Am J Psychiatry 1993; 150:1085-1089
Copyright © 1993 by American Psychiatric Association
Hypochondriacal patients' beliefs about good health
AJ Barsky, RR Coeytaux, MK Sarnie and PD Cleary
Department of Psychiatry, Harvard Medical School, Boston, MA.
OBJECTIVE: The authors hypothesized that hypochondriacal patients
mistakenly believe good health to be a symptom-free state and that they
consider more symptoms to be indicative of disease than do
nonhypochondriacal patients. METHOD: The Health Norms Sorting Task was
developed to assess the standard used to decide whether one is sick or
healthy; the respondent must classify 24 common and ambiguous symptoms as
"healthy" or "not healthy." This instrument demonstrated good test- retest
reliability and intrascale consistency. It was then administered to 60
patients with DSM-III-R hypochondriasis and 60 nonhypochondriacal patients
randomly selected from the same general medicine clinic. RESULTS:
Hypochondriacal patients considered significantly more symptoms to be
indicative of disease than did the comparison group. Health Norms Sorting
Test scores were correlated with hypochondriacal symptoms, somatization,
and self-reported bodily amplification (sensitivity to bodily sensation).
Test scores were not related to aggregate medical morbidity, medical care
utilization, or sociodemographic characteristics. CONCLUSIONS: These data
are compatible with the hypothesis that patients with DSM-III-R
hypochondriasis believe good health to be relatively symptom free and
consider more symptoms indicative of sickness. This may contribute to some
of the clinical features of hypochondriasis, including the numerous somatic
symptoms, bodily preoccupation, resistance to reassurance, and pursuit of
medical care.
