Hypochondriacal patients' beliefs about good health

OBJECTIVE: The authors hypothesized that hypochondriacal patients mistakenly believe good health to be a symptom-free state and that they consider more symptoms to be indicative of disease than do nonhypochondriacal patients. METHOD: The Health Norms Sorting Task was developed to assess the standard used to decide whether one is sick or healthy; the respondent must classify 24 common and ambiguous symptoms as "healthy" or "not healthy." This instrument demonstrated good test- retest reliability and intrascale consistency. It was then administered to 60 patients with DSM-III-R hypochondriasis and 60 nonhypochondriacal patients randomly selected from the same general medicine clinic. RESULTS: Hypochondriacal patients considered significantly more symptoms to be indicative of disease than did the comparison group. Health Norms Sorting Test scores were correlated with hypochondriacal symptoms, somatization, and self-reported bodily amplification (sensitivity to bodily sensation). Test scores were not related to aggregate medical morbidity, medical care utilization, or sociodemographic characteristics. CONCLUSIONS: These data are compatible with the hypothesis that patients with DSM-III-R hypochondriasis believe good health to be relatively symptom free and consider more symptoms indicative of sickness. This may contribute to some of the clinical features of hypochondriasis, including the numerous somatic symptoms, bodily preoccupation, resistance to reassurance, and pursuit of medical care.