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Objective: To study the phenomenon of cyberchondria and related worries about health among individuals without any diagnosed medical condition. ., Methods: The survey-based, cross-sectional study was conducted from January to July 2018 in the twin cities of Rawalpindi and Islamabad, Pakistan, and comprised graduates of either gender aged at least 35 years with access to internet and means of use, and with no current diagnosed medical condition. The self-reporting Cyberchondria Severity Scale was used data-collection along with a demographic sheet. SPSS 21 was used for data analysis., Results: Of the 150 subjects, 90(60%) were men and 60(40%) were women. A total of 40(26.6%) subjects had low level of cyberchondria, while 35(23.3%) experienced a higher level of it. Mean scores of men on total CSS were slightly higher than those of women (p>0.05). Men also scored higher on compulsion, distress, excessiveness and reassurance subsclaes (p>0.05 each), whereas women scored slightly higherthan men on 'mistrust of medical profession' subscale (p>0.05). No significant gender differences werefound on cyberchondria and its subscales (p>0.05 each)., Conclusions: Doctors / health professionals may benefit from the findings by focussing on their patients who use internet as a major source of medical information.

Patients with pathological health anxiety (PHA) tend to automatically interpret bodily sensations as sign of a severe illness. To elucidate the neural correlates of this cognitive bias, we applied an functional magnetic resonance imaging adaption of a body-symptom implicit association test with symptom words in patients with PHA (n = 32) in comparison to patients with depression (n = 29) and healthy participants (n = 35). On the behavioral level, patients with PHA did not significantly differ from the control groups. However, on the neural-level patients with PHA in comparison to the control groups showed hyperactivation independent of condition in bilateral amygdala, right parietal lobe, and left nucleus accumbens. Moreover, patients with PHA, again in comparison to the control groups, showed hyperactivation in bilateral posterior parietal cortex and left dorsolateral prefrontal cortex during incongruent (i.e., harmless) versus congruent (i.e., dangerous) categorizations of body symptoms. Thus, body-symptom cues seem to trigger hyperactivity in salience and emotion processing brain regions in PHA. In addition, hyperactivity in brain regions involved in cognitive control and conflict resolution during incongruent categorization emphasizes enhanced neural effort to cope with negative implicit associations to body-symptom-related information in PHA. These results suggest increased neural responding in key structures for the processing of both emotional and cognitive aspects of body-symptom information in PHA, reflecting potential neural correlates of a negative somatic symptom interpretation bias.

Recalling an event impairs an individual's later ability to recall related knowledge. Impairment in this retrieval-induced forgetting (RIF) produces a dysfunction in autobiographical memory. This, like somatic symptoms, has been documented in trauma and sexual abuse survivors. To investigate the relationship between past trauma and somatoform disorders, and the role of memory recall dysfunction in this relationship, three sex-matched groups were constituted using DSM IV criteria: Somatoform (SD) (n. 22) other Psychiatric Disorders (PD) (n. 26) and Healthy Subjects (HS) (n. 35). Responses to Stressful Life Events Screening Questionnaire revised (SLESQ-R); Direct Forgetting paradigm (DF) for autobiographical memory; Deese-Roediger-McDermott (DRM) paradigm for false memory; Stanford Scale type A for Post-Hypnotic Amnesia (PHA); Stroop Colour Word test and a digit-span for cognitive assessment; and Somatosensory Amplification Scale (SSAS), Somatic Dissociation Questionnaire (SDQ-20), and Toronto Alexithymia Scale (TAS 20) for somatic discomfort were compared among groups. SSAS, SDQ-20 and TAS F1 were correlated with SLESQ-R scores; subjects with higher numbers of traumatic events (NSE) showed greater capacity to remember items-to-be-forgotten (DFF) and higher SDQ-20 scores. Although the SD group showed higher NSE, their autobiographical memory scores were no different to those of other DSM-IV groups. The somatic-trauma-autobiographical memory impairment relationship is identified by DSM V but not DSM IV criteria for somatoform disorder. Higher NSE appears to correlate with both the presence of somatic discomfort and impaired autobiographical memory, suggesting autonoetic consciousness dysfunction in subjects with past trauma and current somatic symptom disorders.

