Multidimensional Inventory of Hypochondriacal Traits (MIHT)

Abstract

The Multidimensional Inventory of Hypochondriacal Traits (MIHT) is a 31-item self-report psychometric instrument developed by Susan L. Longley, David Watson, and Russell Noyes Jr. in 2005. Designed to address critical conceptual, psychometric, and diagnostic limitations present in earlier assessment instruments—such as the Whiteley Index and the Illness Attitude Scales (IAS)—the MIHT operationalizes hypochondriacal tendencies not as a crude, unidimensional psychiatric category, but as a nuanced, multidimensional constellation of psychological traits. Grounded in empirical cognitive-behavioral and personality psychology frameworks, the instrument articulates hypochondriasis across four distinct yet interrelated operational dimensions: Hypochondriacal Alienation (cognitive component; 7 items), Hypochondriacal Reassurance (behavioral component; 8 items), Hypochondriacal Absorption (perceptual component; 9 items), and Hypochondriacal Worry (affective component; 7 items). Respondents rate each item on a 5-point Likert scale ranging from 1 (never) to 5 (always).

Extensive psychometric investigations across non-clinical undergraduate cohorts, general community samples, and medical and psychiatric patient populations have demonstrated that the MIHT possesses robust psychometric properties. Internal consistency estimates across its subscales consistently demonstrate high reliability, with Cronbach’s alpha coefficients typically ranging from .78 to .91 across diverse samples, and strong test-retest temporal stability over multi-week measurement intervals. Structural equation modeling and confirmatory factor analyses (CFA) robustly support its four-factor oblique structure, outperforming traditional single-factor and uncalibrated models. Crucially, the MIHT exhibits exceptional convergent validity through significant positive correlations with legacy measures of health anxiety, somatosensory amplification, and trait neuroticism, alongside superior discriminant validity by dissociating psychological distress from genuine, objective physical morbidity. The scale serves as an invaluable diagnostic and evaluative tool across behavioral medicine, primary healthcare, consultation-liaison psychiatry, and cognitive-behavioral psychotherapy research.

Keywords

Multidimensional Inventory of Hypochondriacal Traits, MIHT, hypochondriasis, health anxiety, somatosensory amplification, illness anxiety disorder, somatic symptom disorder, psychometrics, confirmatory factor analysis, behavioral assessment

Authors

The Multidimensional Inventory of Hypochondriacal Traits was developed through a collaborative psychometric research program led by:

• Susan L. Longley, Ph.D. — Department of Psychology, The University of Iowa, and Johns Hopkins Bloomberg School of Public Health. Dr. Longley’s clinical research focuses on the structural conceptualization of anxiety disorders, somatization, and the psychometric measurement of health-related affective constructs. (Correspondence: [email protected]).
• David Watson, Ph.D. — Andrew J. McKenna Family Professor of Psychology, Department of Psychology, University of Notre Dame (formerly at The University of Iowa). Dr. Watson is an internationally renowned psychometrician and personality theorist, co-creator of the Positive and Negative Affect Schedule (PANAS), and an expert on the structural taxonomy of mood, anxiety, and personality disorders.
• Russell Noyes Jr., M.D. — Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, The University of Iowa. Dr. Noyes was an influential clinical psychiatrist and academic researcher whose empirical work clarified the phenomenology, longitudinal course, and nosological classification of hypochondriasis and panic disorder within the American Psychiatric Association taxonomy.

Purpose

The primary purpose of the Multidimensional Inventory of Hypochondriacal Traits (MIHT) is to provide an empirically rigorous, fine-grained assessment of the heterogeneous manifestations of health anxiety and hypochondriacal traits. For several decades, clinical research into hypochondriasis was severely constrained by legacy instruments developed in the mid-to-late 20th century, notably Pilowsky’s Whiteley Index (1967) and Kellner’s Illness Attitude Scales (1986). While clinically influential, these older inventories suffered from prominent structural and psychometric shortcomings, including inconsistent factor structures across diverse demographic samples, high item redundancy, conflation of actual physical disease symptoms with psychological distress, and inadequate sampling of core interpersonal and attentional dimensions of health anxiety.

