Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-16T03:23:36.988Z Has data issue: false hasContentIssue false

Anxiety Sensitivity and Panic Symptomatology: The Mediator Role of Hypochondriacal Concerns

Published online by Cambridge University Press:  10 April 2014

Carmen Berrocal*
Affiliation:
Universidad de Málaga (Spain)
Francisca Ruiz Moreno
Affiliation:
Instituto de Psicología y Psiquiatría de Málaga (Spain)
Josefina Cano
Affiliation:
Universidad de Málaga (Spain)
*
Correspondence concerning this article should be addressed to Carmen Berrocal. Profesora Asociada de Psicología, Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología Universidad de Málaga, Campus de Teatinos, s/n, Málaga-29071, Spain. Phone: +34 952132553; Fax: +34 952131101. E-mail: [email protected]

Abstract

The present study tests the mediating role of hypochondriasis to explain the relation between anxiety sensitivity and panic symptomatology. Fifty-seven outpatients with clinically significant levels of panic symptomatology were selected to participate in the study. Measures of anxiety sensitivity, hypochondriasis, and panic symptomatology were obtained from standardized, self-administered questionnaires: the Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), the Whiteley Index of Hypochondriasis (WI; Pilowsky, 1967), and the Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001). Regression analyses were performed to test for the mediation models. The results show that the effect of anxiety sensitivity on panic symptomatology is not significant when controlling the hypochondriacal concerns, whereas the latter predicted panic symptoms. This result holds for the overall ASI as well as for the Physical Concerns and the Mental Incapacitation Concerns dimensions of the ASI scale. No evidence of a direct relation between the Social Concerns dimension and panic symptoms was found. The findings suggest that hypochondriacal concerns might represent the mechanism through which anxiety sensitivity is able to influence panic symptoms.

El objetivo del presente estudio es explorar el papel mediador de las preocupaciones hipocondríacas para explicar la relación entre la sensibilidad a la ansiedad y la sintomatología de pánico. Un total de 57 pacientes con niveles clínicamente significativos de sintomatología de pánico fueron seleccionados para participar en el estudio. Se han obtenido medidas de la sensibilidad a la ansiedad, mediante el Anxiety Sensitivity Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986), la sintomatología de pánico, mediante la subescala Panic-like-symptoms del Panic-Agoraphobic Spectrum Self-Report (PAS-SR; Cassano et al., 1997; Shear et al., 2001), e hipocondríasis mediante el Whiteley Index of Hypochondriasis (WI, Pilowsky, 1967) y la subsescala Illness-related Phobia del PAS-SR. Se han llevado a cabo análisis de regresión para poner a prueba los modelos mediacionales. Los resultados obtenidos indican que el efecto de la sensibilidad a la ansiedad sobre la sintomatología de pánico no es significativo cuando se controlan las puntuaciones en hipocondríasis, si bien ésta última variable predice las puntuaciones en pánico. Dichos resultados se han obtenido sea para las puntuaciones totales en el ASI que para dos de las dimensiones que conforman la escala: preocupaciones relativas a problemas físicos y preocupaciones relativas a problemas mentales. La dimensión del ASI relacionada con preocupaciones de carácter social no se asocia con la sintomatología de pánico. Los resultados sugieren que las preocupaciones hipocondríacas podrían representar el mecanismo a través del cual la sensibilidad a la ansiedad ejerce un efecto sobre los síntomas de pánico.

