Cited by 314Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesFibromyalgia and Chronic Fatigue Syndrome Research

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Screening for somatization and hypochondriasis in primary care and neurological in-patients

Fink, Per, Ewald, Henrik, Jensen, Jørgen, Sørensen, Lisbeth, Engberg, Marianne, Holm, Martin, Munk-Jørgensen, Povl·1999·Journal of Psychosomatic Research

DOI 10.1016/s0022-3999(98)00092-0

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Abstract

The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.

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“(Abramowitz, Schwartz, & Whiteside, 2002; Ferguson & Daniel, 1995; Fink et al., 1999; Hadjistavropoulos & Asmundson, 1998; Longley et al., 2005; Salkovskis & Warwick, 1986; Savron et al., 1999; Sexton, Norton, Walker, & Norton, 2003; Speckens et al., 1996; Stewart &Watt, 2000; Taylor & Asmundson,…”
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“Earlier studies on patients’ worries in primary health care have mainly focused on their general tendency to worry about their health (Robbins and Kirmayer, 1996; Fink et al., 1999) and on worries related to specific illnesses, for example diabetes or whiplash (Delahanty et al.”
Background
Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial
Jespersen, C. P., Pedersen, H. F., Kleinstäuber, M., Fink, P., Wellnitz, K. B., Ørnbøl, E., Schröder, A., Agger, J. L., Vase, L., Finnerup, N. B., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107524 · Cited by 2
Self-citation
Neurophysiological Markers of Somatic Symptom Disorder in Different Scenarios
Huang, W., & Liao, S. (2024) · Springer eBooks · doi:10.1007/978-3-031-32035-4_164-1 · Cited by 2
Health anxiety in cancer patients, assessed with the Whiteley Index
Hinz, A., Ernst, M., Schulte, T., Zenger, M., Friedrich, M., & Dornhöfer, N. (2024) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2024.112017 · Cited by 2
Diagnostik der Hypochondrie
Weck, F. (2013) · Psychotherapeut · doi:10.1007/s00278-013-1011-7 · Cited by 2
Hypochondriasis Differs From Panic Disorder and Social Phobia
Höfling, V., & Weck, F. (2016) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000613 · Cited by 2
Anxiety sensitivity elevates the risk of mental health problems in employees with higher probability of contacting COVID-19 at work
Autenrieth, L. K., Benke, C., Asselmann, E., & Pané‐Farré, C. A. (2023) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2023.100491 · Cited by 2
Child Maltreatment
Kisely, S. R., Strathearn, L., & Najman, J. M. (2022) · Springer eBooks · doi:10.1007/978-3-030-98711-4_72-1 · Cited by 1
Obsessive-Compulsive Disorder Related Disorders: Hypochondriasis, Hoarding Disorder, Olfactory Reference Disorder, Body Dysmorphic Disorder, Trichotillomania, Excoriation Disorder
Phillips, K. A., Rodríguez, C. I., Harding, K. J. K., Fallon, B. A., & Stein, D. J. (2023) · Springer eBooks · doi:10.1007/978-3-030-42825-9_24-1 · Cited by 1
Translation and examination of construct validity of the Danish version of the Tampa Scale for Kinesiophobia
Pedersen, M. M., Carstensen, T. B. W., Ørnbøl, E., Fink, P., Jørgensen, T., Dantoft, T. M., & Frostholm, L. (2024) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2024-0022 · Cited by 1
Self-citation
Structural brain abnormalities in patients with severe health anxiety: A cross-sectional MRI study
Gruschow, C., Hampton, A., Gehrt, T. B., Frostholm, L., & Macoveanu, J. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112338 · Cited by 1
Cognition, white matter hyperintensities and suicide risk in late-life depression patients: an exploratory study
Lee, Y., Huang, L., Sajatovic, M., Hu, C., Lee, H., Lin, C.-Y., Wang, C., Tsai, S., & Lin, Y. (2025) · BMC Geriatrics · doi:10.1186/s12877-025-06358-x · Cited by 1
“The Patient Health Question-naire-15 (PHQ-15) [18] and the Whiteley Index (White-ley-7) [19] assessed somatization and health anxiety, respectively.”
Course and predictors of somatic symptom disorder in irritable bowel syndrome and ulcerative colitis: A longitudinal analysis from the SOMA.GUT-RCT
Peters, L., Matysiak, A., Hübener, S., Lohse, A. W., Löwe, B., & Maehder, K. (2026) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2026.03.004 · Cited by 1
Longitudinal changes of COVID-19 vaccine-related health beliefs and associations with psychopathology in Germany
Huth, D., Germer, S., Witthöft, M., & Bräscher, A. (2026) · Current Psychology · doi:10.1007/s12144-026-09360-7 · Cited by 1
“Health anxiety was measured using the short version of the Whiteley Index (WI-7; Fink et al., 1999) that includes seven statements assessing illness conviction and illness worrying that are answered in a dichotomous format (0 = "no", 1 = "yes", range 0 − 7).”
Situación actual de la hipocondría
Díez, C., Rangil, T., & Planell, L. S. (2003) · Psiquiatría Biológica · Cited by 1
Evaluation of a brief psychosocial intervention for health anxiety delivered by medical assistants in primary care: Study protocol for a pilot hybrid trial
Brady, R. E., Hegel, M. T., Curran, G. M., Asmundson, G. J. G., Xie, H., & BRUCE, M. L. (2021) · Contemporary Clinical Trials · doi:10.1016/j.cct.2021.106574 · Cited by 1