The features of clinical symptoms, neurotic disorders and the level of subjective control were studied in patients with fibromyalgia. The analysis of relationship between the level of subjective control and neurotic symptoms (asthenia, depression, anxiety, hypochondria) depending the severity of main clinical manifestations of the disease was carried out. It was found that high intensity of fatigue, muscle pain, stiffness, insomnia, and an increase in the number of diagnostic tender points contribute to the formation of inverse correlation between the level of subjective control and neurotic disturbances. Thus, the increase of the externality of the level of subjective control allows indicating to the formation of patients' passivity in relation to their disease, the lack of adherence to prescribed course of treatment (low compliance). Although drug therapy is the main component of complex treatment of fibromyalgia patients, patients require significantly more - successful treatment requires active involvement of patients in the therapy process, as well as changes in their attitudes and lifestyle, which can be achieved by training in so-called "schools" for patients, use of psychotherapeutic methods.

Emotion reactivity, defined as heightened sensitivity, intensity, and persistence of emotional states, has been shown to contribute to the exacerbation of anxiety. However, the association between emotion reactivity and health anxiety has yet to be examined. The aim of the present investigation was to examine the unique predictive ability of emotion reactivity in terms of health anxiety in a sample of medically healthy undergraduates ( n = 194; 59.3% female, M age = 19.42, SD = 1.51, range = 18-26 years; 84.0% Caucasian). Findings indicated that, after controlling for the effects of gender, age, and anxiety sensitivity, greater emotion reactivity significantly predicted greater overall health anxiety (3.1% variance), as well as higher levels of affective (4.1% unique variance) and behavioral (4.8% unique variance) components. Findings suggest that experiencing emotions more frequently, intensely, and for longer durations of time prior to returning to baseline are associated with greater health preoccupations.

Studies of the comorbidity of hypochondriasis have indicated high rates of cooccurrence with other anxiety disorders. In this study, the contrast among hypochondriasis, panic disorder, and social phobia was investigated using specific processes drawing on cognitive-perceptual models of hypochondriasis. Affective, behavioral, cognitive, and perceptual processes specific to hypochondriasis were assessed with 130 diagnosed participants based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria (66 with hypochondriasis, 32 with panic disorder, and 32 with social phobia). All processes specific to hypochondriasis were more intense for patients with hypochondriasis in contrast to those with panic disorder or social phobia (0.61 < d < 2.67). No differences were found between those with hypochondriasis with comorbid disorders and those without comorbid disorders. Perceptual processes were shown to best discriminate between patients with hypochondriasis and those with panic disorder.

Based on the results of a comprehensive study of 35 people aged from 19 to 52 years, among them 20 women and 15 men with celiac disease features of their physiological status were studied, reflecting the severity of the disease and quality of life. The diagnosis was based on the clinical and anamnestic data, endoscopy, histomorphological, immunological and genetic exams. Psychophysiological analysis showed that in celiac disease is characterized by the formation reactions with anxiety, anxiety-phobic, neurotic, affective, and hypochondriacal symptoms. The results of the study emphasized the importance of adaptive physiological capacity of the body to build tolerance to the development of psycho-vegetative, hypochondriacaldepressive and other disorders.

Objective: To develop a Somatic Symptoms Scale based on the criteria of standard symptoms, and to examine its psychometric properties through exploratory factor analysis., Methods: The study was conducted from January, 2010 to May, 2011 at two teaching hospitals in Lahore city and comprised female adolescents with somatic symptoms diagnosed by a psychiatrist, and an equal number of adolescents with minor physical disability. All patients were recruited from psychiatric out-door units of different hospitals. All subjects were unmarried. Translated Urdu version of the Somatic Symptoms Scale was administered to each participant individually. They were instructed to read the scale carefully and select the response that was most appropriate. The assessment procedure was done in a separate room on the hospital premises., Results: There were 150 female adolescents with somatic symptoms and equal number of females with minor disability. The overall mean age was 15.50+/-1.67 years (range: 14-17 years).Exploratory factor analysis showed that the two groups were significantly different on conversion motor symptoms (p<0.001), conversion sensory symptoms (p<0.001), pain symptoms (p<0.001), hypochondriacal symptoms (p<0.001) and body dysmorphic symptoms (p<0.001)., Conclusions: The Somatic Symptoms Scale was found to be a valid and reliable measure which can be used as screening instrument for non-clinical population and as a diagnostic measure in clinical population.

Based on the conception of correlations between independent endogenous factors (positive and negative disorders), the author present a psychopathological model of psychosomatic (hypochondriac) symptoms in deficit disturbances, comorbid with the changes of «verschroben» type, observed in general medical practice. The psychosomatic symptoms are represented by a wide range of symptom complexes (from idiopathic pain and conversions to restricted hypochondria, organ neuroses, encapsulated organ psychosis) and defined as a syndrome of endoform of somaticized disorders. The syndrome is interpreted beyond schizophrenia as «the second disease», a type of schizophrenia spectrum disorders, in which negative process changes have stopped while the other component (positive psychopathological symptoms) continues to develop.

