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The Health Anxiety Inventory Development and Validation of Scales For The Measurement of Health Anxiety and Hypochondriasis
The Health Anxiety Inventory Development and Validation of Scales For The Measurement of Health Anxiety and Hypochondriasis
ABSTRACT
Background. A self-rated measure of health anxiety should be sensitive across the full range of
intensity (from mild concern to frank hypochondriasis) and should differentiate people suffering
from health anxiety from those who have actual physical illness but who are not excessively
concerned about their health. It should also encompass the full range of clinical symptoms
characteristic of clinical hypochondriasis. The development and validation of such a scale is
described.
Method. Three studies were conducted. First, the questionnaire was validated by comparing the
responses of patients suffering from hypochondriasis with those suffering from hypochondriasis and
panic disorder, panic disorder, social phobia and non-patient controls. Secondly, a state version of
the questionnaire was administered to patients undergoing cognitive-behavioural treatment or wait-
list in order to examine the measure’s sensitivity to change. In the third study, a shortened version
was developed and validated in similar types of sample, and in a range of samples of people seeking
medical help for physical illness.
Results. The scale was found to be reliable and to have a high internal consistency. Hypochondriacal
patients scored significantly higher than anxiety disorder patients, including both social phobic
patients and panic disorder patients as well as normal controls. In the second study, a ‘ state ’ version
of the scale was found to be sensitive to treatment effects, and to correlate very highly with a
clinician rating based on an interview of present clinical state. A development and refinement of the
scale (intended to reflect more fully the range of symptoms of and reactions to hypochondriasis) was
found to be reliable and valid. A very short (14 item) version of the scale was found to have
comparable properties to the full length scale.
Conclusions. The HAI is a reliable and valid measure of health anxiety. It is likely to be useful as
a brief screening instrument, as there is a short form which correlates highly with the longer version.
tests) as indicating that they may be suffering disease with non-response to reassurance ’. The
from a serious physical illness. Such mis- scale has adequate test–retest reliability (0n81).
interpretation can also involve perceiving the The Whiteley Index includes some items that do
consequences of developing a physical illness as not seem to be directly measuring hypochon-
being particularly serious (Salkovskis, 1996). driasis and are likely be answered positively
This theory has been used to develop a treatment by some people who do not have the condition,
for hypochondriasis, which has now been vali- such as, ‘ Is it easy for you to forget yourself and
dated in controlled trials (Warwick et al. 1996 ; think about all sorts of other things ? ’. There is
Clark et al. 1998). no evidence that the Whiteley Index can dis-
Salkovskis & Rimes (1997) proposed a cor- criminate between hypochondriacal patients and
ollary to the cognitive-behavioural theory of psychiatric patients who are matched for levels
severe anxiety. If patients experience severe of anxiety. The Illness Behaviour Questionnaire
health anxiety because they have an enduring was developed from the Whiteley Index. The
tendency to misinterpret ambiguous medical IBQ is not solely concerned with hypochon-
information as a sign of physical illness, it would driasis – it was introduced as a way of meas-
follow that those with relatively high levels of uring ‘ abnormal illness behaviour ’ or inap-
health anxiety should be more likely to mis- propriate ways of responding to the state of
interpret ambiguous medical information such one’s health in a range of clinical groups. The
as medical consultations, health screening pro- IBQ has seven scales : (1) general hypochon-
cedures and information about illnesses de- driasis ; (2) disease conviction ; (3) psychological
scribed in the mass media or the Internet. There versus somatic perception of illness ; (4) affective
are, therefore, a number of important reasons to inhibition ; (5) affective disturbance ; (6) denial ;
develop and validate a continuous measurement (7) irritability. The scales have been criticized for
of health anxiety that is sensitive to normal containing items that do not all measure the
levels of health concern as well as clinical same aspect of illness behaviour (e.g. Kellner et
hypochondriasis. al. 1987). The IBQ was developed with pain
If health anxiety and hypochondriasis do clinic patients and there have been no studies
form a continuum, measurement of health examining the extent to which the IBQ or scales
anxiety requires reliable measurement strategies from it can identify hypochondriacal patients.
that are independent of clinical diagnostic The original Hypochondriasis scale of the
interviewing. In addition, such a scale should MMPI contains a number of items that are
not rely on items such as ‘ I believe that I am unrelated to hypochondriasis or somatization.