Electricians’ Health After Electrical Shocks
Biering, K., Nielsen, K. J., Carstensen, O., & Kærgaard, A. (2022) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002494 · Cited by 1
Do patients with major depressive disorder and generalized anxiety disorder experience more somatosensorial amplification, hypochondriasis, and fear of COVID-19?
Ünal, G. Ö. (2022) · Dusunen Adam The Journal of Psychiatry and Neurological Sciences · doi:10.14744/dajpns.2022.00169 · Cited by 3
“(12) modified the scale and developed a 7-item form that is more comfortable to use in practice.”
Background
Somatic symptom and related disorders
Murray, A., Toussaint, A. C., & Löwe, B. (2017) · doi:10.1093/med/9780198746638.003.0013 · Cited by 1
Work Ability and Functioning Among Individuals with Persistent Indoor Environment-Related Symptoms or Chronic Fatigue: Nine-Month Follow-Up of a Web-Based Randomized Controlled Trial.
Vuokko, A., Immonen, M., Lappalainen, P., Keinonen, K., Sainio, M., Lappalainen, R., Paunio, T., & Selinheimo, S. (2026) · Journal of Occupational Rehabilitation · doi:10.1007/s10926-026-10400-z
Assessing Somatoform Disorders with the African American Client
Behbahani, S. M., & Greenstone, R. M. (2014) · Springer eBooks · doi:10.1007/978-1-4939-1004-5_17
Preoperative Predictors of Low Back Surgery Outcome: Preliminary Six‐Month Review Findings
Young, R. B., & Jones, K. V. (1999) · Pain Research and Management · doi:10.1155/1999/315458
Home Blood Pressure Measurement - Epidemiology and Clinical Application
Niiranen, T. (2008) · STM:n Hallinnonalan avoin julkaisuarkisto (Julkari)
Functional disorders of the gut
Foley, S., & Spiller, R. E. (2005) · Surgery (Oxford) · doi:10.1383/surg.2005.23.10.361
[Home blood pressure measurement].
Niiranen, T., & Jula, A. (2009) · PubMed
Trastornos somatomorfos y trastornos relacionados con sustancias
Hasin, D. S., & Katz, H. (2010) · Elsevier eBooks · doi:10.1016/b978-84-458-2037-7.00007-5
Aus vier mach zwei
Lau, K., Löwe, B., Langs, G., & Voigt, K. (2013) · Psychotherapeut · doi:10.1007/s00278-013-1019-z
Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong
Chan, C., Lau, B. H. P., Chan, T. H. Y., Leung, H. T., So, G. Y. K., & Chan, C. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.01081
“Health anxiety was measured by the Whiteley-7 Index (Fink et al., 1999), a list of seven binary-choice items that measure the extent of health anxiety, encompassing illness somatization and tendency for hypochondriasis, such that higher scores reflect greater health anxiety.”
MethodResultInfluential
Impact of Psychosocial Intervention on Emotional Disorders and Medication Adherence in HIV/AIDS
Kumar, R., Suar, D., & Singh, S. K. (2020) · Springer eBooks · doi:10.1007/978-3-030-48849-9_2
Environmental surveillance at Hanford for CY-1980. [Lead abstract]
Sula, M. J., & Blumer, P. J. (1981) · OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information)
Literaturverzeichnis
Morschitzky, H. (2000) · Springer eBooks · doi:10.1007/978-3-7091-3814-4_8
S
Ettinger, A. B., Weisbrot, D. M., & Gallimore, C. E. (2019) · Cambridge University Press eBooks · doi:10.1017/9781107706866.019
Self-Reported Mental Health and Psychosocial Correlates during the COVID-19 Pandemic: Data from the General Population in Italy
Marchetti, D., Maiella, R., Palumbo, R., D’Ettorre, M., Ceccato, I., Colasanti, M., Crosta, A. D., Malva, P. L., Bartolini, E., Biasone, D., et al. (2023) · Data · doi:10.3390/data8060111
“The present dataset lists the responses to the WI-7 items and the WI-7 total score in columns AW to BC and BD, respectively.”
Method
Child Maltreatment
Kisely, S. R., Strathearn, L., & Najman, J. M. (2023) · Springer eBooks · doi:10.1007/978-3-031-31547-3_72
Obsessive-Compulsive Disorder Related Disorders: Hypochondriasis, Hoarding Disorder, Olfactory Reference Disorder, Body Dysmorphic Disorder, Trichotillomania, Excoriation Disorder
Phillips, K. A., Rodríguez, C. I., Harding, K. J. K., Fallon, B. A., & Stein, D. J. (2024) · Springer eBooks · doi:10.1007/978-3-030-51366-5_24 · Cited by 2
A common metric for questionnaires on health anxiety in cancer patients
Friedrich, M., Schulte, T., Malburg, M., & Hinz, A. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1455121
Short report: Early-onset health anxiety: Insights from a cross-sectional study on adults diagnosed with severe health anxiety
Nyengaard, R., Ingeman, K., Frostholm, L., & Rask, C. U. (2025) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2025.112127 · Cited by 1
Interdisciplinary Pain Treatment
Brose, W. G., You, D. S., Cooley, C., Schmeissing, A., & Cao, F. (2025) · Springer eBooks · doi:10.1007/978-3-031-86057-7_26
Neurophysiological Markers of Somatic Symptom Disorder in Different Scenarios
Huang, W., & Liao, S. (2025) · Springer eBooks · doi:10.1007/978-3-031-73368-0_164
Health anxiety by proxy differs in phenomenology between parents and dog owners
Lass‐Hennemann, J., Braun, M. N., Lüder, C. C., Michael, T., Weigel, M., Zenz, E. M., & Sopp, M. R. (2025) · Scientific Reports · doi:10.1038/s41598-025-18743-y

