Cinosi, Eduardo

Dell'Osso, Bernardo

Fineberg, Naomi

Vismara, Matteo

English

University of Hertfordshire Research Archive

[1]: Loos A. Cyberchondria: too much information for the health anxious patient? J Consum Health Internet. 2013; 17(4): 439-45.[2]: Starcevic V, Berle D. Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert Rev Neurother. 2013;13, 205–213.[3] McMullan RD, Berle D, Arnáez S, Starcevic V. The relationships between health anxiety, online health information seeking, andcyberchondria: Systematic review and meta-analysis. J Affect Disord. 2019 Feb 15; 245:270-278.[4] McElroy E, Kearney M, Touhey J, et al. The CSS-12: Development and validation of a short-form version of the cyberchondria severity scale.Cyberpsychol Behav Soc Netw. 2019 May; 22(5):330-335.[5]: Salkovskis P, Rimes K, Warwick H, & Clark D. The Health Anxiety Inventory: development and validation of scales for the measurement ofhealth anxiety and hypochondriasis. Psychological Medicine. 2002; 32(05), 843-853.[6]: Foa EB, Huppert JD, Leiberg S, et al. The Obsessive-Compulsive Inventory: Development and validation of a short version. PsychologicalAssessment. 2002; 14, 485–496.[7]: McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014 Mar;28(2):259-65.Vismara M. 1,2 , Cinosi E. 1,3 , Dell’Osso B. 2 , Martinotti G. 3,4, Fineberg N.A. 1,31 Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire, UK;   2 University of Milan, Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy;   3 University of Hertfordshire, Hatfield, UK4 University G. D’Annunzio University, Department of Neuroscience, Imaging, Clinical Sciences, Chieti-Pescara, ItalyMethodTable 2. Comparison of DSM-5 Illness Anxiety Disorder and ICD-11 HypochondriasisCYB appears a clinically relevant form of compulsive behaviour but research remains in its infancy.Further studies are needed to understand CYB in terms of definition, clinical features, measurement,,relationship with hypochondriasis and other compulsive disorders and therapeutic interventions.The authors declare no commercial funding and no commercial interests related to the present study. In the last 12 months, Dr Fineberg hasreceived financial support from Sun Pharma, the National Institute of Health Research, EU (Horizon 2020), ECNP, outside the submitted work;Dr Dell’Osso has received financial support from Lundbeck, Angelini, Neurex Pharma, outside the submitted work; Dr Vismara, Dr Cinosi, andDr Martinotti have nothing to declare.ReferencesCase reportConclusionBackgroundAims  Cyberchondria as an emerging trans-diagnostic digital compulsive syndrome: an updated systematic review and clinical case report• Systematic search of PubMed, PsycINFO, Cochrane Library• “cyberchondria” and “cyberchondriasis” used as search terms.• 49 hits: 30 original articles, 5 reviews, 1 case report, 11 other (editorials, chapters, dissertations),and 2 descriptions of RCTs (1 including CBT) both still underway.• Five new studies have been published (>1500 participants) since the most recent review [3]• Studies were exclusively descriptive and cross-sectional with samples recruited from the generalpopulation or university students, mainly via online surveys.• No characterization of CYB in clinical samples was found.• There was no consensus definition of CYB, or agreement on epidemiology, sociodemographicand clinical characteristics or associated comorbid diagnoses.• A 33-item scale [7] to quantify CYB severity, shortened to 12-items [4], based on 5 domains(Compulsion, Distress, Excessiveness, Reassurance and Mistrust), has been developed.• CYB was found to correlate with the presence of health anxiety broadly defined, obsessive-compulsive symptoms, problematic use of the internet and other psychological constructs(intolerance of uncertainty, anxiety sensitivity, pain catastrophizing, metacognitive beliefs).• Psychoeducation and CBT were suggested as possible therapeutic approaches.• Jamie, a 30 years old male with no previous history of psychiatric disorder, referred himself to aNHS primary care CBT service seeking assessment and treatment.• Approximately 9 month before, shortly after ingesting MDMA, he experienced a panic attack(never had one before).• From that point, he developed intrusive thoughts that MDMA had irrevocably damaged his brain,despite medical reassurance to the contrary.• Having been told that his cousin “hears voices”, he started to obsessively worry he haddeveloped schizophrenia.• He became hypersensitive to and misinterpreted sounds and movements.• He also started to worry his heart rhythm was irregular (both parents have heart disease) andstarted checking his pulse frequently.• He repeatedly visited the GP, and had two (normal) ECGs.• He attended a counselor, to help rid himself of the intrusive thoughts, but also looking forreassurance that he does not have schizophrenia.• He also started to research the Internet for information about MDMA-induced brain damage orphysical disorders (cyberchondria).• He compulsively visited many different websites and patients’ forums, spending several hours aday, to the extent his work was interfered with.• He found researching made him more sensitive and anxious about somatic symptoms, andincreased vigilance, further online-searching and bodily checking, panic symptoms and medicalconsultation behavior.