To overcome these limitations, Longley, Watson, and Noyes (2005) initiated an exhaustive psychometric construction program aimed at capturing hypochondriasis as a continuous, multidimensional personality domain rather than an all-or-nothing categorical diagnosis. The MIHT was specifically engineered to achieve three overarching objectives:

• Deconstruct Hypochondriacal Phenomenology: Rather than aggregating disparate cognitive, physiological, and behavioral phenomena into a single, amorphous global index, the MIHT explicitly delineates four distinct domains: perceptual body vigilance (Hypochondriacal Absorption), cognitive interpretations of interpersonal invalidation (Hypochondriacal Alienation), reassurance-seeking and help-soliciting rituals (Hypochondriacal Reassurance), and catastrophic affective processing regarding disease and mortality (Hypochondriacal Worry).
• Differentiate Hypochondriasis from Objective Medical Morbidity: Many traditional instruments include items asking about general bodily pain, fatigue, or somatic dysfunction. Consequently, patients with authentic, severe medical conditions (such as rheumatoid arthritis, multiple sclerosis, or chronic cardiovascular disease) artificially score within the pathological hypochondriacal range. The MIHT resolves this criterion contamination by systematically focusing on the cognitive appraisals, emotional distress, and behavioral reactions to physical cues, rather than the raw baseline prevalence of physical sensations themselves.
• Facilitate Precision in Clinical Research and Cognitive-Behavioral Treatment: In clinical settings, distinct patients with severe health anxiety present with radically disparate symptom profiles. One individual may present with intense interoceptive hyperfocus without interpersonal conflict, whereas another may engage in exhausting, contentious cycles of reassurance-seeking from family members and physicians while feeling profoundly misunderstood and alienated. The MIHT enables clinicians and clinical trial researchers to profile these distinct phenotypic expressions, allowing for modular, tailored cognitive-behavioral interventions (e.g., targeting interoceptive exposure for absorption versus communication training and response prevention for reassurance and alienation).

Furthermore, the development of the MIHT anticipated the major nosological transitions executed in the transition from DSM-IV to DSM-5, wherein hypochondriasis was dismantled and reconfigured into Illness Anxiety Disorder (characterized by high health anxiety with minimal somatic symptoms) and Somatic Symptom Disorder (characterized by disproportionate distress regarding existing somatic symptoms). By isolating perceptual absorption and cognitive worry from medical symptom severity, the MIHT serves as a premier research and clinical profiling instrument congruent with contemporary transdiagnostic and dimensional diagnostic frameworks, including the Hierarchical Taxonomy of Psychopathology (HiTOP).

Psychological Construct

The MIHT operationalizes hypochondriasis as a multidimensional trait system organized across four cardinal components: cognitive, behavioral, perceptual, and affective. Each component embodies a distinct psychological mechanism that contributes to the emergence, exacerbation, and chronic maintenance of pathological health anxiety.

1. Cognitive Component: Hypochondriacal Alienation

The Hypochondriacal Alienation dimension (Items 1–7) assesses the cognitive appraisal that one’s health concerns, physical complaints, and subjective suffering are dismissed, trivialized, or inadequately managed by social networks and healthcare providers. Interpersonal dysfunction has long been recognized as a hallmark of severe hypochondriasis, yet earlier psychometric tools largely neglected this domain. Individuals scoring high on this subscale perceive a profound disconnect between their experienced vulnerability and the empathy offered by their environment (e.g., “Others do not seem sympathetic to my health problems”; “Few people seem to take my health concerns as seriously as I do”).

