The Combination of Health Anxiety and Somatic Symptoms: Examining Associations with Health-Related Beliefs and Gender Differences

Current diagnostic criteria suggest that some individuals experience health anxiety and severe somatic symptoms, whereas others experience health anxiety and either no or mild somatic symptoms. However, to date, our understanding of potential differences among individuals with health anxiety and varying severity of somatic symptoms remains limited. Adopting a dimensional approach, we completed this study to help fill this gap in the literature by exam- ining whether the interactive effect between health anxiety and somatic symptoms was related to health-related beliefs among men (η = 211) and women (η = 220). Among both men and women, health anxiety was related to certain health-related beliefs, particularly anxiety sensitivity, only when coupled with severe somatic symptoms. Conceptual and therapeutic implications of these results are discussed.Keywords: anxiety sensitivity; gender; health anxiety; illness anxiety disorder; somatic symptom disorderAccording to Asmundson and Taylor (2005), "most cognitive-behavioral researchers and practitioners use the term health anxiety to describe the wide range of worry that people can have about their health" (p. 5, emphasis in original). Cognitive-behavioral researchers have conceptualized severe health anxiety as hypochondriasis (Abramowitz & Braddock, 2008; Taylor & Asmundson, 2004), but hypochondriasis was eliminated as a disorder in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (5 th ed.; DSM-5; American Psychiatric Association [APA], 2013a). Health anxiety is still prominently featured within the DSM-5 because two DSM-5 psychological disorders classified within the somatic symptom and related disorders section share health anxiety as a cardinal symptom (APA, 2013a, 2013b). The APA (2013b) noted that most individuals previously diagnosed with hypochondriasis experience health anxiety and severe somatic symptoms. Based on the DSM-5 classification, these individuals would receive a diagnosis of somatic symptom disorder. The APA (2013b) further noted that other individuals experience health anxiety but either no or mild somatic symptoms. Based on the DSM-5 classification, these individuals would receive a diagnosis of illness anxiety disorder.Whereas the distinctiveness of somatic symptom disorder and illness anxiety disorder has been questioned (Starcevic, 2013), preliminary data highlight differences among individuals with health anxiety and varying severity of somatic symptoms. For example, Creed (2011) found that individuals with elevated health anxiety and severe somatic symptoms showed greater mental health complaints and medical consultations relative to individuals with elevated health anx- iety and mild somatic symptoms. Creed's findings raise the possibility that there exist important differences among individuals with health anxiety and varying severity of somatic symptoms. However, beyond Creed's preliminary findings, our understanding of differences in the concur- rent presentation of health anxiety and somatic symptoms remains limited.Starcevic (2013) raised the possibility that individuals with somatic symptom disorder may differ from individuals with illness anxiety disorder, such that individuals with somatic symptom disorder could be especially likely to hold the belief that they suffer from a medical problem. Health-related beliefs lead to disease conviction within cognitive-behavioral models because these models hold that individuals misinterpret bodily experiences (e.g., sensations, symptoms) as the sign of a medical problem as a result of dysfunctional beliefs about health (Abramowitz & Braddock, 2008; Salkovskis & Warwick, 2001; Taylor & Asmundson, 2004). Because somatic symptom disorder is marked by the concurrent presentation of health anxiety and somatic symp- toms, as well as purportedly heightened disease conviction, the combination of health anxiety and somatic symptoms may cluster strongly with certain health-related beliefs. …