physically ill ’, as patients who are ill but not A later version of the scale contains items
suffering from elevated levels of anxiety would related only to somatic complaints (Welsh, 1952)
tend to score highly. What is required is a and does not mention hypochondriacal fears or
validated scale that is sensitive across the full beliefs. The MMPI scale therefore seems to be a
range of health anxiety, which can be used to scale of somatization rather than of hypochon-
help identify people who will meet diagnostic driasis (Kellner, 1986).
criteria without the requirement for separate The Illness Attitude Scale (Kellner, 1986 ;
medical examination. Several questionnaires Kellner et al. 1987) purports to measure
have been used in the past, particularly the ‘ psychopathology which tends to be associated
Illness Behaviour Questionnaire (IBQ) (Pil- with hypochondriasis and which can be re-
owsky & Spence, 1975), the Illness Attitudes sponsible for abnormal illness behaviour ’. The
Scale (IAS) (Kellner et al. 1987) and the questions were constructed from statements
Minnesota Multi-phasic Personality Inventory made by patients who were either diagnosed as
(MMPI) (Butcher et al. 1989). having hypochondriacal neurosis or who showed
The Whiteley Index (Pilowsky, 1967) was abnormal illness behaviour. The IAS consist of
devised in order to clarify the symptom clusters seven scales as follows : (1) Worry about illness ;
that are seen in clinical hypochondriasis by (2) Concerns about pain ; (3) Health habits ; (4)
using factor analysis. Three factors were Hypochondriacal beliefs ; (5) Thanatophobia ;
identified – ‘ bodily preoccupation ’, ‘ disease (6) Disease phobia ; (7) Bodily preoccupations.
phobia ’ and ‘ conviction of the presence of The scales show good test–retest reliabilities
Age 40n6a (13n2) 34n5a,b (9n9) 40n5a (14n4) 29n9b (7n2) 38n9a,b (16n7)
Women, % 64 58 81 50 68
Values that share a superscripts do not differ significantly from each other.
Hyp, Hypochondriasis ; HypjPanic, hypochondriasis and panic disorder ; Panic, panic disorder ; Anx control, anxious control group.
Appendix 1, previous versions may be obtained separate groups the alpha coefficients were also
from the first author). This scale was headed all satisfactory (hypochondriacals, 0n88 ; hypo-
‘ Illness questionnaire ’, and began with the chondriacal with panic disorder, 0n88 ; panic,
following statement. 0n92 ; anxious controls, 0n82 ; and, non-patient
Each question in this section consists of a group of
controls, 0n71).
four statements. Please read each group of statements
carefully, and then select the one which best describes Test–retest reliability
your feelings over the last six months. It may be that Twenty-nine hypochondriacal patients were
more than one statement applies, in which case please asked to complete the HAI on two occasions a
ring any that are applicable. week apart. For those patients, the Pearson
Items for this scale were scored from 0 to 3, and product-moment correlation coefficient was
the total was used. Where more than one item 0n90, indicating a very high level of test–retest
was endorsed, the score for the highest was used. reliability.
Two additional separately scored subscales were
included, specifically designed to measure re- Group differences on measures of
assurance seeking and avoidance behaviours. psychopathology
There are variables closely related to the Means and standard deviations were calculated
phenomenon of health anxiety, and comprised for the measures of depression, anxiety, health
10 and 8 items respectively. Each item is rated anxiety and the ratings of reassurance seeking
on a nine-point scale, anchored every two and avoidance in illness related situations. The
points ; for avoidance the anchors are : ‘ Would mean scores and standard deviations for each of
not … (avoid it) ’, ‘ slightly … ’, ‘ definitely … ’, the five groups are given in Table 2.
‘ markedly … ’ and ‘ always … ’ ; and, for the All group comparisons yielded significant
reassurance scale, ‘ Never, rarely, sometimes, effects (HAI, F(4, 161) l 56n2, P 0n0005 ;
often, daily ’. Reassurance ratings were for Reassurance scale, F(4, 160) l 11n3, P
different sources of reassurance (e.g. ‘ family 0n0005 ; Avoidance scale, F(4, 159) l 6n6, P
doctor ’, ‘ reading books ’, ‘ hospital out-patient 0n0005 ; BDI, F(4, 159) l 7n7, P 0n0005 ; BAI,
clinic ’) ; avoidance ratings were of situations F(4, 161) l 20n8, P 0n0005 and STAI-State,
which health anxious patients typically tend to F(4, 117) l 12n2, P 0n0005). Multiple com-
avoid (e.g. ‘ watching TV programmes about parisons (Bonferroni) indicated that, as ex-
illness ’, ‘ talking about illness ’, ‘ going to a pected, the clinical groups all score significantly
hospital for treatment ’). Totals for each were higher on measures of anxiety and depression
scored. In addition, participants completed the than the non-clinical controls. The clinical
Beck Depression Inventory (BDI) (Beck et al. groups did not differ from each other in terms
1961), the Beck Anxiety Inventory (BAI) (Beck of anxiety and depression measures, indicating
et al. 1988) and the Spielberger State Anxiety that they were appropriate control groups.