This subscale captures perceived medical invalidation and social estrangement. Cognitively, patients interpret a physician’s normal lab results or a spouse’s fatigue with their chronic complaints not as reassuring signals of physical safety, but as evidence of neglect, incompetence, or interpersonal abandonment. This alienation frequently precipitates a paradoxical escalation in help-seeking: feeling unheard, the individual intensifies their symptom reports or seeks out secondary and tertiary medical opinions, reinforcing an adversarial “doctor-shopping” cycle.

2. Behavioral Component: Hypochondriacal Reassurance

The Hypochondriacal Reassurance dimension (Items 8–15) evaluates overt behavioral strategies aimed at mitigating health anxiety through safety-seeking, emotional comfort, and interpersonal support (e.g., “I turn to others for support when I do not feel well”; “I like to be reassured when I feel sick”; “When I feel physical pain, I let others know”). In cognitive-behavioral formulations of health anxiety, reassurance-seeking functions as a core maintaining behavior analogized to compulsive checking in obsessive-compulsive disorder.

When individuals detect ambiguous physical cues, the immediate affective discomfort triggers behavioral attempts to solicit verbal confirmation of wellness from doctors, partners, or friends. Although obtaining reassurance provides immediate, short-term reduction of acute distress, it prevents the cognitive habituation of anxiety and the disconfirmation of catastrophic beliefs. Over time, the soothing effect decays rapidly, necessitating increasingly frequent reassurance rituals that exhaust social support systems and solidify behavioral dependence.

3. Perceptual Component: Hypochondriacal Absorption

The Hypochondriacal Absorption dimension (Items 16–24) operationalizes heightened perceptual vigilance, body focused attention, and elevated interoceptive sensitivity (e.g., “I am aware of my body position”; “Even when I listen to a lecture or talk, I am alert to how my body feels”; “I keep close track of what is happening to me physically”). Rather than measuring the subjective presence of pathology or illness symptoms, this subscale captures attentional allocation directed inward toward baseline, benign somatic processes.

Individuals with high absorption continuously monitor visceral, muscular, and proprioceptive sensations. Normal physiological noise—such as postprandial peristalsis, transient positional twitches, heart rate fluctuations during postural transitions, or the physical tactile sensation of clothing against the skin—is brought into acute conscious awareness. Because focused attention amplifies the perceived intensity and salience of any sensory input, this perceptual absorption directly supplies the raw material that the cognitive and affective systems subsequently misinterpret as catastrophic illness.

4. Affective Component: Hypochondriacal Worry

The Hypochondriacal Worry dimension (Items 25–31) captures the classic affective and cognitive core of health anxiety: persistent, catastrophic fear regarding disease, bodily vulnerability, debilitating aging, and mortality (e.g., “I worry a lot about my health”; “When I experience pain, I fear I may be ill”; “If I notice a skin blemish I worry it might lead to something serious”; “I try to avoid things that make me think of illness or death”).

This subscale assesses cognitive misattributions wherein benign somatic changes are immediately interpreted as pathognomonic evidence of life-threatening illnesses, such as malignancy, cardiovascular catastrophe, or neurodegenerative collapse. Furthermore, it incorporates the affective avoidance strategies utilized to suppress illness-related cues, such as evading medical documentaries, avoiding disease-related literature, or shunning conversations about terminal illness. Hypochondriacal worry constitutes the principal affective engine driving both perceptual vigilance and desperate behavioral reassurance-seeking.

Theoretical Framework

The conceptual architecture of the MIHT is anchored in modern cognitive-behavioral models of health anxiety, somatosensory amplification theories, and the structural taxonomy of personality and affective disorders.

