Scary symptoms? Functional magnetic resonance imaging evidence for symptom interpretation bias in pathological health anxiety
Open accessAbstract
Patients with pathological health anxiety (PHA) tend to automatically interpret bodily sensations as sign of a severe illness. To elucidate the neural correlates of this cognitive bias, we applied an functional magnetic resonance imaging adaption of a body-symptom implicit association test with symptom words in patients with PHA (n = 32) in comparison to patients with depression (n = 29) and healthy participants (n = 35). On the behavioral level, patients with PHA did not significantly differ from the control groups. However, on the neural-level patients with PHA in comparison to the control groups showed hyperactivation independent of condition in bilateral amygdala, right parietal lobe, and left nucleus accumbens. Moreover, patients with PHA, again in comparison to the control groups, showed hyperactivation in bilateral posterior parietal cortex and left dorsolateral prefrontal cortex during incongruent (i.e., harmless) versus congruent (i.e., dangerous) categorizations of body symptoms. Thus, body-symptom cues seem to trigger hyperactivity in salience and emotion processing brain regions in PHA. In addition, hyperactivity in brain regions involved in cognitive control and conflict resolution during incongruent categorization emphasizes enhanced neural effort to cope with negative implicit associations to body-symptom-related information in PHA. These results suggest increased neural responding in key structures for the processing of both emotional and cognitive aspects of body-symptom information in PHA, reflecting potential neural correlates of a negative somatic symptom interpretation bias.
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Studies using the emotional stroop task and implicit association test have shown increased amygdala activation, as well as activity in the rostral anterior cingulate cortex and right posterior parietal cortex and nucleus accumbens, in response to body-symptom words between health anxious and healthy controls.
“Studies using the emotional stroop task and implicit association test have both showed increased amygdala activation, as well as activity in the rostral anterior cingulate cortex [62] and right posterior parietal cortex and nucleus accumbens [63] in response to body-symptom words between health anxious and healthy controls.”
From Illness Anxiety Disorder: A Review of the Current Research and Future Directions (2024) · cites this paper as [63]
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- Authors
- Yan, Z., Witthöft, M., Bailer, J., Diener, C., & Mier, D.
- Affiliations
- Central Institute of Mental Health (DE)
- Johannes Gutenberg University Mainz (DE)
- Heidelberg University (DE)
- Corresponding author
- Mier, Daniela
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2017-08-12
- Volume
- 269
- Issue
- 2
- Pages
- 195-207
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- OpenAlex
- W2743590575
- Cited by
- 19
- References
- 68
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 2 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 2 · 2018: 1
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- green
- nbn-resolving.de
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- KOPS (University of Konstanz) (submittedVersion)
- Funders
- Deutsche Forschungsgemeinschaft (DFG BA1597/5-1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Pain Management and Placebo Effect
- Keywords
- amygdala hyperactivation, nucleus accumbens, posterior parietal cortex, dorsolateral prefrontal cortex, cognitive control, conflict resolution, somatic symptoms, neural correlates, depression
- MeSH terms
- Adult, Anxiety Disorders, Emotions, Female, Humans, Hypochondriasis, Magnetic Resonance Imaging, Male, Middle Aged, Cerebrum, Executive Function, Functional Neuroimaging
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