Authors: Fink, P., Ewald, H., Jensen, J., Sørensen, L., Engberg, M., Holm, M., & Munk-Jørgensen, P.
Affiliations: Aarhus University Hospital (DK)
Corresponding author: Fink, Per
ORCID: Fink, Per
Jensen, Jørgen
Sørensen, Lisbeth
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 1999-03
Volume: 46
Issue: 3
Pages: 261-273
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/s0022-3999(98)00092-0
OpenAlex: W146236585
Cited by: 314
References: 38
Citations by year: 2026: 11 · 2025: 15 · 2024: 15 · 2023: 14 · 2022: 18 · 2021: 15 · 2020: 22 · 2019: 22 · 2018: 10 · 2017: 19 · 2016: 11 · 2015: 8 · 2014: 14 · 2013: 13 · 2012: 12
FWCI: 3.33
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Journal of Psychosomatic Research (publishedVersion)
PubMed (publishedVersion)
Scopus (Elsevier) (submittedVersion)
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
Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
Keywords: somatization, health anxiety, Whiteley Index, somatoform disorders, screening tool, internal validity, generalizability, neurology inpatients, primary care patients, SCL-90, Rasch model, latent structure analysis, sensitivity and specificity
MeSH terms: Adolescent, Adult, Aged, Family Practice, Female, Humans, Male, Mass Screening, Middle Aged, Neurology, Predictive Value of Tests, Primary Health Care, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Somatoform Disorders, Reproducibility of Results

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Screening for somatization and hypochondriasis in primary care and neurological in-patients

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