Inventory (STAI-State) (Spielberger et al. 1983). Scores for the two hypochondriacal groups on
the HAI were significantly higher than all groups.
Results
The anxious and non-clinical controls did not
Internal consistency differ from each other, with the panic disorder
The alpha coefficient for the HAI was good : group scoring significantly higher than the other
0n95 for all participants together. For the control groups and significantly lower than
Table 2. Means and standard deviations for score on the Health Anxiety Inventory
Hyp HypjPanic Panic Anx control Control
Group Mean (..) Mean (..) Mean (..) Mean (..) Mean (..)
HAI-total 35n5a (8n8) 39n3a (9n4) 24n4b (11n7) 16n2c (6n5) 12n5c (4n8)
Reassurance 23n2a (9n9) 22n8a (10n4) 16n9a,b (9n3) 12n3b (7n8) 10n7b (7n3)
Avoidance 21n1a,b (13n3) 23n2b (16n2) 19n8a,b (15n2) 12n8a,c (10n9) 7n3c (5n9)
BDI 15n2a,c (9n9) 19n2a (9n2) 20n8a (10n7) 14n5a,c (9n3) 7n9c (6n4)
BAI 21n7a (10n4) 29n4b (12n2) 30n2b (10n0) 19n7a (7n1) 8n4c (5n7)
STAI-State 49n6a (12n1) 52n7a (12n2) 51n9a (10n7) 45n7a (10n0) 33n5b (8n0)
patients meeting diagnostic criteria for hypo- score (r(28) l 0n85, P 0n0001), providing
chondriasis. The reassurance seeking scale further good evidence of the clinical validity of
showed similar results, except that the panic dis- the measure.
order patients differed from neither the hypo-
chondriacal groups nor the other controls
groups. Specificity was least evident for avoid- STUDY 3
ance scale ; the clinical groups differed signifi- Although the measure as developed performed
cantly only from the non-clinical controls apart satisfactorily, the range of symptoms assessed
from the panic and hypochondriasis group was relatively restricted, and it was considered
being higher than the anxious controls. that it would be helpful to expand these in order
to evaluate the full range of phenomena
encountered in health anxiety. This was done by
STUDY 2
identifying a priori factors suggested as likely to
Sensitivity to change in health anxiety due to be important both by the phenomenology of
treatment hypochondriasis and by cognitive-behavioural
Clearly, a scale that uses 6 months as its theory. Other items were included to ensure a
referent is unlikely to be sensitive to actual full range of sensitivity (i.e. to reflect variations
change over time, with or without treatment. A in the intensity of health anxiety across the full
minor modification was therefore evaluated. spectrum of severity of health anxiety, from mild
Twenty-two hypochondriacal patients from a concern about health through to severe and
treatment trial (Clark et al. 1998) completed a disabling hypochondriasis). The factors identi-
version of the HAI that contained the same fied were : Disease conviction (items from longer
items as the version described above, but which scale 35, 38, 25 and 12) ; Perceived vulnerability
asked the participants to rate their feelings over to illness (items 10, 26, 29, 33 and 36) ; Fear and
the past week rather than past 6 months. worry about illness (items 1, 8, 37 and 39) ;
Fourteen of these patients received treatment Preoccupation, interference and bodily aware-
and eight were in the waiting-list condition. ness (items 2, 3, 5, 9, 16, 18, 20, 23, 32 and 44) ;
Those who received treatment showed a signifi- Psychological reactions to bodily sensations
cantly larger reduction in their HAI scores, pre- (items 4, 7, 27, 40 and 43) ; Deliberate action
to post-treatment than those on the waiting after a bodily sensation (items 11, 14, 19, 24, 31,
list, who were assessed at the equivalent points 34 and 42) ; Avoidance and reassurance (these
in time 16 weeks apart (mean change of 14n2 are 0–3 scored items contained within the body
(.. 5n9) versus mean change of 0n75 (.. 6n2) ; of the questionnaire, distinct from the specific
t(20) lk13n5, P 0n0005). 0–8 ratings contained in the avoidance and
As part of the treatment trial, a clinically reassurance subscales attached to the end of
trained assessor had interviewed the hypochon- the questionnaire) (items 15, 17, 22 and 28) ;
driacal patients, and used a 0–8 scale to rate Concerns about death (items 6, 13, 21, 30 and
global impairment due to hypochondriasis. This 41) and Attitudes of self and others towards
measure correlated extremely well with the HAI health anxiety (45, 46 and 47). Cronbach’s alpha
