FACTORS RELATED WITH HEALTH ANXIETY: IS THERE A ROLE OF ATTACHMENT IN HEALTH ANXIETY?

Abstract

In this study, it is aimed to examine the factors related with health anxiety especially the relationship between health anxiety and attachment styles. In order to achieve this purpose, researches done in the last 20 years have been searched using different databases (Web of Science, EBSCHOHost, Elsevier Science Direct, PsycARTICLES, PsycINFO, SocINDEX, ULAKBIM Turkish Medical Directory / Social Sciences Directory) with the key words of health anxiety, hypochondriasis, illness anxiety, and attachment. Taking into account the dimensions examined in the surveys, the relationship between health anxiety and attachment styles was examined under the headings of health anxiety and hypochondriasis, cognitive and interpersonal model of health anxiety, health anxiety and attachment, and approval seeking. First of all, general information on health anxiety is included. Later, cognitive and interpersonal models developed to better explain health anxiety were mentioned. After that, the theory of attachment found at the base of the interpersonal model, and research on the relationship between health anxiety and attachment styles has been included. It has been noted that health anxiety are a reflection of insecure attachment, particularly associated with anxious attachment. Lastly, reassurance seeking within the scope of the two models, was also included. In the conclusion section, a general summary of researches has been given and suggestions for future studies have been made.

Keywords

• Health Anxiety,Hypochondriasis,Illness Anxiety Disorder,Attachment Styles,Reassurance Seeking

SAĞLIK KAYGISI İLE İLİŞKİLİ FAKTÖRLER: SAĞLIK KAYGISINDA BAĞLANMANIN ROLÜ VAR MIDIR?

Abstract

Bu çalışmada sağlık kaygısı ile ilişkili faktörler özellikle de bağlanma stillerinin sağlık kaygısı ile ilişkisinin incelenmesi amaçlanmıştır. Bu amacı gerçekleştirmek için sağlık kaygısı, hipokondriazis, hastalık kaygısı ve bağlanma anahtar kelimeleri ile değişik veri tabanları kullanılarak (Web of Science, EBSCHOHost, Elsevier Science Direct, PsycARTICLES, PsycINFO, SocINDEX, ULAKBİM Türk Tıp Dizini/Sosyal Bilimler Dizini) son 20 yıl içerisinde yapılan araştırmalar taranmıştır. Taranan araştırmalarda incelenen boyutlar dikkate alınarak, sağlık kaygısı ve bağlanma stilleri arasındaki ilişki sağlık kaygısı ve hipokondriazis, sağlık kaygısının bilişsel ve kişilerarası modeli, sağlık kaygısı ve bağlanma ve onay arayıcılık başlıkları altında ele alınmıştır. Öncelikle, sağlık kaygısı ile ilgili genel bilgilere yer verilmiştir. Sonrasında, sağlık kaygısını daha iyi açıklamak için geliştirilmiş olan bilişsel modele ve kişilerarası modele değinilmiştir. Ardından, kişilerarası modelin temelinde yer alan bağlanma kuramına ve sağlık kaygısı ile bağlanma stilleri ilişkisine dair yapılan araştırmalara yer verilmiştir. Sağlık kaygısının güvensiz bağlanmanın bir yansıması olduğu, özellikle kaygılı bağlanma ile ilişkili olduğu belirtilmiştir. Son olarak, iki model kapsamında da onay arayıcılığa yer verilmiştir. Sonuç bölümünde ise, araştırmalar ile ilgili genel bir özet verilmiş ve gelecek çalışmalar için önerilerde bulunulmuştur. 

