Hiller Wolfgang, Leibbrand Rolf, Rief Winfried, Fichter Manfred M
Psychological Institute, University of Mainz, Staudingerweg 9, D-55099 Mainz, Germany.
J Anxiety Disord. 2005;19(1):29-49. doi: 10.1016/j.janxdis.2003.10.006.
Hypochondriasis and panic disorder are both characterized by prevalent health anxieties and illness beliefs. Therefore, the question as to whether they represent distinct nosological entities has been raised. This study examines how clinical characteristics can be used to differentiate both disorders, taking the possibility of mixed symptomatologies (comorbidity) into account. We compared 46 patients with hypochondriasis, 45 with panic disorder, and 21 with comorbid hypochondriasis plus panic disorder. While panic patients had more comorbidity with agoraphobia, hypochondriasis was more closely associated with somatization. Patients with panic disorder were less pathological than hypochondriacal patients on all subscales of the Whiteley Index (WI) and the Illness Attitude Scales (IAS) except for illness behavior. These differences were independent of somatization. Patients with hypochondriasis plus panic had higher levels of anxiety, more somatization, more general psychopathology and a trend towards increased health care utilization. Clinicians were able to distinguish between patient groups based upon the tendency of hypochondriacal patients to demand unnecessary medical treatments. These results confirm that hypochondriasis and panic disorder are distinguishable clinical conditions, characterized by generally more psychopathology and distress in hypochondriasis.
疑病症和惊恐障碍都以普遍存在的健康焦虑和疾病信念为特征。因此，关于它们是否代表不同的疾病实体这一问题已经被提出。本研究探讨了如何利用临床特征来区分这两种障碍，并考虑了混合症状（共病）的可能性。我们比较了46例疑病症患者、45例惊恐障碍患者和21例疑病症合并惊恐障碍的患者。惊恐障碍患者与广场恐惧症的共病更多，而疑病症与躯体化的关联更紧密。在怀特利指数（WI）和疾病态度量表（IAS）的所有子量表上，除了疾病行为外，惊恐障碍患者的病态程度均低于疑病症患者。这些差异与躯体化无关。疑病症合并惊恐障碍的患者焦虑水平更高、躯体化更严重、一般精神病理学问题更多，且有医疗保健利用率增加的趋势。临床医生能够根据疑病症患者要求进行不必要医疗治疗的倾向来区分患者群体。这些结果证实，疑病症和惊恐障碍是可区分的临床病症，疑病症通常具有更多的精神病理学问题和痛苦。