Hypochondriasis is characterized by intensive fears of serious disease. Most patients with hypochondriasis worry about physical diseases like cancer, although in rare cases, patients report severe fears of mental disorders (e.g., schizophrenia), a phenomenon described in the literature as mental hypochondriasis. However, little is known about this rare subtype of hypochondriasis and experts have questioned whether mental hypochondriasis has much in common with the type of hypochondriasis in which somatic diseases are the focus of preoccupation. This paper presents, a case report of a woman with a fear of schizophrenia, which was treated with cognitive therapy. This patient fulfills the DSM-IV criteria of hypochondriasis and exhibits many characteristics (e.g., selective attention, safety behavior) considered to be maintaining factors in well-established cognitive-behavioral models of hypochondriasis. Cognitive treatment strategies for hypochondriasis (e.g., attention training, behavioral experiments) also proved effective in this case of mental hypochondriasis.

Objective: According to cognitive-behavioral models of hypochondriasis (HYP), biased attentional and memory processes related to health threat stimuli are crucial for the development and maintenance of severe health anxiety. Little is known about the specificity, temporal stability, and modifiability of these biases via psychotherapy., Method: In an emotional Stroop and subsequent recognition task, the authors compared attention and memory processes for health-related words (illnesses, bodily complaints, and panic-related words) in patients with HYP (n = 32), other somatoform disorders (SFD; n = 27), and panic disorder (PD; n = 25). A control group consisted of 31 healthy participants (CG). All patients were reexamined after 4 months of cognitive-behavioral therapy (CBT)., Results: Patients with HYP showed a significant attentional bias toward all 3 target word categories. Evidence for a specific bias was found only for the PD group. General recognition performance for health threat and neutral words was best in the HYP group. After therapy, attentional bias had clearly decreased in the HYP and SFD patients., Conclusions: Patients with HYP can be characterized by attentional bias and more elaborate verbal processing. These irregularities tend to disappear after psychotherapy.

The Diagnostic Criteria for Psychosomatic Research (DCPR) were introduced in 1995 by an international group of investigators to expand the traditional domains of the disease model. The DCPR are a set of 12 'psychosomatic syndromes' which provide operational tools for psychosocial variables with prognostic and therapeutic implications in clinical settings. Eight syndromes concern the main manifestations of abnormal illness behaviour: somatization, hypochondriacal fears and beliefs, and illness denial. The other four syndromes (alexithymia, type A behaviour, demoralization and irritable mood) refer to the domain of psychological factors affecting medical conditions. This review describes the conceptual bases of the DCPR and the main findings concerning their application, with particular reference to the incremental information they added to the customary psychiatric classification. The DCPR were also compared with the provisional DSM-5 somatic symptom disorders. The DCPR were found to be more sensitive than DSM-IV in identifying subthreshold psychological distress and characterizing patients' psychological response to medical illness. DSM-5 somatic symptom disorders seem to neglect important clinical phenomena, such as illness denial, resulting in a narrow view of patients' functioning. The additional information provided by the DCPR may enhance the decision-making process.

Background: Hypochondriacal attitudes were associated with cognitions not related to illness: Social fears, low self-esteem, and reduced warm glow effect, i.e. less positive appraisal of familiar stimuli. Only a single study had investigated the correlation of hypochondriacal attitudes with the warm glow effect so far and the present study aimed to corroborate this association. Particularly, the present investigation tested for the first time whether social fears, low self-esteem, and reduced warm glow effect represent distinct or related biases in hypochondriacal attitudes., Methods: Fifty-five volunteers filled in the Hypochondriacal Beliefs and Disease Phobia scales of the Illness Attitude Scales, two scales enquiring social fears of criticism and intimacy, and the Rosenberg Self-Esteem Scale. The interaction of valence and spontaneous familiarity ratings of Chinese characters indicated the warm glow effect., Results: A stepwise regression model revealed specific covariance of social fears and warm glow with hypochondriacal attitudes independent from the respective other variable. The correlation between low self-esteem and hypochondriacal attitudes missed significance., Conclusions: Hypochondriacal attitudes are embedded in a heterogeneous cluster of non-illness-related cognitions. Each social fears and a reduced cognitive capacity to associate two features--positive appraisal and familiarity--could diminish the susceptibility to safety signals such as medical reassurance. To compensate for reduced susceptibility to safety signals, multifocal treatment and repeated consultations appear advisable.

