Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples

Abstract

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Keywords

health anxiety Whiteley Index latent structure taxometric analysis representative sample

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

Asmundson

G. J.

Taylor

Carleton

R. N.

Weeks

J. W.

Hadjstavropoulos

H. D.

(2012). Should health anxiety be carved at the joint? A look at the health anxiety construct using factor mixture modeling in a non-clinical sample. Journal of Anxiety Disorders, 26(1), 246–251. https://doi.org/10.1016/j.janxdis.2011.11.009

Barsky

A. J.

Cleary

P. D.

Wyshak

Spitzer

R. L.

Williams

J. B.

Klerman

G. L.

(1992). A structured diagnostic interview for hypochondriasis: A proposed criterion standard. The Journal of Nervous and Mental Disease, 180(1), 20–27. https://doi.org/10.1097/00005053-199201000-00006

Bleichhardt

Hiller

(2007). Hypochondriasis and health anxiety in the German population. British Journal of Health Psychology, 12(4), 511–523. https://doi.org/10.1348/135910706X146034

Boston

A. F.

Merrick

P. L.

(2010). Health anxiety among older people: An exploratory study of health anxiety and safety behaviors in a cohort of older adults in New Zealand. International Psychogeriatrics, 22(4), 549–558. https://doi.org/10.1017/S1041610209991712

Conradt

Cavanagh

Franklin

Rief

(2006). Dimensionality of the Whiteley Index: Assessment of hypochondriasis in an Australian sample of primary care patients. Journal of Psychosomatic Research, 60(2), 137–143. https://doi.org/10.1016/j.jpsychores.2005.07.003

Ferguson

(2009). A taxometric analysis of health anxiety. Psychological Medicine, 39(2), 277–285. https://doi.org/10.1017/S0033291708003322

Fink

Ewald

Jensen

Sørensen

Engberg

Holm

Munk-Jørgensen

. (1999). Screening for somatization and hypochondriasis in primary care and neurological in-patients: A seven-item scale for hypochondriasis and somatization. Journal of Psychosomatic Research, 46(3), 261–273. https://doi.org/10.1016/S0022-3999(98)00092-0

Fink

Ørnbøl

Christensen

K. S.

(2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLOS ONE, 5(3), e9873. https://doi.org/10.1371/journal.pone.0009873

10.

Gerolimatos

L. A.

Edelstein

B. A.

(2012). Predictors of health anxiety among older and young adults. International Psychogeriatrics, 24(12), 1998–2008. https://doi.org/10.1017/S1041610212001329

11.

Gropalis

Witthöft

Bailer

Weck

(2018). Optimizing exposure therapy for pathological health anxiety: Considerations from the inhibitory learning approach. Cognitive and Behavioral Practice, 25(2), 250–260. https://doi.org/10.1016/j.cbpra.2017.09.001

12.

Hartmann

Bräscher

A. K.

Forbush

K. T.

Sellbom

Watson

Witthöft

(2022). The somatoform spectrum within the hierarchical taxonomy of psychopathology system: A taxometric test of the latent structure. Psychosomatic Medicine, 84(9), 1067–1076. https://doi.org/10.1097/PSY.0000000000001105

13.

Häuser

Hausteiner-Wiehle

Henningsen

Brähler

Schmalbach

Wolfe

(2020). Prevalence and overlap of somatic symptom disorder, bodily distress syndrome and fibromyalgia syndrome in the German general population: A cross sectional study. Journal of Psychosomatic Research, 133, 110111. https://doi.org/10.1016/j.jpsychores.2020.110111

14.

Hinz

Rief

Brähler

(2003). Hypochondria in the general population: Test statistical assessment and standardization of the Whiteley-Index. Diagnostica, 49, 34–42. https://doi.org/10.1026/0012-1924.49.1.34

15.

JASP Team. (2021). JASP (Version 0.15) [Computer software].

16.

Kellner

Abbott

Winslow

Pathak

(1987). Fears, beliefs and attitudes in DSM-III hypochondriasis. Journal of Nervous and Mental Disease, 175, 20–25. https://doi.org/10.1097/00005053-198701000-00004

17.

