Cognitive-behavioural model of hypochondriasis and health anxiety

So far there has only been one published cognitive-behavioural theory of hypochondriasis and health
anxiety, developed by Warwick . Salkovskis and Clark (e.g. Salkovskis and Warwick, 1986, Warwick and
Salkovskis, 1990; Salkovskis and Clark 1993 ). Their work will therefore by referred to in the rest of the
thesis as "the cognitive-behavioural (CB) model of health anxiety" or the "cognitive-behavioural model".
See figure 1.1 for a diagram showing the main components of this model.

According to the CB model of health anxiety, some people become severely anxious about their health
because they misinterpret bodily variation (including bodily sensations) or medical information as more
threatening than it really is (e.g. as a sign of illness). This occurs because the person has particular
assumptions about health and illness. The model proposes that specific assumptions about illness,
symptoms and health behaviours arise from knowledge of and past experience of illness (in oneself or
others). Early experience may be particularly important but events in the individual's later social
network and cultural factors (such as the mass media) may also play a role.

Examples ofpotentially problematic assumptions about symptoms and illness are "Bodily symptoms are
always the sign of something wrong", "You should go to the doctor whenever you notice something
unusual because otherwise it may be too late", "Doctors often mistake serious illness for something
more trivial", "I'm certain to get cancer in my fifties because I'm very like my mother who died of it at
that age". Salkovskis ( 1990) found that hypochondriacal patients endorsed more dysfunctional
attitudes about health and illness than non-clinical subjects and patients with social phobia.

The CB model of health anxiety suggests that dysfunctional beliefs may be a constant source of anxiety
or may lie dormant until triggered by critical incidents such as illness in a friend, unfamiliar bodily
sensations or new information about illness. Once assumptions have been "activated" they will
influence the way in which situations are interpreted - there will be a tendency for the person to process
information in a way which is consistent with the assumption and ignore or discount
inconsistent evidence (a "confirmatory bias"). Thus once the dysfunctional assumptions are activated
they will influence how the person interprets new bodily sensations, memories of previous symptoms,
medical consultations and so on. When these factors "mesh" with the dysfunctional assumptions, (e.g.
chest pain in someone who thinks that the most likely cause of chest pain is heart disease), this
causes a particularly negative interpretation (appraisal) and a high level of anxiety will result.