Background: Direct comparisons of brain function between obsessive compulsive disorder (OCD) and other anxiety or OCD spectrum disorders are rare. This study aimed to investigate the specificity of altered frontal-striatal and limbic activations during planning in OCD, a prototypical anxiety disorder (panic disorder) and a putative OCD spectrum disorder (hypochondriasis)., Method: The Tower of London task, a 'frontal-striatal' task, was used during functional magnetic resonance imaging measurements in 50 unmedicated patients, diagnosed with OCD (n=22), panic disorder (n=14) or hypochondriasis (n=14), and in 22 healthy subjects. Blood oxygen level-dependent (BOLD) signal changes were calculated for contrasts of interest (planning versus baseline and task load effects). Moreover, correlations between BOLD responses and both task performance and state anxiety were analysed., Results: Overall, patients showed a decreased recruitment of the precuneus, caudate nucleus, globus pallidus and thalamus, compared with healthy controls. There were no statistically significant differences in brain activation between the three patient groups. State anxiety was negatively correlated with dorsal frontal-striatal activation. Task performance was positively correlated with dorsal frontal-striatal recruitment and negatively correlated with limbic and ventral frontal-striatal recruitment. Multiple regression models showed that adequate task performance was best explained by independent contributions from dorsolateral prefrontal cortex (positive correlation) and amygdala (negative correlation), even after controlling for state anxiety., Conclusions: Patients with OCD, panic disorder and hypochondriasis share similar alterations in frontal-striatal brain regions during a planning task, presumably partly related to increased limbic activation.

P wave dispersion (Pd), defined as the difference between the maximum and the minimum P wave duration, has been associated with anxiety. Thus, we wondered whether Pd in hypochondriasis which is associated with anxiety differed from that in healthy controls. Pd was measured in 30 hypochondriac patients and same number of physically and mentally healthy age- and gender-matched controls. Hamilton Depression Rating (HDRS) and Hamilton Anxiety Rating Scales (HARS) were scored. The heart rate and left atrium (LA) sizes were not significantly different between groups. However, both Pmax and Pmin values of the patients were significantly higher than those of healthy controls. As for the main variable investigated in the present study, the corrected Pd was significantly longer in the patient group compared to control group. On the basis of this study, we can conclude that Pd may be related to hypochondriasis though our sample is too small to allow us to obtain a clear conclusion. Future studies with larger sample evaluating the effects of treatment are required., (Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.)

A subset of patients who present for neuropsychological testing report dysfunction in daily life activities secondary to cognitive deficits, but are found on formal testing to have no objective abnormalities, raising the possibility of "neurocognitive hypochondriasis." Such a case is presented, and the factors that appear to give rise to this presentation are explored. Cases of hypochondriacal overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue syndrome, fibromyalgia, toxic mold exposure, and post-polio syndrome.

Purpose of Review: Neuroimaging research in psychiatry has been increasing exponentially in recent years, yet many psychiatrists are relatively unfamiliar with this field. This article summarizes the findings of the most relevant research articles on the neuroimaging of somatoform, conversive, and dissociative disorders published from January 2007 through June 2008., Recent Findings: Neuroimaging findings summarized here include alterations of stress regulation and coping in somatoform pain disorders, the importance of catastrophizing in somatization disorder, and the relevance of a history of physical/sexual abuse in irritable bowel syndrome. Regarding fibromyalgia, three of the most significant advances have been the impossibility of differentiating primary and concomitant fibromyalgia in the presence of quiescent underlying disease, the role of hippocampal dysfunction, and the possibility that fibromyalgia may be characterized as an aging process. In dissociative disorders, the high levels of elaborative memory encoding and the reduced size of the parietal lobe are highlighted., Summary: The most promising clinical consequence of these studies, in addition to improving knowledge about the etiology of these illnesses, is the possibility of using neuroimaging findings to identify subgroups of patients, which could allow treatments to be tailored.

Objective: Previous research reported an association of handedness with a variety of neurologic, psychiatric, and immunologic diseases. Most of these studies assessed handedness via questionnaire. This association might therefore result from response bias., Methods: Participants (n=422) completed 2 standard questionnaires to assess handedness and hypochondriasis: the Edinburgh Handedness Inventory and the Whiteley Index. Subjects with past or present neurologic, psychiatric, or immunologic disease or any severe disease were excluded. Separate analyses were made for the overall sample and 2 subsamples with and without a reported medical history of nonsevere diseases., Results: The distribution of handedness is different for subjects with lower versus higher hypochondriac traits: higher scores of hypochondriac traits are associated with weaker right or left-handedness. The subsample reporting a history of nonsevere diseases had even stronger hypochondriac traits and less extreme handedness scores compared with the other subsample., Conclusions: Handedness scores derived from questionnaires are affected by information bias. Future medical and psychologic research on handedness should control for this bias or use empirical methods to assess hand preference.

