• Mette Viller Thorgaard.
• metthg@rm.dk.
• Dan Med J. 2017 May 1; 64 (5).

AbstractExcessive health anxiety, still designated as hypochondriasis in ICD-10, refers to worries and anxiety about harbouring serious illness. It is common in both primary and secondary health care with prevalence rates up to 9% and causes great suffering for the individual as well as high health care costs when untreated. Growing research suggests that health anxiety may originate in childhood, and studies have demonstrated that cognitive and behavioural features similar to those described for health anxiety in adults may be present. The development of health anxiety probably has a complex nature involving a number of interacting factors such as genetics and environmental factors. A few studies have highlighted a possible transmission of health anxiety symptoms from a parent to a child and found significant associations between child and parental self-reported health anxiety symptoms. Theoretical perspectives also assume an association between childhood experiences and family factors and a later development of health anxiety. This dissertation is based on a systematic review and a family case-control study and aims to answer the following questions: 1) What is the empirical evidence for the influence of childhood and family factors for the development of health anxiety? 2) Does exposure to severe maternal health anxiety contribute to health anxiety symptoms in their children or perhaps more broadly affect the children emotionally? 3) Do mothers with severe health anxiety express more health anxiety on behalf of their child, more maladaptive illness perceptions and behaviours compared to mothers with rheumatoid arthritis and healthy mothers? The first part, the systematic review, was performed in accordance with the PRISMA statement and focused on the current empirical evidence for childhood and family factors involved in the development of health anxiety. In total 25 papers were examined emanating from 23 studies. The results, based on this limited research, suggested potential relationships between the development of health anxiety and 1) the intergenerational transmission, i.e. from parent to child, of health anxiety symptoms, 2) early childhood experience involving illness and 3) the expression of an anxious attachment style. The second part, the family case-control study, adds to the limited knowledge of health anxiety symptoms in childhood with one paper presenting original data on health anxiety, related symptoms and illness behaviour in three groups of children exposed to different maternal health status. Another paper examines the phenomenon of maternal health anxiety by proxy in mothers with severe health anxiety. The data for these two papers stem from 150 families with a child in the age group 8-17 years. These were grouped into a case group of children of mothers with severe health anxiety and two control groups; children of mothers with rheumatoid arthritis and children of healthy mothers. The children completed a questionnaire battery including items on health anxiety and related constructs. The mothers and fathers filled in questionnaires regarding their own mental and physical health including health anxiety, and the mothers moreover filled in questionnaires regarding illness perceptions, illness worries and illness behaviour related to their children. The findings suggest that severe maternal health anxiety only weakly affects children's own report of health anxiety symptoms and hence may not be a strong risk factor for the development and clinical presentation of excessive health anxiety symptoms early in life, i.e. in children aged 8-17 years. However, mothers with severe health anxiety perceived their children as having more emotional and physical symptoms compared to mothers with RA and healthy mothers and accordingly more often took their child to see a doctor compared to mothers with rheumatoid arthritis. They reported a more negative illness perception and more health anxiety on behalf of their child, i.e. health anxiety by proxy, as well as more dissatisfaction with their medical consultation in general practice regarding their child compared to mothers with rheumatoid arthritis and healthy mothers. Thus, although we in the first study did not find that the children of mothers with severe health anxiety themselves reported more physical symptoms compared to children in the control groups, the findings of the second study raise the possibility that the upbringing by a parent with negative illness perceptions and health anxiety in the long run could learn the child that minor bodily changes (i.e. feeling unwell) are unusual and need extra attention. Targeting health anxiety by proxy in the treatment of mothers who suffer from severe health anxiety may therefore be important to prevent not only iatrogenic harm to the child but also the exposure of the child to a maladaptive illness behaviour, which potentially could be a risk factor for the child to develop this behaviour itself when growing up.Articles published in the Danish Medical Journal are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

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