Age, mean (..) 37n7a,b,d (10n1) 39n5a,c (10n1) 47n7c (14n0) 21n9e (4n3) 38n4a (15n9) 47n0c (16n2) 45n3c,d (15n3)
Women, % 58 90 73 63 100 65 57
Has partner, % 57 58 65 37 45 75 —
Education, %
Age 16 10 47 34 2 31 — —
Age 18 40 21 31 77 27
College\University 50 32 34 21 42
Occupation, %
Unemployed 35 37 6 0 9 17 —
Student* 9 0 1 100 24 4 —
Non-professional 17 53 46 0 30 42 —
Professional 39 11 46 0 37 37 —
for these scales ranges from 0n70 to 0n82, gastroenterology clinic, 97 people attending
indicating adequate internal consistency. These a MRI scan, 190 non-anxious controls and
factors have received broad empirical support in 66 students completed the short version of the
a factor analytical study (Rimes, 1996). HAI. Age, gender, education and occupation
The version of the scale described above was for the samples are summarized in Table 3.
validated by comparison with other groups of The clinical participants were recruited from a
anxious patients and non-patients. However, range of sources. Twenty participants with
one of the problems with a scale measuring hypochondriasis and five patients with social
health anxiety is its ability to discriminate phobia had been referred for treatment to
between groups of people who are known to be departments of clinical psychology or psy-
hypochondriacal and other people who are either chiatry. Three hypochondriacal patients were
suspected or known to be physically ill. This is recruited from a radio request for people who
not surprising, since such scales tend to rely for worried too much about their health. From a
validity on the response to statements such as ‘ I self-help organization for people with anxiety
have a serious physical illness ’, which would be problems, one hypochondriacal patient and 14
endorsed both by people suffering from hypo- patients with panic disorder were recruited. In
chondriasis and people who do indeed have a all cases of hypochondriacal participants, diag-
serious physical illness. This type of assessment noses were made according to DSM-III-R, using
is kept to a minimum in the HAI. In the the SCID-III-R and the social phobic patients
validation study reported in this part of the were assessed using DSM-IV.
paper only one group of anxious controls was
included, but a range of patients with actual or Procedure and measures
probable physical illness was also assessed in Participants were given a pack of questionnaires
order to address this issue. to complete, and were asked to complete all of
these on the same day. This pack included either
Method
the long version of the HAI (47 items in the
Participants main scale and 17 negative consequences items)
Twenty-four individuals diagnosed with hypo- or the short version (SHAI), which has 14 items
chondriasis, 19 anxious controls (14 with panic with four negative consequences items. In
disorder and five with social phobia), 159 non- addition, some of the participants completed the
clinical control, from a community subject pool, Beck Depression Inventory (BDI), the Beck
66 students and 107 women attending a general Anxiety Inventory (BAI) and the Spielberger
practice clinic completed the Health Anxiety State or Trait Anxiety Inventory (STAI-State\
Inventory. In addition, 267 people attending a Trait). Twenty-three students completed the
HAI
Total 92n8a (18n2) 45n3b (18n7) 28n9c (11n5) 30n7c (11n8) 35n9d (12n6) — —
Negative consequences 25n1a (7n9) 14n4b (6n2) 12n7b (6n5) 14n4b (5n1) 14n1b (6n3) —
SHAI
Main section 30n1a (5n5) 14n9b (6n2) 9n4c (5n1) 9n6c,d (4n5) 11n2b,d,e (4n6) 11n4b,f (6n3) 10n6c,e,f (5n6)
Negative consequences section 7n8a (2n8) 3n6b,c (2n2) 2n8c (2n1) 3n0c (1n8) 3n2c (2n0) 2n4b (1n9) —
Total (mainjnegative consequences) 37n9a (6n8) 18n5b (7n3) 12n2c (6n2) 12n6c,d (5n0) 14n5b,d (5n9) 13n9d (7n4) —
sections
Reassurance 24n9a (7n9) 17n1b,c (7n3) 14n9b (7n9) 13n7b (7n5) 18n9c (7n8) 17n5c,d (8n5) 14n8b,d (7n9)
Avoidance 24n2a (13n3) 17n6a,b (13n4) 9n2c,d (8n8) 11n2b,c (9n0) 10n0c,d,e (8n3) 12n0b,e (10n0) 11n2b,d (10n5)
BDI 19n9a (8n7) 15n5a (7n9) 7n1b (6n2) 8n8b,c (7n5) 9n9c (9n1) —
BAI 23n2a (7n4) 19n0a (10n5) 8n1b (8n1) 10n4b (6n9) — —
STAI-trait 55n7a (9n1) 54n9a (7n4) 38n8b (10n8) 41n2b,c (9n1) 43n7c (12n0) —
STAI-state 50n5a (11n5) 45n1a (11n7) 34n4b (11n8) 37n2b (10n7) — —
Values that share a superscript do not differ significantly from each other.
