Is Hypochondriasis Related to Obsessive-Compulsive Disorder, Panic Disorder, or Both? An Empirical Evaluation

Although hypochondriasis (HC) is considered a somatoform disorder in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision), some authors have pointed out that the symptoms of HC overlap with certain anxiety disorders, namely, panic disorder (PD) and obsessive-compulsive disorder (OCD). Few studies have empirically addressed this overlap. In the present investigation, we used discriminant function analysis to explore how patients with a principal diagnosis of HC, OCD, or PD varied with respect to cardinal symptoms of these disorders (i.e., health anxiety, obsessions and compulsions, and panic-related anxiety and avoidance) and key cognitive biases (i.e., intolerance of uncertainty, anxiety sensitivity, and body vigilance). Fifty treatment-seeking individuals with PD, 21 with OCD, and 23 with HC completed self-report measures of symptoms and cognitions during their clinic visit. Results indicated that whereas individuals with HC experience panic attacks, obsessions, and compulsions, these symptoms are markedly less pronounced than among those with PD and OCD. Conversely, overlaps were found in terms of cognitive biases, with HC patients demonstrating elevated levels of intolerance of uncertainty, body vigilance, and fear of cardiovascular symptoms. Implications for the conceptualization and treatment of HC are discussed.

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Intolerance of Uncertainty in OCD

10.1093/med/9780190228163.003.0017 ◽

2017 ◽

Author(s):

Ryan J. Jacoby ◽

Jonathan S. Abramowitz

Keyword(s):

Obsessive Compulsive Disorder ◽

Daily Life ◽

Intolerance Of Uncertainty ◽

Self Report ◽

Obsessive Compulsive ◽

Reassurance Seeking ◽

Compulsive Disorder ◽

Definition Of ◽

Behavioral Methods ◽

Cognitive Construct

Intolerance of uncertainty (IU) is a key cognitive construct in the maintenance of obsessive-compulsive disorder (OCD) symptoms. Whereas most individuals feel “certain-enough” that situations are relatively safe, those with OCD who have elevated IU have difficulty managing the feeling of not knowing “for sure” whether a feared outcome may occur. As a result, they engage in compulsive rituals (e.g., checking, reassurance seeking) with the aim of restoring a sense of certainty. Given the pervasiveness of uncertainty in daily life, these doubts and rituals can lead to heightened daily distress for individuals with OCD. Accordingly, the present chapter reviews the following: (a) a comprehensive definition of IU, (b) the conceptualization of IU as important in the development and maintenance of OCD across various symptom presentations, (c) the measurement of IU using both self-report and behavioral methods, and (d) recommendations for the consideration of IU in OCD treatment.

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Patterns of Reassurance Seeking and Reassurance-Related Behaviours in OCD and Anxiety Disorders

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465812000665 ◽

2012 ◽

Vol 41 (1) ◽

pp. 1-23 ◽

Cited By ~ 33

Author(s):

Osamu Kobori ◽

Paul M. Salkovskis

Keyword(s):

Panic Disorder ◽

Anxiety Disorders ◽

Obsessive Compulsive Disorder ◽

Reliability And Validity ◽

The Other ◽

Self Report ◽

Healthy Controls ◽

Obsessive Compulsive ◽

Reassurance Seeking ◽

Compulsive Disorder

Background: Reassurance seeking is particularly prominent in obsessive-compulsive disorder (OCD) and may be important in OCD maintenance. Aims: This study used a new self-report questionnaire to measure the range of manifestations of reassurance-seeking behaviours, describing their sources from which they seek, frequency, process (how they seek), and consequences (as opposed to triggers and motivations). This study also attempts to identify the degree to which reassurance is specific to OCD as opposed to panic disorder. Method: Reassurance Seeking Questionnaire (ReSQ) was administered to 153 individuals with OCD, 50 individuals with panic disorder with/without agoraphobia, and 52 healthy controls. The reliability and validity of the measure was evaluated and found to be satisfactory. Results: Reassurance seeking was found to be more frequent in both anxiety disorders relative to healthy controls. Individuals diagnosed with OCD were found to seek reassurance more intensely and carefully, and were more likely to employ “self-reassurance” than the other two groups. Conclusions: Further investigation of reassurance will enable better understanding of its role in the maintenance of anxiety disorders in general and OCD in particular.