Keywords

• Sağlık Kaygısı,Hipokondriazis,Hastalık Kaygısı Bozukluğu,Bağlanma Stilleri,Onay Arayıcılık

References

1. Abramowitz, J. S., Deacon, B. J. & Valentiner, D. P. (2007). The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31 (6): 871-883.
2. Alberts, N. M. & Hadjistavropoulos, H. D. (2014). Parental illness, attachment dimensions, and health beliefs: testing the cognitive-behavioural and interpersonal models of health anxiety. Anxiety, Stress & Coping, 27 (2): 216-228.
3. Allen, L. A., Woolfolk, R. L., Escobar, J. I., Gara, M. A. & Hamer, R. M. (2006). Cognitive-behavioral therapy for somatization disorder: a randomized controlled trial. Archives of Internal Medicine, 166 (14): 1512-1518.
4. Amerikan Psikiyatri Birliği (APA) (2000). DSM-IV tanı ölçütleri başvuru el kitabı. E. Köroğlu (Çev.). Ankara: Hekimler Yayın Birliği.
5. Amerikan Psikiyatri Birliği (APA) (2013). DSM-V tanı ölçütleri başvuru el kitabı. E. Köroğlu (Çev.). Ankara: Hekimler Yayın Birliği.
6. Anagnostopoulos, F. & Botse, T. (2016). Exploring the role of neuroticism and ınsecure attachment in health anxiety, safety-seeking behavior engagement, and medical services utilization: A study based on an extended ınterpersonal model of health anxiety. SAGE Open, 6 (2): 1-13.
7. Asmundson, G. J., Abramowitz, J. S., Richter, A. A. & Whedon, M. (2010). Health anxiety: current perspectives and future directions. Current Psychiatry Reports, 12 (4): 306-312.
8. Bailer, J., Witthöft, M., Wagner, H., Mier, D., Diener, C. & Rist, F. (2014). Childhood maltreatment is associated with depression but not with hypochondriasis in later life. Journal of Psychosomatic Research, 77 (2): 104-108.

