Is health anxiety a significant problem for individuals with multiple sclerosis?

  • Melissa D. Kehler
  • Heather D. Hadjistavropoulos
Original Paper


Although symptoms of anxiety and depression are often present in individuals with Multiple Sclerosis (MS), less is known about the role of health anxiety in this population. This study investigated the relationship between health anxiety and coping in a sample of people with MS (n = 246). Participants with MS reported higher levels of health anxiety compared to an age-matched control sample. Furthermore, compared to normal levels of health anxiety, participants with MS with elevated health anxiety (around 25%) were differentiated by endorsement of greater use of Emotional Preoccupation and Social Support and less use of Problem-Focused Coping. In addition, participants with elevated health anxiety experienced greater disability and generalized anxiety. We further explored the overlap between generalized anxiety and health anxiety in understanding coping strategies and found that health anxiety and generalized anxiety were both uniquely associated with Emotional Preoccupation coping, whereas only health anxiety was uniquely associated with Problem-Focused coping. The results provide support for the importance of assessing health anxiety in individuals with MS over and above generalized anxiety. Potential avenues for research and clinical practice are described.


Multiple sclerosis Health anxiety Coping Anxiety 


  1. Barsky, A. J., Ettner, S. L., Horsky, J., & Bates, D. W. (2001). Resource utilization of patients with hypochondriacal health anxiety and somatization. Medical Care, 39, 705–715. doi: 10.1097/00005650-200107000-00007.PubMedCrossRefGoogle Scholar
  2. Beck, C. A., Metz, L. M., Svenson, L. W., & Patten, S. B. (2005). Regional variation of multiple sclerosis prevalence in Canada. Multiple Sclerosis, 11, 516–519. doi: 10.1191/1352458505ms1192oa.PubMedCrossRefGoogle Scholar
  3. Bombardier, C. H., D’Amico, C., & Jordan, J. S. (1990). The relationship of appraisal and coping to chronic illness adjustment. Behaviour Research and Therapy, 28, 297–304. doi: 10.1016/0005-7967(90)90081-S.PubMedCrossRefGoogle Scholar
  4. Chalk, H. M. (2007). Mind over matter: Cognitive-behavioral determinants of emotional distress in multiple sclerosis patients. Psychology Health and Medicine, 12, 556–566. doi: 10.1080/13548500701244965.CrossRefGoogle Scholar
  5. Endler, N. S., Parker, J. D. A., & Summerfeldt, L. J. (1998). Coping with health problems: Developing a reliable and valid multidimensional measure. Psychological Assessment, 10, 195–205. doi: 10.1037/1040-3590.10.3.195.CrossRefGoogle Scholar
  6. Endler, N. S., & Parker, J. D. A. (2000). Coping with Health Injuries and Problems (CHIP): Manual. Toronto: Multi-Health Systems Inc.Google Scholar
  7. Feinstein, A., O’Connor, P., Gray, T., & Feinstein, K. (1999). The effects of anxiety on psychiatric morbidity in patients with multiple sclerosis. Multiple Sclerosis, 5, 323–326.PubMedGoogle Scholar
  8. Freeston, M. H., Gagnon, F., Ladouceur, R., Thibodeau, N., Letarte, H., & Rheaume, J. (1994). Health-related intrusive thoughts. Journal of Psychosomatic Research, 38, 203–215. doi: 10.1016/0022-3999(94)90116-3.PubMedCrossRefGoogle Scholar
  9. Furer, P., Walker, J. R., & Freeston, M. H. (2001). Approach to integrated cognitive-behavior therapy for intense illness worries. In G. J. G. Asmundson, S. Taylor & B. J. Cox (Eds.), Health anxiety: Clinical and research perspectives on hypochondriasis and related conditions (pp. 161–192). Toronto: Wiley.Google Scholar
  10. Furer, P., Walker, J. R., & Stein, M. B. (2007). Treating Health Anxiety and Fear of Death: A Practitioner’s Guide. New York: Springer.Google Scholar
  11. Gold, S. M., Schulz, H., Mönch, A., Schulz, K. H., & Heesen, C. (2003). Cognitive impairment in multiple sclerosis does not affect reliability and validity of self-report health measures. Multiple Sclerosis, 9, 404–410. doi: 10.1191/1352458503ms927oa.PubMedCrossRefGoogle Scholar
  12. Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about Internet questionnaires. The American Psychologist, 59, 93–104. doi: 10.1037/0003-066X.59.2.93.PubMedCrossRefGoogle Scholar
  13. Gureje, O., Üstün, T. B., & Simon, G. E. (1997). The syndrome of hypochondriasis: A cross-national study in primary care. Psychological Medicine, 27, 1001–1010. doi: 10.1017/S0033291797005345.PubMedCrossRefGoogle Scholar
  14. Hadjistavropoulos, H. D., Asmundson, G. J. G., & Kowalyk, K. M. (2004). Measures of anxiety: Is there a difference in their ability to predict functioning at three-month follow-up among pain patients? European Journal of Pain, 8, 1–11. doi: 10.1016/S1090-3801(03)00059-4.PubMedCrossRefGoogle Scholar
  15. Hadjistavropoulos, H. D., Craig, K. D., & Hadjistavropoulos, T. (1998). Cognitive and behavioral responses to illness information: The role of health anxiety. Behaviour Research and Therapy, 36, 149–164. doi: 10.1016/S0005-7967(98)00014-X.PubMedCrossRefGoogle Scholar