• He self-medicated with Vitamin D, magnesium, fish oil and multivitamins and reported he wasfeeling 75% better when he came to our clinic.• However, he admitted this referral was linked to residual medical reassurance-seeking.• On mental state examination, signs of schizophrenia and affective disorder were excluded.Psychometric evaluation.• Cyberchondria Severity Scale (12 items [4]; Table 1): 44/60• Short Health Anxiety Inventory 18 items [5]: 29/54• Obsessive-Compulsive Inventory-Revised [6]: 8/72• Internet Severity and Activities Addiction Questionnaire (developed from Young’s InternetAddiction Test [REF]): excessive online gaming (severe), pornography usage (moderate),streaming (severe).Differential diagnosis.• DSM-5 Illness Anxiety Disorder - care seeking type and ICD-11 Hypochondriasis (Table 2).• “Problematic internet usage” – not fully meeting ICD-11 Gaming Disorder or Compulsive SexualBehaviour Disorder criteria.Treatment Plan.• Exposure and response-prevention based CBT, aimed at resisting cyberchondria urges (on waitinglist June 2019; outcome - not yet known).DSM-5 ICD-11 (proposal)Category Somatic symptom and related disordersPrimary: OCRD - Secondary: anxietyDisordersName Illness Anxiety Disorder Hypochondriasis (illness anxiety disorder)DiagnosticcriteriaA) Preoccupation with having or acquiring  a serious illnessB) Somatic symptoms not present or, if present, only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate.C) High level of anxiety about health, and the individual is easily alarmedabout personal health statusD) Excessive health-related behaviors or maladaptive avoidanceE) Symptom duration >= 6 months A) Persistent preoccupation with or fear about the possibility of having one or more serious progressive or life-threatening diseases B) The preoccupation is associated withhypervigilance and catastrophic misinterpretation of bodily signs or symptoms, including normal or commonplace sensationsC) The preoccupation/fear is not simply areasonable concern and persists or recurs despite appropriate medical evaluation and reassuranceD) One or more of the following behaviors occur in relation to the preoccupation: avoidance, checking, information seeking, and/or requests for reassuranceE) The preoccupation/fear causes clinically significant distress or functional impairment F) Includes those with no insight or delusional beliefsSpecifiers Care-seeking typeCare-avoidant typeNo insightWe present1. One of the first reported cases of a treatment-seeking patient with DSM-5 illness anxietydisorder and CYB.2. An updated systematic review of the existing literature describing the association between CYBand psychiatric disordersCyberchondria (CYB), a term coined by the UK Press in the 1990s [1], represents a poorly characterized syndrome involving the urge-driven tendency to excessivelyseek health or illness-related information on the Internet. Intended to provide reassurance, searching is thought to end up increasing anxiety and distress,uncertainty and reinforcing CYB [2]. CYB may be differentiated from non-pathological information-seeking by compulsive characteristics [2]. A recent meta-analysis[3] found CYB to be associated with “health anxiety” broadly defined. CYB may even represent a trans-diagnostic digital compulsive syndrome. However, theextent to which CYB contributes to the psychopathology of compulsive psychiatric disorders, such as illness anxiety disorder (hypochondriasis), obsessive-compulsive and related disorders (OCRD) or other online disorders of behavioral addiction, is not understood.Never Rarely Some-timesOften Always1. If I notice an unexplained bodily sensation I will search for it on the internet 1 2 3 4 52. Researching symptoms or perceived medical conditions online distracts mefrom reading news/sports/entertainment articles online1 2 3 4 53. I read different web pages about the same perceived condition 1 2 3 4 54. I start to panic when I read online that a symptom I have is found in arare/serious condition1 2 3 4 55. Researching symptoms or perceived medical conditions online leads me toconsult with my GP1 2 3 4 56. I enter the same symptoms into a web search on more than one occasion 1 2 3 4 57. Researching symptoms or perceived medical conditions online interrupts mywork (e.g. writing emails, working on word documents or spreadsheets)1 2 3 4 58. I think I am fine until I read about a serious condition online 1 2 3 4 59. I feel more anxious or distressed after researching symptoms or perceivedmedical conditions online1 2 3 4 510. Researching symptoms or perceived medical conditions online interruptsmy offline social activities (e.g. reduces time spent with friends/family)1 2 3 4 511. I suggest to my GP/medical professional that I may need a diagnosticprocedure that I read about online (e.g. a biopsy/a specific blood test)1 2 3 4 512. Researching symptoms or perceived medical conditions online leads me toconsult with other medical specialists (e.g. consultants)1 2 3 4 5Table 1. The Cyberchondria Severity Scale (12 items version; [4])Method and ResultsResults

Cyberchondria as an emerging trans-diagnostic digital compulsive syndrome: An updated systematic review and clinical case report

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Cyberchondria as an emerging trans-diagnostic digital compulsive syndrome: An updated systematic review and clinical case report

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