Rolf Leibbrand

Hypochondriasis and somatization: two distinct aspects of somatoform disorders?

We investigated boundaries and overlap between somatization and hypochondriasis on different levels of psychopathology: (1) comorbidity between hypochondriasis and somatization on the level of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994): (2) comorbidity with other mental disorders; (3) differences in clinical characteristics: and (4) overlap on the level of psychometric measures. The sample consisted of 120 psycho somatic inpatients. Somatoform, hypochondriacal, and depressive symptomatology, cognitions about body and health, and further aspects of general symptomatology were investigated. Diagnoses of Axis I and II were based on DSM-IV Our results suggest a large overlap on the level of DSM-IV-diagnoses: only 3 of 31 hypochondriacal patients had no multiple somatoform symptoms, while 58 of 86 patients with multiple somatoform symptoms had no hypochondriasis. However, the overlap between hypochondriacal and somatization symptomatology on the level of psychometric measurement is only moderate, indicating that hypochondriasis is a markedly distinct aspect of somatoform disorders.

Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment

Background: Predictors of treatment outcome were evaluated in a clinical sample suffering from hypochondriasis. Methods: The sample consisted of 96 patients with hypochondriacal disorder according to DSM-IV or high syndrome scores on the Illness Attitude Scales (IAS) or Whiteley Index (WI). After intense inpatient cognitive-behavioral treatment (CBT), 60% of the patients were classified as responders because of substantial improvements or recovery from hypochondriacal symptomatology. Results: Non-responders were characterized by a higher degree of pre-treatment hypochondriasis, more somatization symptoms and general psychopathology (SCL-90R), more dysfunctional cognitions related to bodily functioning, higher levels of psychosocial impairments, and more utilization of the health care system as indicated by the number of hospital days and costs for inpatient treatments and medication. No predictive value was found for sociodemographic variables, comorbidity with other mental disorders and chronicity. Multiple linear regression showed that pre-treatment variables significantly predicted IAS scores at post-treatment (R2 = 0.59), changes during treatment (0.10), IAS scores at follow-up two years later (0.41) and changes between baseline and follow-up (0.25). Conclusions: The results demonstrate the relevance of various psychopathological variables and health care utilization as important indicators for outcome and further course of clinical hypochondriasis.

Assessment of functional gastrointestinal disorders using the Gastro-Questionnaire.

The purpose was to investigate the reliability and factorial structure of the Gastro-Questionnaire for the screening and psychometric measurement of functional gastrointestinal disorders (FGDs). The questionnaire contains 27 gastrointestinal symptom items drawn from the Rome—II criteria, which are rated by frequency and severity, as well as some items to exclude organic diseases. The questionnaire was administered to 259 normal participants and to 69 participants of the annual German meeting of patients with irritable bowel syndrome. Reliability was good (Cronbach’s alpha for frequency and severity items: α = .86 and α = .87). Factor analysis yielded a six-factor solution explaining 60.7% of the variance. Diagnostic frequencies ranged from 32.8%to100% for FGDs in general, from 1.3% to 76.8% for irritable bowel syndrome, and from 7.0% to 100% for functional dyspepsia, depending on samples and symptom definitions. The Gastro-Questionnaire is a very economic, reliable, and content-valid instrument for the assessment of FGDs.

Functional gastrointestinal disorders: cognitive-behaviour treatment

Purpose of review The present paper reviews recent cognitive-behaviour treatment trials in functional gastrointestinal disorders. One striking finding is that research activities in this field have been very limited in the past few years. For that reason, the focus of this review was extended to the period 1998 to May 2002, and the reasons for insufficient research into functional gastrointestinal disorder treatments are discussed. Recent findings Findings suggest good efficacy for various intervention strategies, e.g. relaxation techniques, stress management, contingency management and cognitive-behaviour therapy, in combination with medical treatment. However, the empirical basis is very limited because of small sample sizes, a small overall number of psychological treatment trials, and the non-standardized measurement of gastrointestinal symptoms. Deficits may partly be associated with special characteristics of the concept of functional gastrointestinal disorders, according to the revised Rome criteria. Summary Different types of cognitive-behaviour treatments seem to be effective in functional gastrointestinal disorders. However, further empirical trials, standardized and comparable outcome measures, and specific interventions for functional gastrointestinal disorders are required to obtain more exact knowledge on the efficacy of cognitive-behaviour therapy and treatment mechanisms.