9. Barsky, A. J. (1992). Hypochondriasis and obsessive compulsive disorder. Psychiatric Clinics of North America, 15 (4): 791–801.
10. Barsky, A. J. & Ahern, D. K. (2004). Cognitive behavior therapy for hypochondriasis. Journal of the American Medical Association, 291 (12): 1464-1470.
11. Barsky, A. J., Ettner, S. L., Horsky, J. & Bates, D. W. (2001). Resource utilization of patients with hypochondriacal health anxiety and somatization. Medical Care, 39 (7): 705–715.
12. Barsky, A. J., Orav, E. J. & Bates, D. W. (2005). Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity. Archives of General Psychiatry, 62 (8): 903–910.
13. Barsky, A. J., Wool, C., Barnett, M. C. & Cleary, P. D. (1994). Histories of childhood trauma in adult hypochondriacal patients. American Journal of Psychiatry, 151 (3): 397-397.
14. Bartholomew, K. & Horowitz, L. (1991). Attachment styles among young adults: A test of a four category model. Journal of Personality and Social Psychology, 61 (2): 226-241.
15. Bellet, B. L. (2003). An investigation of personality factors in somatization and hypochondriacal tendencies: A study of coping style, attachment, alexithymia and empathy. Yayınlanmamış Doktora Tezi. Adelphi University, The Institute of Advanced Psychological Studies, New York.
16. Bianchi, G. N. (1971). The origins of disease phobia. Australia and New Zealand Journal of Psychiatry, 5 (4): 241-257.
17. Birley, A. J., Gillespie, N. A., Heath, A. C., Sullivan, P. F., Boomsma, D. I. & Martin, N. G. (2006). Heritability and nineteen-year stability of long and short EPQ-R Neuroticism scales. Personality and Individual Differences, 40 (4): 737-747.
18. Birnie, K. A., Sherry, S. B., Doucette, S., Sherry, D. L., Hadjistavropoulos, H. D. & Stewart, S. H. (2013). The Interpersonal Model of Health Anxiety: Testing predicted paths and model specificity. Personality and Individual Differences, 54 (7): 856-861.
19. Bleichhardt, G. & Hiller, W. (2007). Hypochondriasis and health anxiety in the German population. British Journal of Health Psychology, 12 (4): 511–523.
20. Bowlby, J. (1969). Attachment and loss (Vol. 1): Attachment. New York, NY: Basic Books.
21. Bowlby, J. (1973). Attachment and loss: Separation, anxiety and anger. New York: Basic Books.
22. Bowlby, J. (1988). A secure base: Clinical applications of attachment theory. London, England: Routledge.
23. Brennan, K. A., Clark, C. L. & Shaver, P. R. (1998). Self-report measurement of adult romantic attachment: An integrative overview. J. A.
24. Simpson & W. S. Rholes (Der.) Attachment theory and close relationships: İçinde 46-76. New York, NY: Guilford Press.
25. Calboli, F. C., Tozzi, F., Galwey, N. W., Antoniades, A., Mooser, V., Preisig, M., ... & Muglia, P. (2010). A genome-wide association study of neuroticism in a population-based sample. PloS One, 5 (7): e11504.
26. Ciechanowski, P. S., Walker, E. A., Katon, W. J. & Russo, J. E. (2002). Attachment theory: a model for health care utilization and somatization. Psychosomatic Medicine, 64 (4): 660-667.
27. Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennell, M., Ludgate, J., ... & Gelder, M. (1998). Two psychological treatments for hypochondriasis. A randomised controlled trial. The British Journal of Psychiatry, 173 (3): 218-225.
28. Creed, F. & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56 (4): 391–408.
29. DiLalla, D. L., Carey, G., Gottesman, I. I. & Bouchard Jr, T. J. (1996). Heritability of MMPI personality indicators of psychopathology in twins reared apart. Journal of Abnormal Psychology, 105 (4): 491-499.
30. Doherty-Torstrick, E. R., Walton, K. E. & Fallon, B. A. (2016). Cyberchondria: Parsing Health Anxiety From Online Behavior. Psychosomatics, 57 (4): 390-400.
31. Eifert, G. H. & Forsyth, J. P. (1996). Heart-focused and general illness fears in relation to parental medical history and separation experiences. Behaviour Research and Therapy, 34 (9): 735-739.
32. Escobar, J. I., Gara, M., Waitzkin, H., Silver, R. C., Holman, A. & Compton, W. (1998). DSM-IV hypochondriasis in primary care. General Hospital Psychiatry, 20: 155–159.
33. Fallon, B. A., Harper, K. M., Landa, A., Pavlicova, M., Schneier, F. R., Carson, A., ... & Liebowitz, M. R. (2012). Personality disorders in hypochondriasis: prevalence and comparison with two anxiety disorders. Psychosomatics, 53 (6): 566-574.
34. Feeney, J. A. & Ryan, S. M. (1994). Attachment style and affect regulation: relationships with health behavior and family experiences of illness in a student sample. Health Psychology, 13 (4): 334-345.
35. Ferguson, E. (2004). Personality as a predictor of hypochondriacal concerns. Journal of Psychosomatic Research, 56 (3): 307–312.