HAI, Health Anxiety Inventory ; SHAI, short version HAI ; BDI, Beck Depression Inventory ; BAI, Beck Anxiety Inventory ; GP, general
practitioner ; Gastro, gastroenterology ; MRI, magnetic resonance imaging scan.
HAI twice, with a mean of 22 days between were as follows : HAI-total, F(4, 436) l 140n4,
occasions, in order to assess test–retest P 0n0005 ; Reassurance scale F(6, 940) l 12n8,
reliability. P 0n0005 ; Avoidance scale F(6, 950) l 10n7,
P 0n0005 ; Beck Depression Inventory
Results F(4, 489) l 19n5, P 0n0005 ; Beck Anxiety In-
Internal consistency ventory F(3, 289) l 27n7, P 0n0005 ; Spiel-
The alpha coefficient for the HAI was good : berger Trait-Anxiety Inventory (F(4, 490) l
0n95 for all participants together. For the 22n1, P 0n0005) and Spielberger State-
different groups the alpha coefficients were also Anxiety Inventory F(3, 333) l 15n8, P 0n0005.
all satisfactory (hypochondriacals, 0n94 ; anxious Multiple comparisons (Bonferroni) indicated
controls, 0n82 ; non-patient controls, 0n71). For that, on the general measures of psychopath-
the Avoidance scale the alpha coefficient was ology, hypochondriacal and anxious controls
0n81 and for the Reassurance scale it was 0n75. did not differ from each other, but did from the
other groups. The specificity of the long version
Test–retest reliability of the health anxiety measure to hypochondriasis
For the 23 participants who completed the HAI was again evident. Reassurance ratings also
on two occasions, the Pearson product-moment showed such specificity, with high avoidance
correlation coefficient was 0n76, indicating a scores being apparent in the anxious control
satisfactory level of test–retest reliability (mean group but not the other controls.
scores were 8n7 on the first occasion of measure-
ment, 8n3 on the second). STUDY 4
Group differences on measures of Development and validation of the short version
psychopathology of the Health Anxiety Inventory
Means and standard deviations were calculated Having identified a comprehensive set of items
for the measures of depression, anxiety, health useful for the assessment of health anxiety, a
anxiety and ratings of reassurance seeking and short version of the HAI was derived. The aim
avoidance in illness related situations. Means was to maintain specificity between patients
and standard deviations were calculated for suffering from health anxiety on the one hand,
each of the groups, and are shown in Table 4. and other anxiety disorders and physically ill
All measures of psychopathology showed a patients on the other. This was done by taking
significant group effect. Main effects of group 14 items that had the highest item – total
correlation in the hypochondriacal patients and when the main section and negative conse-
reflected different symptoms of hypochondriasis. quences are totalled (main effect of group,
The means and standard deviations for scores F(5, 970) l 76n9, P 0n0005).
on the short version of the HAI are shown in Finally, a principal components factor analy-
Table 4 (some participants completed only the sis (employing a varimax rotation) was con-
short version of the HAI as part of another ducted for the HAI main and negative conse-
study). The alpha coefficient of the short version quences section combined. This was done for
(0n89) indicated a satisfactory level of internal both the short and long versions separately. In
consistency for the main scale across groups. both instances, the scree plots indicated two
Means are given in Table 4. There was a factor solutions, with all of the main section
significant main effect of group on the scores for items loading most heavily on the first factor
the short version of the HAI (F(6, 1087) l 59n7, and all of the negative consequences items
P 0n0005) ; multiple comparisons again in- loading on the second factor. Correlations
dicate considerable specificity. It is notable that between the scores on these sections were r l
the short HAI scores are not substantially 0n479 (P 0n0001) for the full HAI, and r l
elevated in a group of physically ill patients. 0n405 (P 0n0001) for the short HAI. Taken
together, these results provide support the
addition of the negative consequences section of
STUDY 5
the scale.
