume 38, Issue 1, March 2007, Pages 86-94
Behavior Therapy

Health Anxiety, Hypochondriasis, and the Anxiety Disorders

https://doi.org/10.1016/j.beth.2006.05.001Get rights and content

Abstract

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI’s latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operating characteristic analyses supported the utility of the SHAI as a diagnostic tool for screening patients with hypochondriasis utilizing empirically derived cut scores. Findings are discussed in terms of cognitive-behavioral models of anxiety disorders.

Section snippets

Participants

Participants were 157 adults (i.e., ≥ 18 years old) with a primary (principal) diagnosis of HC or an anxiety disorder (diagnostic and assessment procedures are described below) who were seeking evaluation and treatment. Forty-nine patients had a principal diagnosis of PD, followed by 32 with social phobia, 21 with GAD, 18 with OCD, and 16 with specific phobia. Twenty-one patients had HC. Many had additional Axis I diagnoses (42.0%), including 26 (16.64%) with depressive disorders. The mean age

Reliability and Item-Level Analyses

The mean SHAI total score for the patient sample was 36.6 (SD = 13.2, range = 3–68). SHAI total scores were not significantly associated with age (r = .06, p > .10) or gender, t(155) = –1.61, p > .10. The SHAI demonstrated excellent internal consistency (α = .96). Each of the 18 items evidenced acceptable corrected item-total correlations (range = .61 to .87) based on the criterion of .30 recommended by Nunnally and Bernstein (1994).

Confirmatory Factor Analysis of the SHAI

Using AMOS 5.0 (Arbuckle, 2003), we conducted a confirmatory factor analysis

Discussion

Clinical observations suggest that health anxiety is present in a variety of psychological disorders, yet very little empirical research on health anxiety exists in the literature. One reason for this dearth of research is that very few measures have been developed to assess the construct of health anxiety. The SHAI is a novel instrument that assesses the cognitive and behavioral features of health anxiety. It possesses good psychometric properties among individuals with HC and among

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