36. Fernandez, C., Fernandez, R. & Amigo, D. I. (2005). Characteristics and one-year follow-up of primary care patients with health anxiety. Primary Care and Community Psychiatry, 10 (3), 89-101.
37. Fink, P., Ornbol, E., Toft, T., Sparle, K. C., Frostholm, L. & Olesen, F. (2004). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161 (9): 1680-1691.
38. Fraley, R. C. & Shaver, P. R. (2000). Adult romantic attachment: Theoretical developments, emerging controversies, and unanswered questions. Review of General Psychology, 4 (2): 132-154.
39. Fraley, R. C. & Spieker, S. J. (2003). Are infant attachment patterns continuously or categorically distributed? A taxometric analysis of strange situation behavior. Developmental Psychology, 39 (3): 387-404.
40. Hadjistavropoulos, H. & Lawrence, B. (2007). Does anxiety about health influence eating patterns and shape-related body checking among females? Personality and Individual Differences, 43 (2): 319–328.
41. Hollifield, M., Tuttle, L., Paine, S. & Kellner, R. (1999). Hypochondriasis and somatization related to personality and attitudes toward self. Psychosomatics, 40 (5): 387-395.
42. Hotopf, M., Mayou, R., Wadsworth, M. & Wesseley, S. (1999). Childhood risk factors for adults with medically unexplained symptoms: Results from a national birth cohort study. American Journal of Psychiatry, 156 (11): 1796–1800.
43. Jones, S. L., Hadjistavropoulos, H. D. & Sherry, S. B. (2012). Health anxiety in women with early-stage breast cancer: What is the relationship to social support?. Canadian Journal of Behavioural Science/Revue Canadienne Des Sciences Du Comportement, 44 (2): 108-116.
44. Jordan, K. D., Williams, P. G. & Smith, T. W. (2015). Interpersonal Distinctions among Hypochondriacal Trait Components: Styles, Goals, Vulnerabilities, and Perceptions of Health Care Providers. Journal of Social and Clinical Psychology, 34 (6): 459-475.
45. Kendler, K. S., Aggen, S. H., Knudsen, G. P., Røysamb, E., Neale, M. C. & Reichborn-Kjennerud, T. (2011). The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. American Journal of Psychiatry, 168 (1): 29-39.
46. Kenyon, F. E. (1964). Hypochondriasis: A clinical study. British Journal of Psychiatry, 110 (467): 478-488.
47. Lagoe, C. & Atkin, D. (2015). Health anxiety in the digital age: An exploration of psychological determinants of online health information seeking. Computers in Human Behavior, 52: 484-491.
48. Longley, S. L., Watson, D. & Noyes Jr, R. (2005). Assessment of the hypochondriasis domain: the multidimensional inventory of hypochondriacal traits (MIHT). Psychological Assessment, 17 (1): 3-14.
49. Looper, K. J. & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psychological Medicine, 31 (4): 577–584.
50. Lopez-Sola, C., Alonso, P., Fontenelle, L. F., Cuadras, D., Menchón, J. M. & Harrison, B. J. (2013). P. 4. b. 005 Hypochondriasis, panic and obsessive–compulsive symptoms: genetic overlap in a twin-based population sample. European Neuropsychopharmacology, 23 (2): S514.
51. Macdonald, G. & Kingsbury, R. (2006). Does physical pain augment anxious attachment? Journal of Social and Personal Relationships, 23 (2): 291–304.
52. Main, M., Kaplan, N. & Cassidy, J. (1985). Security in infancy, childhood, and adulthood: A move to the level of representation. Monographs of the Society for Research in Child Development, 50 (1&2, Serial No. 209): 66-104.
53. Martin, A. & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68 (5): 770–777.
54. Maunder, R. G. & Hunter, J. J. (2001). Attachment and psychosomatic medicine: developmental contributions to stress and disease. Psychosomatic Medicine, 63 (4): 556-567.
55. Mykletun, A., Heradstveit, O., Eriksen, K., Glozier, N., Overland, S., Maland, J. G. & Wilhelmsen, I. (2009). Health anxiety and disability pension award: The HUSK Study. Psychosomatic Medicine, 71 (3): 353–360.
56. Noyes, R., Kathol, R. G., Fisher, M. M., Phillips, B. M., Suelzer, M. T. & Woodman, C. L. (1994). Psychiatric comorbidity among patients with hypochondriasis. General Hospital Psychiatry, 16 (2): 78-87.
57. Noyes, R., Carney, C. P., Hillis, S. L., Jones, L.E. & Langbehn, D. R. (2005). Prevalence and correlates of illness worry in the general population. Psychosomatics, 46 (6): 529–539.
58. Noyes Jr, R., Stuart, S. P., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A. & Yagla, S. J. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65 (2): 292-300.
59. Noyes, R., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L. & Yagla, S. J. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43 (4): 282–289.