Type
Articles
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: American Psychiatric Association.Google Scholar
Baron, R.M., & Kenny, D.A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 11731182.CrossRefGoogle ScholarPubMed
Berrocal, C., Ruiz Moreno, M., Gil Villa, M., Hermoso, P., Rucci, P., & Cassano, G.B. (2006). Multidimensional assessment of the Panic-Agoraphobic Spectrum: Reliability and validity of the Spanish version of the PAS-SR. Journal of Anxiety Disorders, 20, 562579.CrossRefGoogle ScholarPubMed
Bravo, I.M., & Silverman, W.K. (2001). Anxiety sensitivity, anxiety, and depression in older patients and their relation to hypochondriacal concerns and medical illnesses. Aging and Mental Health, 5, 349357.CrossRefGoogle ScholarPubMed
Cassano, G.B., Banti, S., Mauri, M., Dell'Osso, L., Miniati, M., Maser, J.D., Shear, M. K., Frank, E., Grochocinski, V., & Rucci, P. (1999). Internal consistency and discriminant validity of the Structured Clinical Interview for Panic-Agoraphobic Spectrum (SCI-PAS). International Journal of Methods in Psychiatric Research, 8, 138145.CrossRefGoogle Scholar
Cox, B.J., Fuentes, K., Borger, S.C., & Taylor, S. (2001). Psychopathological correlates of anxiety sensitivity: Evidence from clinical interviews and self-report measures. Journal of Anxiety Disorders, 14, 317332.CrossRefGoogle Scholar
Fava, G.A., Grandi, S., & Canestrari, R. (1988). Prodromal symptoms in panic disorder with agoraphobia. American Journal of Psychiatry, 145, 15641567.Google ScholarPubMed
Fava, G.A., Grandi, S., Rafanelli, C., & Canestrari, R. (1992). Prodromal symptoms in panic disorder with agoraphobia: A replication study. Journal of Affective Disorders, 26, 8588.CrossRefGoogle ScholarPubMed
Feske, U., Frank, E., Mallinger, A.G., Houck, P.R., Fagiolini, A., & Shear, M.K. (2000). Anxiety as a correlate of response to the acute treatment of bipolar I disorder. American Journal of Psychiatry, 157, 956962.CrossRefGoogle Scholar
Frank, E., Cyranowski, J.M., Rucci, P., Shear, M.K., Fagiolini, A., Thase, M.E., Cassano, G.B., Grochocinski, V.J., Kostelnik, B., & Kupfer, D.J. (2002). Clinical significance of lifetime panic spectrum symptoms in the treatment of patients with bipolar I disorder. Archives of General Psychiatry, 59, 905911.CrossRefGoogle ScholarPubMed
Frank, E., Shear, M.K., Rucci, P., Cyranowski, J.M., Endicott, J., Fagiolini, A., Grochocinski, V.J., Houck, P., Kupfer, D.J., Maser, J.D., & Cassano, G.B. (2000). Influence of panic-agoraphobic spectrum symptoms on treatment response in patients with recurrent major depression. American Journal of Psychiatry, 157, 11011107.CrossRefGoogle ScholarPubMed
Furer, P., Walker, J.R., Chartier, M.J., & Stein, M.B. (1997). Hypochondriacal concerns and somatization in panic disorder. Depression and Anxiety, 6, 7885.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Keller, M.B., Yonkers, K.A., Warshaw, M.G., Pratt, L.A., Gollan, J.K., Massion, A.O., White, K., Swartz, A.R., Reich, J., & Lavori, P.W. (1994). Remission and relapse in subjects with panic disorder and panic with agoraphobia: A prospective short-interval naturalistic follow-up. The Journal of Nervous and Mental Disease, 182, 290296.CrossRefGoogle ScholarPubMed
MacKinnon, D.P. (1994). Analysis of mediating variables in prevention and intervention research. In Cazares, A. & Beatty, L.A. (Eds.), Scientific methods in prevention research. NIDA Research Monograph 139 (pp. 127153). Washington, DC: U.S. Government Printing Office.Google Scholar
Maller, R.G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6, 241247.CrossRefGoogle Scholar
Messenger, C., & Shean, G. (1998). The effects of anxiety sensitivity and history of panic on reactions to stressors in a non clinical sample. Journal of Behavior Therapy and Experimental Psychiatry, 29, 279288.CrossRefGoogle Scholar
Noyes, R., Woodman, C.L., Bodkin, J.A., & Yagla, S.J. (2004). Hypochondriacal concerns in panic disorder and major depressive disorder: A comparison. The International Journal of Psychiatry in Medicine, 2, 143154.CrossRefGoogle Scholar
Otto, M.W., Demopulos, C.M., McLean, N.E., Pollack, M.H., & Fava, M. (1998). Additional findings on the association between anxiety sensitivity and hypochondriacal concerns: Examination of patients with major depression. Journal of Anxiety Disorders, 12, 225232.CrossRefGoogle ScholarPubMed
