“I constantly feel bad”. “I can’t stop worrying”. “When someone says something negative to me, it really affects me”. These phrases characterize people who score high in neuroticism or negative affectivity (for practical purposes, they’re synonymous terms). Neuroticism is a personality variable that’s been associated with hypochondria.
In fact, neuroticism acts as a springboard or enhancer that, under certain circumstances, increases the risk of suffering from hypochondria. Occasionally, the individual may already have been diagnosed. In these cases, patients with high scores in neuroticism exhibit a more severe and complex course of the disease.
An approach to the concept of hypochondria
Hypochondria is a disorder that ‘straddles’ between obsessive clinical entities, such as obsessive-compulsive disorder (OCD), and those related to anxiety, like generalized anxiety disorder (GAD).
These people manifest great nervousness, fear, and concern about the possibility of suffering from a particular medical condition. In effect, they’re afraid that this condition could cause serious injury or death (WHO, 2021).
Hypochondria has been related to biases or errors in the data that patients perceive and interpret about their bodies. In other words, they misperceive information about their own health. Consequently, they experience extremely high levels of discomfort. This has an impact on important spheres of their lives, such as socio-labor, academic, and relational.
The American Psychiatric Association (APA, 2015) states that, for hypochondria to be diagnosed, the symptoms must last for at least six months. However, these symptoms might vary in this time period and can manifest in various ways.
“To make a diagnosis of hypochondriasis, there must be an absence of organic alterations evaluated by medical tests.”
Neuroticism: the perfect breeding ground
The relationship between neuroticism and hypochondria is well-established. In fact, the APA (2015) considers it as an element that worsens the prognosis of the disease. It makes the hypochondria last longer and it becomes more difficult to treat.
From a cognitive perspective, negative affectivity (NA) plays a significant role in the most severe pole of anxiety about illness, especially when combined with high levels of scrupulosity.
“The tendency to make negative evaluations, a core aspect of negative affectivity or neuroticism, in the context of hypochondriasis would also include benign bodily sensations.”
Williams Cognitive-Behavioral Integrative Model
This model relates vulnerability to the development of hypochondria with negative affectivity or neuroticism. If we apply this term to the context of hypochondria, it can be defined as “the predisposition to focus attention specifically on threatening stimuli” (Belloch, 2020).
This makes everything related to the body itself easier for sufferers to perceive. In effect, they access information about their physical symptoms more quickly, compared to individuals without the disorder.
The factor combines experiences of intense discomfort in childhood associated with the disease. Progressively, both elements (experiences of illness and neuroticism or negative affectivity) could trigger the onset of the disorder. Consequently, the sufferer focuses their attention on abnormal bodily signals.
Furthermore, as a result of the heightened neuroticism that sufferers experience, they tend to react pessimistically about the consequences of their symptoms. For example, “My throat hurts, I’m sure I have cancer. I’m going to die”.
By assessing their symptoms as extremely threatening, they produce a thought loop that progressively amplifies the discomfort they feel. Consequently, rumination processes occur. For example, “It’s hurting even more now. I know the doctor said that it’s just a sore throat, but they were wrong. I know I have cancer so I need to see another doctor”.
“To him who is in fear, everything rustles.”
The links between neuroticism and hypochondria
The scientific evidence linking neuroticism or negative affectivity (NA) with hypochondria is clear. Here’s a brief summary of the findings (Fernández, 1998):
- A higher level of neuroticism is related to the misperception of bodily symptoms.
- A high level of neuroticism favors ruminative thought processes over the fact of suffering from a medical condition.
- The high scores in this variable make sufferers frequently feel bad. More specifically, they may develop symptoms of depression and anxiety. This could aggravate their misperceptions about the possibility of suffering from a disease.
As you can see, current data supports the existence of a link between both factors. Indeed, neuroticism is a perfect breeding ground for hypochondria. It’s a factor that mediates between the perception of symptoms in the sufferer’s body, their evaluation of them as negative and indicative of disease, and their negative reactions to them. For example, discomfort, worry, and anxiety.
“As negative affectivity increases, the propensity to exaggerate or overreact to physiological disturbances increases.”