60. Noyes, R., Watson, D. B., Carney, C. P., Letuchy, E. M., Peloso, P. M., Black, D. W. & Doebbeling, B. N. (2004). Risk factors for hypochondriacal concerns in a sample of military veterans. Journal of Psychosomatic Research, 57 (6): 529-539.
61. Puri, P. & Dimsdale, J. (2011). Health care utilization and poor reassurance. Psychiatric Clinics of North America, 34 (3): 525–544.
62. Ravitz, P., Maunder, R., Hunter, J., Sthankiya, B. & Lancee, W. (2010). Adult attachment measures: A 25-year review. Journal of Psychosomatic Research, 69 (4): 419-432.
63. Reiser, S. J. (2013). Childhood abuse and health anxiety: The roles of attachment and emotion regulation. Yayınlanmamış Doktora Tezi. University of Regina, Faculty of Graduate Studies and Research, Alberta.
64. Sakai, R., Nestoriuc, Y., Nolido, N. V. & Barsky, A. J. (2010). The prevalence of personality disorders in hypochondriasis. The Journal of Clinical Psychiatry, 71 (1): 41-47.
65. Salkovskis, P. M. & Warwick, H. M. C. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24 (5): 597-602.
66. Salkovskis, P. M. & Warwick, H. (2001). Making sense of hypochondriasis: a cognitive theory of health anxiety. G. Asmundson, S. Taylor & B. J. Cox (Der.) Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions. İçinde 46-64. New York: Wiley.
67. Salkovskis, P. M., Warwick, H. M., & Clark, D. M. (1993). Panic disorder and hypochondriasis. Advances in Behavior Research and Therapy, 15 (1): 23-48.
68. Salmon, P. & Calderbank, S. (1996). The relationship of childhood physical and sexual abuse to adult illness behavior. Journal of Psychosomatic Research, 40 (3): 329-336.
69. Schmidt, S., Strauss, B. & Braehler, E. (2002). Subjective physical complaints and hypochondriacal features from an attachment theoretical perspective. Psychology and Psychotherapy: Theory, Research and Practice, 75 (3): 313-332.
70. Sherry, D. L., Sherry, S. B., Vincent, N. A., Stewart, S. H., Hadjistavropoulos, H. D., Doucette, S. & Hartling, N. (2014). Anxious attachment and emotional instability interact to predict health anxiety: An extension of the interpersonal model of health anxiety. Personality and Individual Differences, 56: 89-94.
71. Starcevic, V. & Noyes, R. (2014). Hypochondriasis and Health Anxiety: A guide for Clinicians. New York: Oxford University Press.
72. Stuart, S., & Noyes, R. (1999). Attachment and interpersonal communication in somatization. Psychosomatics, 40 (1): 34-43.
73. Sunderland, M., Newby, J. M. & Andrews, G. (2013). Health anxiety in Australia: prevalence, comorbidity, disability and service use. The British Journal of Psychiatry, 202 (1): 56-61.
74. Sümer, N. & Güngör, D. (1999). Yetişkin bağlanma stilleri ölçeklerinin Türk örneklemi üzerinde psikometrik değerlendirmesi ve kültürlerarası bir karşılaştırma. Türk Psikoloji Dergisi, 14 (43): 71-106.
75. Taylor, S. & Asmundson, G. (2004). Treating health anxiety: A cognitive-behavioralapproach. New York, NY: Guilford.
76. Taylor, S., Thordarson, D. S., Jang, K. L. & Asmundson, G. J. (2006). Genetic and environmental origins of health anxiety: A twin study. World Psychiatry, 5 (1): 47-50.
77. te Poel, F., Baumgartner, S. E., Hartmann, T. & Tanis, M. (2016). The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. Journal of Anxiety Disorders, 43: 32-40.
78. Torgersen, S. (1986). Genetics of somatoform disorders. Archives of General Psychiatry, 43 (5): 502-505.
79. Waldinger, R., Schulz, M., Barsky, A. & Ahern, D. (2006). Mapping the road from childhood trauma to adult somatization: The role of attachment. Psychosomatic Medicine, 68 (1): 129–135.
80. Warwick, H. M. C. & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28 (2): 105-117.
81. Watt, M., O’Connor, R., Stewart, S., Moon, E. & Terry, L. (2008). Specificity of childhood learning experiences in relation to anxiety sensitivity and illness/ injury sensitivity. Journal of Cognitive Psychotherapy, 22 (2): 128–142.
82. Wearden, A., Perryman, K. & Ward, V. (2006). Adult attachment, reassurance seeking and hypochondriacal concerns in college students. Journal of Health Psychology, 11 (6): 877-886.
83. Weck, F., Neng, J. M., Göller, K. & Müller-Marbach, A. M. (2014). Previous experiences with illness and traumatic experiences: a specific risk factor for hypochondriasis? Psychosomatics, 55 (4): 362-371.
84. Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. John Wiley & Sons.
85. Williams, P. G., Smith, T. W., & Jordan, K. D. (2010). Health anxiety and hypochondriasis: Interpersonal extensions of the cognitive-behavioral perspective. G. Beck (Der.) Interpersonal processes in the anxiety disorders: İçinde 261–284. Washington, DC: American Psychological Association.