Otto, M.W., Pollack, M.H., Sachs, G.S., & Rosenbaum, J.F. (1992). Hypochondriacal concerns, anxiety, sensitivity, and panic disorder. Journal of Anxiety Disorders, 6, 93104.CrossRefGoogle Scholar
Perugi, G., Toni, C., Benedetti, A., Simonetti, M., Torti, C., Musetti, L., & Akiskal, H.S. (1998). Delineating a putative phobicanxious temperament in 126 panicagoraphobic patients. Journal of Affective Disorders, 47, 1123.CrossRefGoogle ScholarPubMed
Peterson, R.A., & Heilbronner, R.L. (1987). The Anxiety Sensitivity Index: Construct validity and factor analytic structure. Journal of Anxiety Disorders, 2, 117121.CrossRefGoogle Scholar
Peterson, R.A., & Reiss, S. (1992). Anxiety Sensitivity Index Manual (2nd ed.). Worthington, OH: International Diagnostic Systems.Google Scholar
Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 8993.CrossRefGoogle ScholarPubMed
Reiss, S. (1987). Theoretical perspectives on the fear of anxiety. Clinical Psychology Review, 7, 585596.CrossRefGoogle Scholar
Reiss, S. (1991). Expectancy model of fear, anxiety, and panic. Clinical Psychology Review, 11, 141153.CrossRefGoogle Scholar
Reiss, S., Peterson, R.P., Gursky, D.M., & McNally, R.J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 18.CrossRefGoogle ScholarPubMed
Sandín, B., Chorot, P., & McNally, R.J. (1996). Validation of the Spanish version of the Anxiety Sensitivity Index in a clinical sample. Behaviour Research and Therapy, 34, 283290.CrossRefGoogle Scholar
Schmidt, N.B., Lerew, D.R., & Jackson, R.J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106, 355364.CrossRefGoogle ScholarPubMed
Schmidt, N.B., Lerew, D.R., & Jackson, R.J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: Replication and extension. Journal of Abnormal Psychology, 108, 532537.CrossRefGoogle ScholarPubMed
Shear, M.K., Frank, E., Rucci, P., Fagiolini, A., Grochocinski, V., Houck, P., Cassano, G.B., Kupfer, D.J., Endicott, J., Maser, J., Mauri, M., & Banti, S. (2001). Panic-agoraphobic spectrum: Reliability and validity of assessment instruments. Journal of Psychological Research, 35, 5966.CrossRefGoogle ScholarPubMed
Sobel, M.E. (1990). Effect analysis and causation in linear structural equation models. Psychometrika, 55, 495515.CrossRefGoogle Scholar
Speckens, A.E.M., Spinhoven, P., & Sloekers, P.P.A. (1996). A validation study of the Whiteley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95104.CrossRefGoogle Scholar
Speckens, A.E.M. (2001). Assessment of hypochondriasis. In Starcevic, V. & Lipsitt, D.R. (Eds.), Hypochondriasis: Modern BERROCAL, RUIZ, AND CANO166 perspectives on an ancient malady (pp. 6188). New York: Oxford University Press.CrossRefGoogle Scholar
Taylor, S., & Cox, B.J. (1998). Anxiety sensitivity: Multiple dimensions and hierarchic structure. Behaviour Research and Therapy, 36, 3751.CrossRefGoogle ScholarPubMed
Taylor, S., Koch, W.J., & McNally, R.J. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 6, 249259.CrossRefGoogle Scholar
Watt, M.C., & Stewart, S.H. (2000). Anxiety sensitivity mediates the relationships between childhood learning experiences and elevated hypochondriacal concerns in young adulthood. Journal of Psychosomatic Research, 49, 107118.CrossRefGoogle ScholarPubMed
World Health Organization (1992). International Classification of Diseases (10th revision). Geneva: World Health Organization.Google Scholar
Zinbarg, R.E., Brown, T.A., & Barlow, D.H. (1997). Hierarchical structure and general factor structure saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277284.CrossRefGoogle Scholar
Zinbarg, R.E., Brown, T.A., Barlow, D.H., & Rapee, R.M. (2001). Anxiety sensitivity, panic, and depressed mood: A reanalysis teasing apart the contributions of the two levels in the hierarchical structure of the anxiety sensitivity index. Journal of Abnormal Psychology, 110, 372377.CrossRefGoogle Scholar
Zvolensky, M.J., Goodie, J.L., McNeil, D.W., Sperry, J.A., & Sorrell, J.T. (2001). Anxiety sensitivity in the prediction of pain-related fear and anxiety in a heterogeneous chronic pain population. Behaviour Research and Therapy, 39, 683696.CrossRefGoogle Scholar