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Panic Attacks and Anxiety Disorders

10.2310/em.4192 ◽

2020 ◽

Author(s):

Curtis Wittmann

Keyword(s):

Emergency Department ◽

Anxiety Disorder ◽

Panic Disorder ◽

Anxiety Disorders ◽

Obsessive Compulsive Disorder ◽

Stress Disorder ◽

Acute Stress ◽

Panic Attacks ◽

Obsessive Compulsive ◽

Compulsive Disorder

This review discusses the acute diagnosis and management of panic and anxiety disorders. Anxiety disorders are among the most common psychiatric disorders in the country and are a relatively common cause of presentation to the emergency department. Most anxiety disorders can be conceptualized as fear- or phobia-based disorders, including panic disorder, specific phobia, social phobia, acute stress disorder, posttraumatic stress disorder, and obsessive-compulsive disorder. Each of these disorders is discussed, including prevalence and common clinical presentations. The initial evaluation of patients with a suspected or diagnosed anxiety disorder will be based on their current symptoms. Some patients may be highly agitated and may require deescalation or sedation to perform a reasonable history and physical examination. To achieve this, providers should ensure their own safety first, with attention to the physical layout of the emergency department, ensuring that they are closer to the room exit than the patient (so that they cannot be trapped). The presence of police or security may be necessary to provide optimal care and an appropriate evaluation. Typical treatment of acute exacerbations of anxiety disorders includes medical management, most often benzodiazepines, which can provide immediate relief. Psychiatric consultation may be necessary in certain cases. For most patients, outpatient management rather than inpatient admission will lead to the most effective management of their anxiety. Key words: anxiety disorder, obsessive-compulsive disorder, panic disorder, phobia, stress disorder This review contains 1 highly rendered figure, 17 tables, and 29 references.

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Affective forecasting accuracy in obsessive compulsive disorder

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465819000134 ◽

2019 ◽

Vol 47 (5) ◽

pp. 573-584 ◽

Cited By ~ 1

Author(s):

Dianne M. Hezel ◽

S. Evelyn Stewart ◽

Bradley C. Riemann ◽

Richard J. McNally

Keyword(s):

Obsessive Compulsive Disorder ◽

Cognitive Biases ◽

Affective Forecasting ◽

Self Report ◽

Negative Events ◽

Obsessive Compulsive ◽

Socially Anxious ◽

Forecasting Accuracy ◽

Compulsive Disorder ◽

Broad Domain

AbstractBackground:Research indicates that people suffering from obsessive compulsive disorder (OCD) possess several cognitive biases, including a tendency to over-estimate threat and avoid risk. Studies have suggested that people with OCD not only over-estimate the severity of negative events, but also under-estimate their ability to cope with such occurrences. What is less clear is if they also miscalculate the extent to which they will be emotionally impacted by a given experience.Aims:The aim of the current study was twofold. First, we examined if people with OCD are especially poor at predicting their emotional responses to future events (i.e. affective forecasting). Second, we analysed the relationship between affective forecasting accuracy and risk assessment across a broad domain of behaviours.Method:Forty-one OCD, 42 non-anxious, and 40 socially anxious subjects completed an affective forecasting task and a self-report measure of risk-taking.Results:Findings revealed that affective forecasting accuracy did not differ among the groups. In addition, there was little evidence that affective forecasting errors are related to how people assess risk in a variety of situations.Conclusions:The results of our study suggest that affective forecasting is unlikely to contribute to the phenomenology of OCD or social anxiety disorder. However, that people over-estimate the hedonic impact of negative events might have interesting implications for the treatment of OCD and other disorders treated with exposure therapy.

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To achieve a sense of rightness: The joint role of Not Just Right Experiences and Intolerance of Uncertainty in Obsessive-Compulsive Disorder

Journal of Obsessive-Compulsive and Related Disorders ◽

10.1016/j.jocrd.2021.100627 ◽

2021 ◽

Vol 29 ◽

pp. 100627

Author(s):

Belén Pascual-Vera ◽

Amparo Belloch ◽

Marta Ghisi ◽

Claudio Sica ◽

Gioia Bottesi

Keyword(s):

Obsessive Compulsive Disorder ◽

Intolerance Of Uncertainty ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Not Just Right Experiences ◽

Just Right

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The inner world of overactive monitoring: neural markers of interoception in obsessive–compulsive disorder

Psychological Medicine ◽

10.1017/s0033291717000368 ◽

2017 ◽

Vol 47 (11) ◽

pp. 1957-1970 ◽

Cited By ~ 29

Author(s):

A. Yoris ◽

A. M. García ◽

L. Traiber ◽

H. Santamaría-García ◽

M. Martorell ◽

...