The Cognitive-Behavioral Model of Health Anxiety

The MIHT relies heavily on the cognitive formulation of hypochondriasis pioneered by Paul Salkovskis and Hilary Warwick (1986, 1990). In this model, health anxiety is sustained through a self-perpetuating dysfunctional cognitive loop consisting of five reciprocal elements:

1. Dysfunctional Health Beliefs: Deeply held core schemas regarding bodily frailty (e.g., “Bodily sensations are always indicative of underlying pathology”).
2. Triggers: Internal sensations (captured by MIHT Absorption) or external cues (e.g., media reports about illnesses, captured by MIHT Worry).
3. Catastrophic Misinterpretations: The automatic cognitive appraisal that somatic sensations signal imminent fatal disease.
4. Affective Distress: Heightened anxiety, autonomic arousal, and dread.
5. Maladaptive Coping Behaviors: Safety-seeking behaviors such as reassurance-seeking (captured by MIHT Reassurance), body scanning, and social conflicts over unrecognized symptoms (captured by MIHT Alienation).

The MIHT directly maps onto this cognitive-behavioral cycle. By disaggregating the loop into its perceptual, cognitive, behavioral, and affective elements, the instrument allows researchers to evaluate how each component dynamically reinforces the others over the clinical trajectory of the disorder.

Somatosensory Amplification

The perceptual component of the MIHT is conceptually rooted in Arthur Barsky’s theory of somatosensory amplification (Barsky & Wyshak, 1990). Barsky posited that hypochondriacal individuals possess an enduring perceptual style characterized by hyper-attentiveness to somatic sensations, a tendency to select and focus on relatively weak or infrequent bodily sensations, and a disposition to react to normal somatic sensations with negative emotionality and catastrophic cognitive appraisal. The MIHT Absorption subscale directly operationalizes the attentional and perceptual baseline of this amplification mechanism, differentiating the non-evaluative sensory awareness of bodily states from the catastrophic affective distress measured by the Worry subscale.

Personality Structure and Trait Negative Affectivity

From a personality psychology perspective, Longley, Watson, and Noyes integrated the MIHT into the broader literature on trait neuroticism and Negative Affectivity (NA), as delineated by Watson and Clark (1984). Extensive research demonstrates that hypochondriasis shares substantial shared variance with broad negative emotionality, generalized anxiety disorder, and major depressive disorder. However, general neuroticism alone is insufficient to explain the specific somatic channeling observed in hypochondriacal patients.

The MIHT reflects a hierarchical model of psychopathology: broad Negative Affectivity occupies the higher-order structural apex, while hypochondriasis exists at the lower-order, specific-trait level, characterized by idiosyncratic somatic hypervigilance (Absorption), disease-specific catastrophic cognition (Worry), interpersonal invalidation schemas (Alienation), and compulsive reassurance-seeking (Reassurance). This hierarchical framing aligns the MIHT with contemporary quantitative structural paradigms of emotional and somatoform disorders.

Validity

The psychometric validity of the MIHT has been rigorously substantiated across numerous validation cohorts, encompassing diverse non-clinical student groups, community adult samples, and clinical populations receiving psychiatric or general medical outpatient care.

Construct and Structural Validity

Construct validity was initially established by Longley et al. (2005) through exploratory and confirmatory factor analytic protocols. Across independent samples, the four hypothesized factors—Alienation, Reassurance, Absorption, and Worry—emerged cleanly, exhibiting substantial within-factor convergent loadings (predominantly > .50) and minimal cross-loadings. Confirmatory factor analysis confirmed that an oblique four-factor model yielded superior fit compared to rival single-factor models (which displayed unacceptably poor fit indices, demonstrating that hypochondriasis cannot be accurately characterized as a unidimensional construct) and orthogonal configurations.

Convergent Validity

The MIHT subscales exhibit strong, theoretically predictable convergent associations with established legacy measures of health anxiety and somatic preoccupation:

• Whiteley Index (WI): The MIHT Total score and specifically the Hypochondriacal Worry subscale demonstrate robust positive correlations with the Whiteley Index (typically r = .65 to .78), confirming that the MIHT effectively captures the classical illness-phobia domain.
• Illness Attitude Scales (IAS): Strong convergent associations are observed between the MIHT Worry subscale and the IAS Fear of Death, Disease Phobia, and Worry About Illness subscales (rs ranging from .60 to .75). Furthermore, the MIHT Reassurance subscale correlates strongly with the IAS Treatment Experience and Reassurance subscales (r > .60).
• Somatosensory Amplification Scale (SSAS): The MIHT Absorption subscale displays strong convergent validity with Barsky’s SSAS (r = .52 to .64), validating its sensitivity to interoceptive hypervigilance and bodily perceptual tracking.
• Short Health Anxiety Inventory (SHAI): In subsequent comparative research, the MIHT Worry and Absorption subscales correlated highly with the SHAI core illness likelihood and illness consequence indices (r = .68 and .54, respectively).

