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Test of an Interpersonal Model of Hypochondriasis

From the Departments of Biostatistics (D.R.L.), Internal Medicine (B.A.M.), and Psychiatry (R.N., S.P.S., D.R.L.), University of Iowa Colleges of Medicine and Public Health, Iowa City, Iowa, and the Institute of Health, Health Care Policy and Aging Research (S.L.L.), Rutgers University, New Brunswick, New Jersey.

Address correspondence to: Dr. Russell Noyes, Jr., Psychiatry Research, Medical Education Bldg., Iowa City, IA 52242-1000. Email: russell-noyes{at}uiowa.edu

OBJECTIVE: The aim of this study was to test the interpersonal model of hypochondriasis proposed by Stuart and Noyes. According to this model, hypochondriasis is associated with insecure attachment that in adults gives rise to abnormal care-seeking behavior. Such behavior is associated with interpersonal difficulties and strained patient-physician relationships.

METHODS: One hundred sixty-two patients attending a general medicine clinic were interviewed and asked to complete self-report measures. Instruments included the Whiteley Index of Hypochondriasis, Somatic Symptom Inventory, Relationship Scales Questionnaire, Inventory of Interpersonal Problems, NEO Five-Factor Index, and measures of physician-patient interaction. The Structured Diagnostic Interview for DSM-III-R Hypochondriasis was also administered.

RESULTS: Hypochondriacal and somatic symptoms were positively correlated with all of the insecure attachment styles, especially the fearful style. These same symptoms were positively correlated with self-reported interpersonal problems and negatively correlated with patient ratings of satisfaction with, and reassurance from, medical care. Hypochondriacal and somatic symptoms were also positively correlated with neuroticism.

CONCLUSIONS: The findings indicate that hypochondriacal patients are insecurely attached and have interpersonal problems that extend to and include the patient-physician relationship. These data support the proposed interpersonal model of hypochondriasis.

Key Words: attachment style, • hypochondriasis, • interpersonal model, • patient-physician relationship, • interpersonal problems, • reassurance.

Abbreviations: HAQ = Health Anxiety Questionnaire.

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