Hiller W, Rief W, Fichter M M
Roseneck Center of Behavioural Medicine, Prien, Germany.
Psychol Med. 2002 May;32(4):707-18. doi: 10.1017/s0033291702005524.
The DSM-IV definition of hypochondriasis is contrasted with hypochondriacal dimensions as provided by the Whiteley Index (WI) and Illness Attitude Scales (IAS).
Exploratory factor analysis was conducted on self-report data from 570 patients with mental and psychophysiological disorders. Of these, 319 were additionally diagnosed according to DSM-IV by structured interviews.
The three 'classic' factors of the WI labelled disease phobia, somatic symptoms and disease conviction were confirmed. The IAS consisted of two dimensions indicating health anxiety and illness behaviour. The overall scores of both instruments were highly correlated (0.80). Optimal cut-off points for case identification yielded sensitivity/specificity rates of 71/80% (WI) and 72/79% (IAS). The IAS was superior to the WI when patients with hypochondriacal disorder were to be discriminated from non-hypochondriacal somatizers. Largest group differences were found for scales related to affective components (health anxieties), smallest for illness behaviours. Affective components of hypochondriasis explained more variance of diagnostic group membership than somatization symptoms. The subscales of disease phobia (WI) and health anxiety (IAS) were most sensitive to treatment-related changes.
The self-rating scales are valid for screening, case definition and dimensional assessment of hypochondriacal disorder, including the differentiation between hypochondriasis and somatization. The existence of distinguishable affective and cognitive components was confirmed.
将《精神疾病诊断与统计手册》第四版（DSM-IV）中疑病症的定义与由怀特利指数（WI）和疾病态度量表（IAS）所提供的疑病维度进行对比。
对570名患有精神和心理生理障碍患者的自我报告数据进行探索性因素分析。其中，319名患者还通过结构化访谈依据DSM-IV进行了额外诊断。
WI的三个“经典”因素，即疾病恐惧、躯体症状和疾病坚信度得到了确认。IAS由两个维度组成，分别表明健康焦虑和疾病行为。两种工具的总体得分高度相关（0.80）。用于病例识别的最佳临界点产生的敏感度/特异度分别为71/80%（WI）和72/79%（IAS）。当要将疑病症患者与非疑病性躯体化患者区分开来时，IAS优于WI。在与情感成分（健康焦虑）相关的量表上发现的组间差异最大，在疾病行为方面的差异最小。疑病症的情感成分比躯体化症状能解释更多诊断组成员的差异。疾病恐惧（WI）和健康焦虑（IAS）的分量表对与治疗相关的变化最为敏感。
自评量表对于疑病症的筛查、病例定义和维度评估是有效的，包括疑病症与躯体化之间的区分。证实了存在可区分的情感和认知成分。