  16. Hadjistavropoulos, H. D., Hadjistavropoulos, T., & Quine, A. (2000). Health anxiety moderates the effects of distraction versus attention to pain. Behaviour Research and Therapy, 38, 425–438. doi: 10.1016/S0005-7967(99)00044-3.PubMedCrossRefGoogle Scholar
  17. Jean, V. M., Paul, R. H., & Beatty, W. W. (1999). Psychological and neurological predictors of coping patterns by patients with multiple sclerosis. Journal of Clinical Psychology, 55, 21–26. doi:10.1002/(SICI)1097-4679(199901)55:1<21::AID-JCLP2>3.0.CO;2-B.PubMedCrossRefGoogle Scholar
  18. Langlois, F., & Ladouceur, R. (2004). Adaptation of a GAD treatment for hypochondriasis. Cognitive and Behavioral Practice, 11, 393–404. doi: 10.1016/S1077-7229(04)80056-7.CrossRefGoogle Scholar
  19. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  20. Martin, A., & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68, 770–777. doi: 10.1097/01.psy.0000238213.04984.b0.PubMedCrossRefGoogle Scholar
  21. McCabe, M. P., McKern, S., & McDonald, E. (2004). Coping and psychological adjustment among people with multiple sclerosis. Journal of Psychosomatic Research, 56, 355–361. doi: 10.1016/S0022-3999(03)00132-6.PubMedCrossRefGoogle Scholar
  22. Mohr, D. C., & Cox, D. (2001). Multiple sclerosis: Empirical literature for the clinical health psychologist. Journal of Clinical Psychology, 57, 479–499. doi: 10.1002/jclp.1042.PubMedCrossRefGoogle Scholar
  23. Noonan, C. W., Kathman, S. J., & White, M. C. (2002). Prevalence estimates for MS in the United States and evidence of an increasing trend for women. Neurology, 58, 136–138. doi: 10.1159/000064489.PubMedGoogle Scholar
  24. Pakenham, K. I. (1999). Adjustment to Multiple Sclerosis: Application of a stress and coping model. Health Psychology, 18, 383–392. doi: 10.1037/0278-6133.18.4.383.PubMedCrossRefGoogle Scholar
  25. Pakenham, K. I. (2001). Coping with Multiple Sclerosis: Development of a measure. Psychology Health and Medicine, 6, 411–428.CrossRefGoogle Scholar
  26. Pakenham, K. I. (2006). Investigation of the coping antecedents to positive outcomes and distress in multiple sclerosis (MS). Psychology and Health, 21, 633–649. doi: 10.1080/14768320500422618.CrossRefGoogle Scholar
  27. Rossier, P., & Wade, D. T. (2002). The Guy’s Neurological Disability scale in patients with multiple sclerosis: A clinical evaluation of its reliability and validity. Clinical Rehabilitation, 16, 75–95. doi: 10.1191/0269215502cr447oa.PubMedCrossRefGoogle Scholar
  28. Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32, 843–853. doi: 10.1017/S0033291702005822.PubMedCrossRefGoogle Scholar
  29. Scherer, R. F., Luther, D. C., Wiebe, F. A., & Adams, J. S. (1988). Dimensionality of coping: Factor stability using the Ways of Coping Questionnaire. Psychological Reports, 62, 763–770.PubMedGoogle Scholar
  30. Schwartz, C. E. (1999). Teaching coping skills enhances quality of life more than peer support: Results of a randomized trial with Multiple Sclerosis patients. Health Psychology, 18, 211–220. doi: 10.1037/0278-6133.18.3.211.PubMedCrossRefGoogle Scholar
  31. Seivewright, H., Salkovskis, P., Green, J., Mullan, N., Behr, G., Carlin, E., et al. (2004). Prevalence and service implications of health anxiety in genitourinary medicine clinics. International Journal of STD and AIDS, 15, 519–522. doi: 10.1258/0956462041558122.PubMedCrossRefGoogle Scholar
  32. Sharrack, B., & Hughes, R. A. C. (1999). The Guy’s Neurological Disability Scale (GNDS): A new disability measure for multiple sclerosis. Multiple Sclerosis, 5, 223–233.PubMedGoogle Scholar
  33. Stenager, E., Knudsen, L., & Jensen, K. (1994). Multiple sclerosis: Correlation of anxiety, physical impairment and cognitive dysfunction. Italian Journal of Neurological Sciences, 15, 99–103. doi: 10.1007/BF02340120.CrossRefGoogle Scholar
  34. Tabachnick, B. G., & Fidell, L. S. (2001). Using multivariate statistics (Fourth Edition). Toronto, ON: Allyn and Bacon.Google Scholar
  35. Taillefer, S., Kirmayer, L. J., Robbins, J. M., & Lasry, J. C. (2003). Correlates of illness worry in chronic fatigue syndrome. Journal of Psychosomatic Research, 54, 331–337. doi: 10.1016/S0022-3999(02)00332-X.PubMedCrossRefGoogle Scholar
  36. Taylor, S., & Asmundson, G. J. G. (2004). Treating Health Anxiety: A Cognitive-Behavioral Approach. New York: The Guilford Press.Google Scholar
  37. Tsivgoulis, G., Triantafyllou, N., Papageorgiou, C., Evangelopoulos, M. E., Kararizou, E., Sfagos, C., et al. (2007). Associations of the Expanded Disability Status Scale with anxiety and depression in multiple sclerosis outpatients. Acta Neurologica Scandinavica, 115, 67–72. doi: 10.1111/j.1600-0404.2006.00736.x.PubMedCrossRefGoogle Scholar
  38. Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105–117. doi: 10.1016/0005-7967(90)90023-C.PubMedCrossRefGoogle Scholar
  39. Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Melissa D. Kehler
    • 1
  • Heather D. Hadjistavropoulos
    • 1
  1. 1.Department of PsychologyUniversity of ReginaReginaCanada

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