Discriminant and Criterion Validity

A critical psychometric achievement of the MIHT is its enhanced discriminant validity relative to objective physical illness. In studies comparing healthy controls with patient groups afflicted with confirmed medical diagnoses (e.g., chronic gastrointestinal disorders, hypertension, rheumatologic diseases), the MIHT effectively separated objective medical impairment from psychological hypochondriasis:

• While legacy scales frequently inflated pathology scores among genuine medical patients due to bodily pain and functional limitation items, the MIHT Worry and Alienation subscales successfully differentiated hypochondriacal illness anxiety from genuine, realistic medical distress.
• Discriminant validity against broad affective constructs was confirmed via comparisons with the Positive and Negative Affect Schedule (PANAS). While MIHT Worry correlated moderately with general Negative Affect (r ≈ .40 to .50), MIHT Absorption and Reassurance maintained distinct, lower-magnitude associations (r ≈ .20 to .30), confirming they measure discrete behavioral and perceptual phenomena rather than mere diffuse emotional distress.
• Correlations with Positive Affectivity are consistently near zero or mildly negative (r = -.05 to -.18), confirming that hypochondriacal traits operate orthogonally to positive emotional vigor.

Reliability

The MIHT exhibits exemplary internal consistency reliability and temporal test-retest stability across diverse research and clinical contexts.

Internal Consistency

In the foundational validation investigations conducted by Longley, Watson, and Noyes (2005), Cronbach’s alpha coefficients demonstrated high internal consistency across all four subscales and the total instrument:

• Hypochondriacal Alienation (7 items): Cronbach’s α values consistently range between .83 and .88 across non-clinical college, community adult, and medical outpatient samples.
• Hypochondriacal Reassurance (8 items): Cronbach’s α values range from .79 to .85, reflecting a unified behavioral repertoire of support-soliciting behaviors.
• Hypochondriacal Absorption (9 items): Cronbach’s α values span .78 to .84, illustrating high internal coherence among items indexing baseline bodily vigilance and proprioceptive awareness.
• Hypochondriacal Worry (7 items): Demonstrating the highest internal consistency, alpha coefficients range between .86 and .91, confirming robust item covariance regarding disease apprehension and somatic catastrophizing.
• MIHT Total Scale (31 items): The full composite scale displays exceptional reliability, with Cronbach’s alpha consistently exceeding .90 (typically α = .91 to .94).

Mean inter-item correlations across the subscales generally fall within the optimal psychometric target range of .30 to .55, confirming that the subscales possess adequate construct coherence without suffering from excessive, redundant item phrasing.

Test-Retest Stability

Evaluation of temporal stability over intervals ranging from 4 to 8 weeks in non-clinical cohorts has yielded test-retest correlation coefficients (r_tt) exceeding .75 for the individual subscales and .82 for the total score. These data confirm that the MIHT captures stable, enduring trait dimensions rather than transient, state-dependent fluctuations in situational medical concern.

Factor Analysis

The structural dimensionality of the MIHT was established through an iterative scale-development pipeline combining exploratory factor analysis (EFA) and confirmatory factor analysis (CFA).

Exploratory Factor Analysis (EFA)

During scale construction, Longley et al. generated an initial candidate pool of 75 items designed to reflect theoretical components of hypochondriacal attitudes, behaviors, and perceptions. Principal Axis Factoring and Maximum Likelihood extraction with oblique (Promax) rotation were conducted on developmental samples of university undergraduates (N > 800) and general medical patients.

