Health anxiety prevalence is increasing (Tyrer et al., 2019). Health anxiety is a preoccupation or overestimation of the serious physiological symptoms that cause significant distress (Salkovskis & Warwick, 2001). Those with health anxiety may endure significant suffering, intense misery, and for some health anxiety leads to suicide (Tyrer & Tyrer 2018). It is a condition that is often under diagnosed and the average patient may go years prior to appropriate diagnosis (Hedman et al, 2011; Tyrer & Tyrer 2018). The study of language has long history within the field of mental health. Language use can provide information about an individual’s beliefs, social relationships, personality, thinking patterns, and fears (Pennebaker et al., 2015). Additionally, language can be investigated to identify important psychological markers that are indicative of an individual’s inner workings (Choundry et al., 2013). Little is known about the linguistic attributes specific to health anxiety in online discourse. To address the research gap, two studies were conducted to determine the linguistic attributes of individuals with health anxiety. The first study used the Language and Inquiry Word (LIWC) application to evaluate categorical data for online health anxiety communication (Pennebaker et al., 2015). The second study utilized AntConc to identify keywords and collocations associated to identify what words make health anxiety discourse distinct from other forms of online communication (Anthony, 2020).
The first study examined the summary, linguistic, and psycholinguistic frequencies of word usage for health anxiety communication. One year of posts and comments were extracted from the subreddit r/HealthAnxiety to create a study corpus. The Corpus of Contemporary American English was used as a reference corpus (COCA; The COCA, 2021). The research questions were:
1. What is the score of summary variables about health anxiety?
2. What is the level of use of linguistic processes in online posts about health anxiety?
3. What is the pattern of use of linguistic processes variables in online posts about health anxiety compared to a reference corpus?
4. What is the level of use of psychological processes in online posts about health anxiety?
5. What is the pattern of use of psychological processes in online posts about health anxiety compared to a reference corpus?
Descriptive statistics were reported related to scores and level of use in the study corpus.
For the study corpus, summary variables scores indicate that those in the study corpus are high in authenticity, low in emotional tone, low in analytic processes, and low in clout. For linguistic and psychological process variables, log-likelihood ratio (G2) and Bayes Information Criterion (BIC) were used to compare the study and reference corpus. Log-likelihood for all variables understudy exceeded the critical value for significance (G2 = 484579.4 to 276.0733, df = 1, p < .01). Bayes factor (BIC) scores for results were “very strong” (BIC = 465696.04 to 257.09, df = 1).
For the second study, a keyword and collocation analysis were completed on the study corpus. Keyness refers to the “aboutness” of a text—that is, what distinguishes a text from other texts (Egbert & Biber, 2019). The study and reference corpus from study one were used for the analysis. Our research questions were:
1. What are the keywords of online posts about health anxiety?
2. What words distinguish general online posts from online posts about health anxiety?
3. What are the most common collocations of the strongest keyword of online posts about health anxiety?
4. What are the most common collocations of the term “health anxiety” in online posts about health anxiety?
The log-likelihood scale was used to determine significance with p < .01 for the top 100 keywords in both corpora. All keywords for study corpus exceeded the critical value (6.63) for significance (G2 = 9127.9 to 94.26, df = 1, p < .01). All keywords for the reference corpus exceeded the critical value for significance (G2 = 6901.08 to 295.55, df = 1, p < .01). Hardie’s (2014) log-ratio (LR) was used to determine effect size (LR = 13.381 to 9.1715). The results from the study corpus were used to identify collocates associated with the top 5 keywords and the term “health anxiety.” The mutual information (MI) score was used to measure the strength of association between two words of interest. MI scores above three are considered of linguistic interest (Hunston, 2002). The results for most common collocates measures above and below the threshold of three for linguistic interest (MI = 11.06 to 2.31).
The results of both studies indicate a significant difference between health anxiety communication and other web-based discourse. Summary scores suggest that communication is authentic and has a degree of negative emotion. Negative emotion amongst those with health anxiety is consistent with previous research (Marcus et al., 2008; Mor & Winquist, 2002). Those in the health anxiety corpus used high levels of first-person pronouns indicative of increased self-focus similar to other pathologies (Marcus et al., 2008; O’Bryan et al., 2017). Percentage of use of first-person pronoun words corresponded with other anxiety groups in an in-person context reported in previous research (Sonnenschein et al., 2018). Additionally, a linguistic profile emerged. Those with health anxiety present as high in authenticity, low in clout, low in tone, low in analytic thinking, high in first-person pronoun usage, negative emotion and biological terminology. Those with health anxiety were unique in words related to medical conditions or diseases, medication and supplements, medical tests, symptom words, body words, and anxiety words.
The findings may inform clinicians regarding the linguistic attributes of those with health anxiety to increase accurate diagnosis and understanding of the experience of those with health anxiety. Counselor-educators should consider integrating discourse analysis in training programs for counselors-in-training to view the experiences of those with health anxiety, especially descriptions of acute episodes which may not be disclosed during clinical sessions. Researchers may use the results as a baseline measurement for future quantitative or qualitative analysis