Keyword(s):

Panic Disorder ◽

Obsessive Compulsive Disorder ◽

Evoked Potential ◽

Cognitive Profile ◽

Healthy Controls ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Inner World ◽

External Stimuli ◽

Internal Body

BackgroundObsessive–compulsive disorder (OCD) patients typically overmonitor their own behavior, as shown by symptoms of excessive doubt and checking. Although this is well established for the patients’ relationship with external stimuli in the environment, no study has explored their monitoring of internal body signals, a process known to be affected in anxiety-related syndromes. Here, we explored this issue through a cardiac interoception task that measures sensing of heartbeats. Our aim was to explore key behavioral and electrophysiological aspects of internal-cue monitoring in OCD, while examining their potential distinctiveness in this condition.MethodWe administered a heartbeat detection (HBD) task (with related interoceptive confidence and awareness measures) to three matched groups (OCD patients, panic disorder patients, healthy controls) and recorded ongoing modulations of two task-relevant electrophysiological markers: the heart evoked potential (HEP) and the motor potential (MP).ResultsBehaviorally, OCD patients outperformed controls and panic patients in the HBD task. Moreover, they exhibited greater amplitude modulation of both the HEP and the MP during cardiac interoception. However, they evinced poorer confidence and awareness of their interoceptive skills.ConclusionsConvergent behavioral and electrophysiological data showed that overactive monitoring in OCD extends to the sensing of internal bodily signals. Moreover, this pattern discriminated OCD from panic patients, suggesting a condition-distinctive alteration. Our results highlight the potential of exploring interoceptive processes in the OCD spectrum to better characterize the population's cognitive profile. Finally, these findings may lay new bridges between somatic theories of emotion and cognitive models of OCD.

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Pindolol augmentation in treatment-resistant panic disorder and obsessive-compulsive disorder

European Neuropsychopharmacology ◽

10.1016/s0924-977x(98)80074-6 ◽

1998 ◽

Vol 8 ◽

pp. S99 ◽

Cited By ~ 3

Author(s):

J. Zohar ◽

P.N. Dannon ◽

Y. Sasson ◽

S. Hirschmann ◽

I. Iancu ◽

...

Keyword(s):

Panic Disorder ◽

Obsessive Compulsive Disorder ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Compulsive Disorder

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Initial Data on Recollections of Pathways to Inflated Responsibility Beliefs in Patients with Obsessive-Compulsive Disorder

Behavioural and Cognitive Psychotherapy ◽

10.1017/s1352465813001112 ◽

2014 ◽

Vol 43 (4) ◽

pp. 385-395 ◽

Cited By ~ 7

Author(s):

Meredith E. Coles ◽

Casey A. Schofield ◽

Jacob A. Nota

Keyword(s):

Initial Data ◽

Obsessive Compulsive Disorder ◽

Self Report ◽

Published Data ◽

Obsessive Compulsive ◽

Childhood Experiences ◽

Childhood Exposure ◽

Compulsive Disorder ◽

Inflated Responsibility ◽

Maladaptive Beliefs

Background: Despite literature establishing a relationship between maladaptive beliefs and symptoms of obsessive-compulsive disorder (OCD), there are few studies addressing how these beliefs develop. Salkovskis and colleagues (1999) proposed specific domains of childhood experiences leading to heightened beliefs regarding responsibility. Prior studies in students and individuals who just completed treatment for OCD have found support for this theory. However, we are not aware of published data from individuals with current OCD. Aims: This paper presents initial data from adults currently meeting criteria for OCD as well as both anxious and non-anxious controls. Method: Recollections of childhood experiences, current OCD-related beliefs, and OCD symptoms were assessed using self-report measures in 39 individuals seeking treatment for OCD, 36 anxious controls and 39 healthy controls. Results: Initial data suggested that in individuals with OCD, increased reports of childhood exposure to overprotection and experiences where one's actions caused or influenced misfortune were associated with stronger OCD-related beliefs. Further, compared to community controls, individuals with OCD reported more childhood experiences where one's actions caused or influenced misfortune, though they did not differ from anxious controls in childhood responsibility experiences. Conclusions: These initial findings provide minimal support for the proposed model of the development of inflated responsibility beliefs, and highlight the need for research examining the etiology of OCD related beliefs with updated models, larger samples, and ultimately using prospective methods.

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