Background: Elevated Minnesota Multiphasic Personality Inventory (MMPI) scores on the hysteria (Hy) scale are reported in several forms of pain. Previous results were possibly biased by diagnostic heterogeneity (psychogenic, somatic and mixed pain syndromes included in the same index sample) or Hy heterogeneity (failure to differentiate Hy scores into clinically meaningful subscales, such as admission of symptoms [Ad] and denial of symptoms [Dn])., Methods: To overcome this drawback, 48 patients diagnosed as having a Diagnostic and Statistical Manual of Mental Disorders, 4th edn, Text Revision (DSM-IV-TR) diagnosis of "pain disorder associated with psychological factors" were compared with 48 patients experiencing somatic pain excluding psychological factors, and 42 somatic controls without pain., Results: MMPI Hy and hypochondriasis (Hs) scores were significantly higher in the pain disorder group than in control groups, who scored similarly. MMPI correction (K) scores and Dn scores were similar in the three groups, whereas Ad was significantly higher in the pain disorder group and lower and similar in the two control groups, respectively. In the pain disorder group, Ad and Dn were negatively correlated, whereas in control groups they were unrelated., Conclusions: These findings suggest that whereas a pattern of high Hs and Hy scores together with a normal K score might characterize patients with a pain disorder associated with psychological factors, elevated Hy scores per se do not indicate hysterical traits. In the pain disorder group, elevated Hy scores reflected the Ad subscale alone, indicating a strikingly high frequency of distressing somatic symptoms. They tend not to repress or deny the emotional malaise linked to symptoms, as the hysterical construct expects. The pain disorder designation should be considered a nonhysterical form of somatization.

Aim: To describe some clinical variants of hypochondriac syndrome in patients with duodenal ulcer (DU)., Material and Methods: A hypochondriac trend was studied clinically and was confirmed by changes in the first scale of AMPI in 150 DU patients. If the first scale contained a rise over 70 points, the examinee was stated to be much concerned about his/her health., Results: Hypochondriac syndrome in exacerbation was registered in 59 (39.3%) patients. It was accompanied with anxiety in 28.8% cases. Introversion and original attitude to somatic disorders were observed in 25.4% cases. Demonstrative behavior was seen in 23.8% patients. Depressive trends occurred in 13.5% patients. Conception of the disease was confirmed in 5.1% cases. Hypochondriac state with protest reactions and hyperthymic effect occurred least frequently (1 and 1 case, respectively)., Conclusion: Hypochondriac states aggravate DU, deteriorate quality of life. Early diagnosis of a variant of hypochondriac syndrome enables a directed individual psychotherapy which improves emotional state of the patient and prevent further development of psychopathological traits.

Hypochondriasis (HA) involves the fear of serious illness despite appropriate reassurances. Because HA is associated with patients' personal suffering and clinical management problems, it is important for clinicians to be knowledgeable about current conceptual and treatment approaches to this problem.

Background: The relation of demographic and psychological factors to the presence and extent of gut transit impairment in the functional gastrointestinal disorders has received little attention., Aims: To compare the psychosocial and demographic features of patients with functional gastrointestinal disorders and delayed transit in one region of the gastrointestinal tract with those displaying more widespread delayed transit (that is, delay in two or three regions), and those with normal transit in all three regions., Patients: Of 110 outpatient participants who satisfied standardised criteria for functional gastrointestinal disorders, 46 had delayed transit in one region, 32 had delay in two or three regions, and 17 exhibited normal transit in all regions., Methods: Transit in the stomach, the small intestine, and the large intestine was assessed concurrently using a wholly scintigraphic technique; psychological status was assessed using established psychometric measures., Results: Patients with delayed transit displayed demographic and psychological features that contrasted with patients with normal transit in all regions. In particular, widespread delayed transit featured female sex, a highly depressed mood state, increased age, frequent control of anger, and more severe gastric stasis, while the features distinguishing normal transit were male sex and high levels of hypochondriasis., Conclusion: These data suggest the existence of a distinct psychophysiological subgroup, defined by the presence of delayed transit, in patients with functional gastrointestinal disorders.