Kotov

Krueger

R. F.

Watson

Achenbach

T. M.

Althoff

R. R.

Bagby

R. M.

Brown

T. A.

Carpenter

W. T.

Caspi

Clark

L. A.

Eaton

N. R.

Forbes

M. K.

Forbush

K. T.

Goldberg

Hasin

Hyman

S. E.

Ivanova

M. Y.

Lynam

D. R.

Markon

. . .Zimmerman

(2017). The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126(4), 454–477. https://doi.org/10.1037/abn0000258

18.

Longley

S. L.

Broman-Fulks

J. J.

Calamari

J. E.

Noyes

Wade

Orlando

C. M.

(2010). A taxometric study of hypochondriasis symptoms. Behavior Therapy, 41(4), 505–514. https://doi.org/10.1016/j.beth.2010.02.002

19.

Meehl

P. E.

(1995). Bootstraps taxometrics: Solving the classification problem in psychopathology. American Psychologist, 50(4), 266–275. https://doi.org/10.1037/0003-066X.50.4.266

20.

Norbye

A. D.

Abelsen

Førde

O. H.

Ringberg

(2020). Distribution of health anxiety in a general adult population and associations with demographic and social network characteristics. Psychological Medicine, 52(12), 2252–2262. https://doi.org/10.1017/S0033291720004122

21.

Pilowsky

(1967). Dimensions of hypochondriasis. The British Journal of Psychiatry, 113(494), 89–93. https://doi.org/10.1192/bjp.113.494.89

22.

R Core Team. (2021)R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/

23.

Rief

Hiller

Geissner

Fichter

M. M.

(1994). Hypochondriasis: Assessment and initial clinical results. Zeitschrift für Klinische Psychologie, 23(1), 34–42.

24.

Ruggero

C. J.

Kotov

Hopwood

C. J.

First

Clark

L. A.

Skodol

A. E.

Mullins-Sweatt

S. N.

Patrick

C. J.

Bach

Cicero

D. C.

Docherty

Simms

L. J.

Bagby

R. M.

Krueger

R. F.

Callahan

J. L.

Chmielewski

Conway

C. C.

De Clercq

Dornbach-Bender

. . .Zimmermann

(2019). Integrating the Hierarchical Taxonomy of Psychopathology (HiTOP) into clinical practice. Journal of Consulting and Clinical Psychology, 87(12), 1069–1084. https://doi.org/10.1037/ccp0000452

25.

Ruscio

Carney

L. M.

Dever

Pliskin

Wang

S. B.

(2018). Using the Comparison Curve Fit Index (CCFI) in taxometric analyses: Averaging curves, standard errors, and CCFI profiles. Psychological Assessment, 30(6), 744–754.

26.

Ruscio

A. M.

Carney

L. M.

(2011). Performing taxometric analysis to distinguish categorical and dimensional variables. Journal of Experimental Psychopathology, 2(2), 170–196. https://doi.org/10.5127/jep.010910

27.

Ruscio

Walters

G. D.

(2011). Differentiating categorical and dimensional data with taxometric analysis: Are two variables better than none? Psychological Assessment, 23(2), 287–299. https://doi.org/10.1037/a0022054

28.

Ruscio

Wang

S. B.

(2021). RTaxometrics: Taxometric analysis (R package version 3.1). https://CRAN.R-project.org/package=RTaxometrics

29.

Schomerus

Matschinger

Angermeyer

M. C.

(2013). Continuum beliefs and stigmatizing attitudes towards persons with schizophrenia, depression and alcohol dependence. Psychiatry Research, 209(3), 665–669. https://doi.org/10.1016/j.psychres.2013.02.006

30.

Schwarz

Witthöft

Bailer

(2007). Critical testing of the factoral structure and construct validity of the Whiteley-Index—An established screening instrument to assess hypochondriasis. Zeitschrift für Klinische Psychologie und Psychotherapie, 36(2), 128–136. https://doi.org/10.1026/1616-3443.36.2.128

31.

Sellbom

Forbush

K. T.

Gould

S. R.

Markon

K. E.

Watson

Witthöft

(2022). HiTOP assessment of the somatoform spectrum and eating disorders. Assessment, 29(1), 62–74. https://doi.org/10.1177/10731911211020825

32.

Tyrer

(2020). COVID-19 health anxiety. World Psychiatry, 19(3), 307–308. https://doi.org/10.1002/wps.20798

33.

Walters

G. D.

Ruscio

(2009). To sum or not to sum: Taxometric analysis with ordered categorical assessment items. Psychological Assessment, 21, 99–111. https://doi.org/10.1037/a0015010