Hypochondriasis and symptom reporting: The effect of attention versus distraction

Background: This study examined symptom perception in hypochondriacal patients without physical stimulation. Methods: Seventeen outpatients with DSM-III-R hypochondriasis and 16 healthy control subjects were compared. All subjects were asked to report perceived sensations in three conditions: attention, distraction and control. Results: It was found that hypochondriacal subjects showed remarkably higher levels of symptom reporting than healthy subjects in all three conditions. In spite of excessive attention to bodily sensations in a control condition, attention instructions still added significantly to symptom reporting in hypochondriacal patients. The effect of distraction was not significant in either of the groups. Furthermore, group differences in symptom reporting appeared to be related to preoccupation with bodily symptoms rather than to general anxiety level as measured by the STAI. Conclusions: Hypochondriacal patients report more bodily sensations than healthy controls when no instructions are given. In addition, focussing on bodily sensations seems to cause a significant overall increase of perceived symptoms in hypochondriacal patients, whereas in healthy subjects there is a trend towards an increase in symptom reporting.