‘ Negative consequences ’ subscale
The cognitive theory of health anxiety suggests
DISCUSSION
that perceived negative consequences of being ill
are important, because threat is a function not This paper described the further development of
only of likelihood but also of anticipated burden the health anxiety inventory (HAI) as a measure
or ‘ awfulness ’. A further subscale was therefore of clinical and non-clinical health anxiety. The
developed in order to evaluate this dimension, scale was found to have good criterion validity
i.e. the second section of the scale in Appendix 1 in comparisons of hypochondriacal patients with
(see preamble preceding question 15). equally anxious groups (social phobic patients)
This subscale has 16 items in the full version, and panic disorder patients (anxious patients
and was administered to participants in the with somatic pre-occupation). The HAI was
studies above ; the results are given in Table 4. also found to be sensitive to treatment effects in
Scoring was the same as the main section of the a version in which a referent of ‘ over the last
questionnaire (0–3, with the highest score being week ’ was used. The severity of health anxiety
taken if more than one item were endorsed). and associated degree of disability as assessed
Those participants who completed a short and rated by a clinician in the course of an
version of the main HAI scale also completed a interview designed to evaluate this was found, in
short (4 item) version of the negative conse- a group of hypochondriacal patients, to be very
quences subscale. This was compiled by taking highly correlated with scores on the HAI. Both
the 4 items that had the highest item – total internal consistency and test–retest reliability of
correlation in the hypochondriacal patients. the scales were found to be high. The addition
Internal consistency was again good for this of a second component evaluating the percep-
short version, with the alpha coefficients being tion of negative consequences of illness was
0n84 for the full version and 0n72 for the supported. The data suggest that this is a
short version. Analysis of variance indicated relatively independent factor in hypochon-
main effect of group on both the full version driasis, consistent with current cognitive theories
(F(4, 434) l 21n1, P 0n0005) and the short (Salkovskis, 1996).
version (F(5, 974) l 33n1, P 0n0005). Multiple A major reason for developing the scale was
comparisons (Bonferroni) suggest that the the need for a measure of health anxiety that
negative consequences of illness subscale has could be applied in medical contexts. Most
particularly high specificity in health anxiety as scales that measure health anxiety tend to
compared with other anxious groups and people emphasize the endorsement of statements con-
with physical illness. Similar results are obtained cerning the belief that one is seriously ill, which,
APPENDIX 1
Short Health Anxiety Inventory
Negative consequences items begin at item 15. The longer version can be obtained on request from the first
author (or, see supplementary information).
(c) If I developed a serious illness there is a very small chance that modern medicine would be able to
cure me.
(d) If I developed a serious illness there is no chance that modern medicine would be able to cure me.
17. (a) A serious illness would ruin some aspects of my life.
(b) A serious illness would ruin many aspects of my life.
(c) A serious illness would ruin almost every aspect of my life.
(d) A serious illness would ruin every aspect of my life.
18. (a) If I had a serious illness I would not feel that I had lost my dignity.
(b) If I had a serious illness I would feel that I had lost a little of my dignity.
(c) If I had a serious illness I would feel that I had lost quite a lot of my dignity.
(d) If I had a serious illness I would feel that I had totally lost my dignity.
Paul Salkovskis conducted this work as a Wellcome Lucock, M. P., Morley, S., White, C. & Peake, M. D. (1997).
Trust Senior Research Fellow ; David M. Clark was a Responses of consecutive patients to reassurance after gastroscopy :
results of self administered questionnaire survey. British Medical
Wellcome Trust Principal Research Fellow. Katharine Journal 315, 572–575.
Rimes was supported by the Medical Research Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal
Council of the UK. of Psychiatry 113, 89–93.
Pilowsky, I. & Spence, N. D. (1975). Patterns of illness behaviour in
patients with intractable pain. Journal of Psychosomatic Research
19, 279–287.
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