Background: Both psychological and physiological disturbances have been implicated in the aetiopathogenesis of irritable bowel syndrome (IBS)., Aims: To investigate how the psychological factors act, and the involvement of infective and physiological factors., Methods: Consecutive patients hospitalised for gastroenteritis reported life events for the previous 12 months, and past illness experiences on standardised questionnaires. They also completed psychometric questionnaires for anxiety, neuroticism, somatisation, and hypochondriasis. In some patients, rectal biopsy specimens were obtained during the acute illness and at three months postinfection., Results: Ninety four patients completed all questionnaires: 22 patients were diagnosed with IBS after their gastroenteritis (IBS+), and 72 patients returned to normal bowel habits (IBS-). IBS+ patients reported more life events and had higher hypochondriasis scores than IBS- patients. The predictive value of the life event and hypochondriasis measures was highly significant and independent of anxiety, neuroticism, and somatisation scores, which were also elevated in IBS+ patients. Rectal biopsy specimens from 29 patients showed a chronic inflammatory response in both IBS+ and IBS- patients. Three months later, specimens from IBS+ patients continued to show increased chronic inflammatory cell counts but those from IBS- patients had returned to normal levels. IBS+ and IBS- patients exhibited rectal hypersensitivity and hyper-reactivity and rapid colonic transit compared with normal controls, but there were no significant differences between IBS+ and IBS- patients for these physiological measurements., Conclusion: Psychological factors most clearly predict the development of IBS symptoms after gastroenteritis but biological mechanisms also contribute towards the expression of symptoms.

Objective: This study investigates psychological and psychobiological processes in patients with somatization syndrome., Method: We compared physiological measures (heart rate, finger pulse volume, electrodermal activity, electromyography), cortisol levels, and subjective well-being during rest and during a mental stress task as well as selective attention and memory for illness-related words in 58 patients with somatization syndrome and 21 healthy controls., Results: The somatization group had higher morning salivary cortisol concentrations, higher heart rates, and lower levels of finger pulse volume. During the mental stress task, patients with somatization syndrome felt more distressed and had higher heart rates, whereas controls showed habituation to the experimental situation. We were unable to demonstrate an attention or memory bias specific for somatization., Conclusions: The results point to several psychological, psychophysiological, and psychobiological mechanisms that might be involved in the maintenance of somatization syndrome. These results are discussed from a cognitive-psychobiological perspective.

In a sample of 131 patients with panic disorder, we explored both the presence of DSM-III-R criteria for hypochondriasis and the occurrence of illness phobia before the onset of panic disorder. To explore further the possible relationship between hypochondriacal features and panic-agoraphobic syndrome, we compared patients both with and without current hypochondriasis and then patients both with and without illness phobia before the onset of panic disorder. Finally, we investigated the relationship between premorbid phobic-anxious traits and hypochondriasis during panic disorder. No differences were found between patients with and without hypochondriasis, either in terms of clinical features or in the course of panic disorder. Patients with illness phobia before the onset of panic disorder reported higher levels of anticipatory anxiety in nonagoraphobic situations and more depersonalization and derealization during panic attacks, and they met our definition of phobic-anxious temperament more frequently than the rest of the sample. This would suggest that illness phobia before the onset of panic disorder may be viewed either as a separate disorder, a prodrome, or a mild, early-onset form of panic disorder without full-blown attacks. Although patients with premorbid illness phobia are more likely to develop hypochondriasis after the onset of panic disorder, approximately 40% of them do not; therefore, illness phobia should not be considered the only factor that influences the development of hypochondriasis during panic disorder.

This study investigated the perceptual/cognitive abnormality model of hypochondriasis, which suggests that hypochondriacal patients amplify and misinterpret normal bodily sensations. The hypothesis was evaluated by assessing pain perception and stress reactivity in female hypochondriacal (N = 15) and female nonhypochondriacal control subjects (N = 15). Subjects completed self-report measures and participated in a laboratory stress reactivity assessment consisting of the cold pressor task and an imagery task. Hypochondriacal subjects exhibited a significant increase in heart rate during the cold pressor task and a significant drop in hand temperature relative to controls. Hand temperature remained lower among the hypochondriacal subjects after the cold pressor task was terminated. Hypochondriacal subjects terminated the cold pressor task more frequently, left their feet in the cold water bath a significantly shorter period of time, and rated the cold pressor task as significantly more unpleasant (although not more intense) relative to controls. Group differences were not observed in the imagery task. Of interest, hypochondriacal subjects' baseline heart rate was significantly lower than that of controls. Taken together, these data suggest that hypochondriacal behavior may be mediated, in part, by objective differences in physiological reactivity.

The history of the concept of Cotard's syndrome is traced from its inception in 1880 to the present day. Nihilistic delusions were described by Cotard to refer to a special type of hypochondriacal delusion associated to melancholia. Although Cotard himself and other XIX and XX centuries' psychiatrists have considered it from different approaches a specific clinical entity, most of the authors estimate that nihilistic delusion is either a syndrome or a symptom which can appear in different psychiatric disorders.

