Avoidance in hypochondriasis

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Highlights

  • The DSM-5 adds avoidance as a behavioral response to illness fears in IAD, but not SSD

  • 195 individuals with DSM-IV-tr hypochondriasis were evaluated using latent class and FMM analyses using the H-YBOCS-M

  • A 2-class model was best. Avoidant vs. Non-avoidant further analyzed

  • The Avoidant group demonstrated more hypochondriacal symptom severity, functional impairment, anxiety, and lower quality of life

  • Avoidance appears to be a valid behavioral construct, but may be applicable to SSD as well as IAD

Abstract

The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears – one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported.

Methods

195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale – Modified.

To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models.

Results

A two-class factor mixture model fit the data best, with Class 1 (n = 147) exhibiting a greater level of severity of avoidance than Class 2 (n = 48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life.

Conclusion

These results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder.

Section snippets

Participants

One hundred ninety-five individuals with primary hypochondriasis participated in a dual-site randomized double-blind intervention trial of two therapies for hypochondriasis, (cognitive behavior therapy and pharmacotherapy), conducted from 2006 to 2011 (for more detailed information, see Skritskaya et al., [8]). The sample was 56.4% female, with mean age of 39.7 years (SD = 14.3 [8]). For the purposes of this study, we examined baseline data prior to treatment, with all participants meeting DSM-IV

Descriptive statistics

Participants were rated by Independent Evaluator clinicians—blinded to treatment wing—to have “marked” illness concerns on the HIC Severity Scale in the past two weeks [8]. Participants had average WI scores of 49.39 (SD = 9.58, Range = 0–69), average STAI scores of 51.57 (SD = 13.62), and mild depression (BDI-II M = 16.67, SD = 11.34, Range = 0–50). Participants reported a mean score of 43.68 on the Q-LES-Q-SF (SD = 10.13, Range = 0–50), lower than reported in participants with GAD [39]. Functional impairment

Discussion

Maladaptive avoidance in hypochondriasis has not been well-studied. We sought to address this gap in the literature, given that the DSM-5 includes subtypes demarcated by care-seeking versus care-avoidant behaviors and new criteria for IAD. Our hypotheses that comparison of latent trait, latent class, and factor mixture model fit to H-YBOCS-M avoidance items would reveal a two-class model, and that these two classes would be distinguished as avoidant and non-avoidant of illness stimuli, were

Acknowledgments

Supported in part by an NIH grant to Dr. Fallon (RO1MH071456) and Dr. Barsky (RO1MH071456).

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