Scree plot examinations, parallel analyses, and eigenvalues-greater-than-one criteria uniformly converged on a four-factor solution. Items exhibiting low primary factor loadings (< .40) or high cross-loadings (> .25 on non-target factors) were iteratively eliminated, yielding the final 31-item, four-factor simple structure. The factors aligned precisely with theoretical expectations:

• Factor 1: Hypochondriacal Worry — Salient loadings (.58 to .83) for items reflecting health dread, death anxiety, and fear of cancer or severe systemic disease.
• Factor 2: Hypochondriacal Absorption — Strong loadings (.48 to .76) for items assessing heightened sensitivity to body position, clothes against skin, and visceral digestion cues.
• Factor 3: Hypochondriacal Alienation — High loadings (.54 to .82) on items capturing feelings that doctors, friends, and family lack sympathy and fail to validate illness concerns.
• Factor 4: Hypochondriacal Reassurance — Robust loadings (.49 to .78) on items capturing safety-seeking, emotional soothing requests, and wanting parents or clinicians to fuss over illness.

Confirmatory Factor Analysis (CFA)

Subsequent cross-validation studies using CFA evaluated competitive structural models to substantiate the construct validity of the 31-item scale:

• Single-Factor Model: Positing all 31 items load onto a single general hypochondriasis factor yielded unacceptable fit indices (χ²/df > 5.2, CFI < .75, TLI < .72, RMSEA > .095, SRMR > .088), definitively rejecting the notion of hypochondriasis as a unidimensional construct.
• Orthogonal Four-Factor Model: Constraining factor correlations to zero also produced inadequate fit (χ²/df > 4.1, CFI < .81, RMSEA > .082), reflecting the empirical reality that these trait components share meaningful covariance.
• Oblique Four-Factor Model: Allowing the four latent factors to correlate yielded excellent model fit across independent student, community, and clinical cohorts (χ²/df ≈ 1.85 to 2.20, Comparative Fit Index [CFI] = .94 to .96, Tucker-Lewis Index [TLI] = .93 to .95, Root Mean Square Error of Approximation [RMSEA] = .042 to .051, Standardized Root Mean Square Residual [SRMR] = .045 to .052).
• Higher-Order Hierarchical Model: A model specifying a higher-order General Hypochondriasis factor accounting for the correlations among the four lower-order factors also demonstrated acceptable fit (χ²/df ≈ 2.10, CFI = .93, RMSEA = .050), validating both the calculation of individual subscale profiles and the aggregation of a global composite score.

Inter-factor correlations in the oblique model reveal moderate shared variance: Worry correlates positively with Absorption (r ≈ .42 to .52), Alienation (r ≈ .38 to .48), and Reassurance (r ≈ .30 to .40), demonstrating that while these components coalesce within the overarching hypochondriacal domain, each retains substantial unique variance justifying separate clinical assessment.

Instrument / Measurement Tool

The MIHT is a standardized, self-administered psychological inventory. Its structural and administrative specifications are outlined below:

• Test Type: Multidimensional self-report rating scale / objective trait inventory.
• Administration Format: Paper-and-pencil questionnaire or computerized/online digital administration.
• Target Population: Adults and adolescents aged 18 and older. Adaptable for clinical psychiatric outpatients, primary care populations, and non-clinical research cohorts.
• Completion Time: Approximately 5 to 10 minutes.
• Total Item Count: 31 items.
• Subscale Breakdown:
  • Hypochondriacal Alienation: 7 items (Items 1, 2, 3, 4, 5, 6, 7)
  • Hypochondriacal Reassurance: 8 items (Items 8, 9, 10, 11, 12, 13, 14, 15)
  • Hypochondriacal Absorption: 9 items (Items 16, 17, 18, 19, 20, 21, 22, 23, 24)
  • Hypochondriacal Worry: 7 items (Items 25, 26, 27, 28, 29, 30, 31)
• Response Format: 5-point Likert scale scored as follows:
  • 1 = Never
  • 2 = Rarely
  • 3 = Sometimes
  • 4 = Usually
  • 5 = Always
• Scoring Methodology:
  • All 31 items are positively keyed; there are no reverse-coded items.
  • Subscale Scores: Calculated by summing the individual item ratings within each respective subscale (Alienation range: 7–35; Reassurance range: 8–40; Absorption range: 9–45; Worry range: 7–35). Alternatively, mean subscale scores (ranging from 1.0 to 5.0) can be calculated to facilitate direct cross-scale comparisons.
  • Total MIHT Composite Score: Calculated by summing all 31 items (total score range: 31–155). Higher overall scores reflect elevated hypochondriacal trait severity.
• Clinical Interpretation Guidelines: Profile analyses rather than simple total score interpretation are strongly recommended. Disproportionately elevated scores on Alienation indicate therapeutic alliance vulnerability and perceived medical dismissal; elevated Reassurance scores signify behavioral safety rituals requiring response prevention; high Absorption denotes interoceptive sensory amplification requiring attention-training techniques; and elevated Worry denotes catastrophic cognitive misinterpretations requiring cognitive restructuring.

Permissions & Fee and Test Year

The Multidimensional Inventory of Hypochondriacal Traits was published in 2005 by the American Psychological Association (APA). The original instrument and its validation metrics are detailed in the foundational empirical paper: Psychological Assessment, Vol. 17, No. 1, pp. 3–14.

The MIHT is considered an open-access psychometric instrument for non-commercial academic research, educational instruction, and individual clinical evaluation purposes, provided proper citation is attributed to the original authors and the copyright holders. The instrument is publicly accessible via academic repositories and institutional author archives (e.g., Susan L. Longley Academic Resource File). Clinicians, healthcare systems, and commercial developers seeking to embed the MIHT within proprietary software platforms, for-profit electronic health record (EHR) systems, or commercial digital health applications should contact the primary corresponding author (Dr. Susan L. Longley at [email protected]) or the American Psychological Association’s Rights and Permissions Office to secure appropriate licensing authorization.

References

• Barsky, A. J., & Wyshak, G. (1990). Hypochondriasis and somatosensory amplification. The British Journal of Psychiatry, 157(3), 404–409. https://doi.org/10.1192/bjp.157.3.404
• Kellner, R. (1986). Somatization and hypochondriasis. Praeger Publishers.
• Longley, S. L., Watson, D., & Noyes Jr, R. (2005). Assessment of the hypochondriasis domain: The Multidimensional Inventory of Hypochondriacal Traits (MIHT). Psychological Assessment, 17(1), 3–14. https://doi.org/10.1037/1040-3590.17.1.3
• Noyes, R. (1999). The relationship of hypochondriasis to anxiety disorders. General Hospital Psychiatry, 21(1), 8–17. https://doi.org/10.1016/S0163-8343(98)00063-4
• Noyes, R., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., & Yagla, S. J. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65(2), 292–300. https://doi.org/10.1097/01.PSY.0000033128.87754.E6
• Pilowsky, I. (1967). Dimensions of hypochondriasis. The British Journal of Psychiatry, 113(494), 89–93. https://doi.org/10.1192/bjp.113.494.89
• Salkovskis, P. M., & Warwick, H. M. C. (1986). Morbid fears of illness: A cognitive approach to hypochondriasis. Behaviour Research and Therapy, 24(5), 497–502. https://doi.org/10.1016/0005-7967(86)90034-7
• Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117. https://doi.org/10.1016/0005-7967(90)90023-C
• Watson, D., & Clark, L. A. (1984). Negative affectivity: The disposition to experience aversive emotional states. Psychological Bulletin, 96(3), 465–490. https://doi.org/10.1037/0033-2909.96.3.465

Items of the Scale