Psychophysiological responses to imagery of self-relevant illness threats were examined for high and low extreme groups of hypervigilants and health care utilizers. Heart rate, skin conductance, and respiration were the physiological measures recorded; self-reports of perceived illness vulnerability, negative affect, image clarity, and image realness were the psychological measures obtained. Responses to neutral, exercise, and illness threat scenes were compared. Hypervigilants showed an increased heart rate response to imagery of illness scenes, whereas all other groups returned more quickly to baseline levels. The results are similar to those reported by Lang for snake phobics. They also lend some support to Horowitz's theory of intrusive imagery, in which self-relevant, anxiety-provoking events tend to continuously intrude upon one's thoughts, and this intrusive imagery was reflected cardiovascularly. There could be several possible underlying mechanisms for these findings.

The paper has analysed hypochondriasis in terms of defence behaviour. The study sample consisted of 39 treated neurotics who felt themselves menaced by a serious disease which was not confirmed by appropriate medical examination and who came to the therapist with anxious states. Specific defence acts induced by hypochondriacal threat, stimuli inducing the states of threat and mechanisms responsible for formation and maintenance of their capability for inducing emotion were found in every patient. The results demonstrated that many manifestations of hypochondriasis considered generally as psychopathological symptoms were in fact meaningful defence responses against a threat which the patient believed existed.

Monosymptomatic hypochondriasis, including delusional parasitosis and non-neurotic dysmorphophobia, are disorders which have been observed and recorded over the past century. These disorders occur commonly, and can be associated with significant morbidity. Once ominous of an extremely poor prognosis, there now exists a significant literature to suggest efficacy for pimozide. Taking LSD as a model for 5-HT2 agonist mediated hallucinogenesis, it is possible to draw comparisons to the clinical picture associated with MHP and to identify potent 5-HT2 antagonism as a shared and perhaps requisite criterion for the successful pharmacologic treatment of this disorder. Additional studies are suggested which would add to the understanding of the pathophysiology of MHP.

The author lists the main theories of somatization and some of the pertinent empirical studies. The studies suggest that there is no single theory that can adequately explain somatization, which is not only multifactorially determined but is an exceedingly complex phenomenon. There is consistent empirical support for some of the theories, such as somatization being a function of depression or of anxiety, and little or inconsistent research support for some other theories, such as its being a symbolic method of communication or an attempt at conflict resolution. The contributions of the various etiological factors differ from one individual to the next, and it requires sometimes lengthy exploration before the extent of the various contributions can be gleaned.

Clinical descriptions of somatoform disorders tend to fall largely into the two main categories of conversion disorder and hypochondriasis. These disorders frequently occur in the context of other psychopathology and also tend to have a significant association with CNS disease. Evidence implicating alterations in brainstem reticular arousal and attentional mechanisms in the etiology of these disorders is reviewed. Relevant studies investigating cerebral asymmetry of function have tended to associate right hemisphere information processing style with the sensory, attentional and affective changes that characterize conversion disorders. It is suggested that brain research in the field of somatoform disorders look to the second somatosensory area (SII), which appears to be especially suited to the types of neurophysiological and neuropsychological dynamics that are generally presumed to underlie this class of maladies. Finally, it is argued that a biopsychosocial approach to the understanding of somatoform disorders requires the incorporation of neuropsychological data into a multidimensional conceptual framework.

The operant conditioning theory states that environmental stimuli greatly influence chronic pain behavior. In contrast, the hypochondriasis theory states that pain behavior is the result of an intensified pain perception which is part of a more general augmentation and amplification of normal bodily sensations. The operant theory predicts that pain behavior (operationalized as poorer endurance on the part of chronic low back pain patients as compared to the endurance of control subjects in a series of 6 working-to-tolerance treadmill tests) will decrease when no verbal or non-verbal feedback for treadmilling behavior is given. This hypothesis could not be confirmed in the present study. The hypochondriasis theory predicts that chronic pain patients will report more bodily sensations, both at rest and after treadmill exercises. This hypothesis was strongly supported by the findings of the present study.

The state of and interrelations between the kinesthetic and visual sensitivity were studied in 70 patients and 24 normal subjects by using the technique of parallel-sequential sensometry suggested by A. V. Zavyalov. At 30 sec intervals at the constant baseline irritation, 16 thresholds of weight differentiation and 16 thresholds of brightness differentiation were registered. The results were subjected to the correlational and informational analysis. It was established that hyposensitivity of the sensory systems studied was accompanied with the weakening of direct and strengthening of the inverse optical-kinesthetic correlation, the absence of the functional predominance of the kinesthetic analyzer over the visual one, low orderliness of the parameters of the interanalyzer relationship and a sharp liability of the intersensory correlation to the effect of the heterosensory irritant. Changes in the systemic organization of the sensory sphere seem to be responsible for various cenesthopathies.

