Illness Anxiety Disorder

Question 1

Psychological risk factors

Answer 1

Physical and sexual abuse

Inadequate/inattentive parenting

High levels of childhood sickness

Parental overprotection and encouragement of sick-role behaviour

Insecure attachment styles, especially fearful

Modelling & reward of health/medical behaviours e.g. health anxiety mothers more attentive when child plays with medical kit

Question 2

Psychoanalytic models

Ego defence

Answer 2

Freud 1914

• libido has 2 dimensions:
  
  • object libido - love of external objects
  • ego libido - love for oneself & body (narcissism)
• Individual becomes absorbed by ego libido –> focus on external sources of love diminishes –> develop anxiety about physical state
• Focus on love for body and physicality but is also anious they may love the object of their love and attention
• —–> focus on good things about their body but also any threats to health that may destroy the object of their love

Question 3

Interpersonal theory

Answer 3

Health anxiety as a way to gain emotional attention

• seeking emotional care from professionals, family, friends through reporting of physical symptoms
• results from anxious/insecure parental attachments
  
  • child views others as unreliable caregivers
  • only able to gain attention through complaints of physical symptoms bc parents unresponsive to psych stress
  • becomes primary way of gaining adult attention…..
    
    • both child and adult learn to use complaints of physical symptoms to gain attention & love
    • fail to learn other ways of eliciting care and attention from their environment

Question 4

Illness anxiety as threat

Answer 4

Immediate cognitive processes. Current life stresses or simply noticing bodily signs activate activates latent cognitive schemata about health and disease that are pessimistic –>

• selective attention to information supporting schema
  
  • lumps, bumps, physiological sensations
• cognitive errors
  
  • disconfirmatory info i.e. medical reassurance ignored, rumination about consequences - usually in some catastrophic form
• physiological changes
  
  • autonomic activity increases with anxiety –> changing bowel habits, sleeping…
• behavioural responses
  
  • safety behaviours e.g. repeated checking, taking unnecessary preventative medication…
  • avoid activities that trigger health rumination or seek reassurance from pros/family that “all is well”

Question 5

Threat plus symptom sensitivity

Answer 5

Variant of threat model

• People with illness anxiety are more aware of physiological processes e.g. heartbeat
• BUT Evidence isn’t strong :/
  
  • no difference between hyperchondriasis & controls in acute awareness of heart beats (Barksey et al., 1995)

Question 6

CBT

Answer 6

ERP

• reduce checking behaviour either frequency or time spent each time or both
• +/- strategies designed to change fundamental illness beliefs
  
  • behavioural hypothesis testing
  • cognitive challenge

‘Scripted’ sessions

• each an hour long, dedicated to a different factor that causes patients to amplify somatic symptoms & misattribute them to disease
  
  • attention to bodily hypervigilance
  • beliefs about symptom aetiology
  • circumstances & context
  • illness & sick-role behaviours
  • mood
• educational info about symptom amplifiers, illustrative exercises, discussions to personalise the material

Question 7

ACT

Answer 7

Mindfullness

• fixed illness beliefs may be difficult to address using cognitive challenge - can’t prove somebody will never get ill!
• Focus on here and now, we can’t predict the future

Question 8

Types of illness anxiety disorder

Answer 8

Care seeking & Care avoidant

Care seeking

• more obvious! Constantly seeking medical attention
• women have higher prevalence rate but perhaps simply more likely to have care seeking type?