EEG was used to study stable dominant states in 12 patients with sluggish forms of schizophrenia and 11 alcoholics. The control group consisted of 15 normals. The patients demonstrated the following traits : deviations in the EEG readings, reflecting the interaction of different cortical zones; a complex of signs indicative of changes in the development of a generalized, nonspecific component of the activation reaction compared to data of the control group; a certain rigidity in the dominant-subdominant relationships. In reduction of the pathological symptomatology and under the impact of unloading, dietic therapy (hunger) there were positive changes in the parameters characterizing the reaction of activators as well as differences in the EEG-correlations of 2 selected types of dominant states.

In an attempt to validate recent assertions that the strongest indicators of hysteria are the "positive" findings in the neurological examination, seven of the most accepted features (history of hypochondriasis, secondary gain, la belle indifference, nonanatomical sensory loss, split of midline by pain or vibratory stimulation, changing boundaries of hypalgesia, giveaway weakness) were sought in 30 consecutive neurology service admissions with acute structural nervous system damage. All subjects showed at least one of these findings; most presented three or four. The presence of these "positive" findings of hysteria in patients with acute structural brain disease invalidates their use as pathognomonic evidence of hysteria. A second, retrospective study on the misdiagnosis of hysteria demonstrated that women, homosexual men, the psychiatrically ill, and patients presenting plausible psychogenic explanations for their illness are most liable to be misdiagnosed. Certain disorders, particularly movement disorders and paralysis, are most often mislabeled as hysteria. A diagnosis of hysteria must be made with great caution as it so often proves incorrect.

The personality of two groups of constipated women (by delayed colonic transit or by colonic inertia) was compared to that of two control groups of arthritic patients (rheumatoid or degenerative disease) with the Minnesota Multiphasic Personality Inventory (MMPI). All subjects suffered from chronic pain. Constipated women were found to have significantly higher scores on the hypochondria, hysteria, control, and low back pain scales and a lower score on the masculinity-femininity scale. Discriminant analysis permitted us to sort out constipated from arthritic patients in 83% of the cases, on the basis of only the personality data. In women with constipation by delayed colonic transit, multiple regression analysis demonstrated a close link (r = 0.90; P less than 0.001) between transit time in the ascending colon and levels of anxiety. It is concluded that women with constipation of colonic origin have a different pattern of personality than arthritic women and that severe constipation may play the role of a defense mechanism, where psychophysiologic responses to life stresses replace normal emotional reactions.

It is usual to consider hypocondriac patients as jailed in their own bodies; of course, this jail may be a protection against declared paranoiac or paranoid states. However, our experience has shown us that in certain cases, there are some possibilities of aperture if we feel ourself free enough with our medical identity and if we keep silent as long as the patient is not able to hear us. A step is then allowed to him. Our prudent remark concerns the story which is then gradually revealed: it is often the story of the secret of maternal suffering which is enclosed in his own body.

A case of factitious diabetes is reported. The patient gave herself insulin intermittently over a four year period. A high concentration of insulin binding antibody was found with the antibody showing much greater avidity towards beef than human insulin. There was resistance to intravenously administered beef insulin with low concentrations of free insulin and high concentrations of bound insulin. In contrast, in response to a glucose tolerance test, both the free insulin and C-peptide responses were normal as was glucose tolerance. The clinical difference in responsiveness to the human and beef insulins is well illustrated in vitro by insulin binding differences and is probably a function not only of different equilibrium constants of the antibody for human and beef insulins but also of different high affinity binding site concentrations.

The effects of measured blood pressure, history of hypertension diagnosis, age, and neuroticism on number of somatic complaints and self-rated health were examined in a sample of 970 non-health-care-seeking adult men and women. Significant differences in number of somatic complaints and self-rated health were found due to age, neuroticism, and history of hypertension diagnosis. Measured blood pressure, however, was unrelated to both measures of health perception. With the exception of the effect of neuroticism on somatic complaints, the effects of the independent variables on health perceptions were rather small in magnitude and explained only small proportions of the variance. Age differences had a particularly weak effect on health perceptions, accounting for less variance than either neuroticism or history of hypertension diagnosis. A significant interaction of neuroticism with awareness of hypertension was found, but only for number of somatic complaints. These results suggest that health perception is a complex, multidimensional construct. The relatively weak influence of hypertension diagnosis on health perception may account for the difficulties in maintaining patient compliance with antihypertensive treatment.