title: The impact of health anxiety in patients with relapsing remitting multiple sclerosis: Misperception, misattribution and quality of life.
abstract: OBJECTIVE
  Multiple sclerosis (MS) is a progressive disease with an unpredictable prognosis. Previous studies have reported health anxiety within the MS population. This study examines the effect of health anxiety on MS patients' quality of life (QoL) and evaluates the potential contribution of cognitive factors in maintaining health anxiety.
  
  
  METHODS
  A total of 84 patients with relapsing remitting multiple sclerosis (RRMS) were screened for health anxiety. From this sample, a group with relatively high and another group with low anxiety (n = 21 in each group) were identified. A further 21 healthy controls were recruited for comparison. A measure of QoL was then completed. Cognitive biases were investigated by measuring perception and attribution of common bodily symptoms as well as appraisal of performance on neuropsychological and physical fatigue tests.
  
  
  RESULTS
  The high health anxiety group reported poorer QoL relative to the other groups, independent of level of disability. They were also more likely to misattribute common bodily changes to MS, and perceive their (objectively intact) performance on tests of cognition and fatigue as being impaired, attributing the cause of impairment to MS.
  
  
  CONCLUSIONS
  Health anxiety may be a factor in mediating the psychosocial impact of MS. Skilled psychological treatment which changes misperception and misattribution may significantly benefit patients with MS and elevated health anxiety.
  
  
  CONCLUSIONS
  Clinical implications Health anxiety impacts on quality of life in patients with MS even when disability and other measures of psychological distress are taken into account. High levels of health anxiety distort perceptions of symptoms in patients with MS in line with the predictions made by the cognitive model of health anxiety. Limitations of study This study is limited to patients with RRMS within the relatively early stages of their disease and is based on a small sample size. Health anxiety is correlated with measures of generalized anxiety, depression, and worry, although it is found to have a unique impact on quality of life in patients with MS.
authors.affiliation: Department of Psychology, King's College, Institute of Psychiatry, London, UK. aimee.hayter@gmail.com.
authors.forename: Aimee L
authors.initials: AL
authors.lastname: Hayter
authors.affiliation: Department of Psychology, Bath University, UK.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Salkovskis
authors.affiliation: King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Eli
authors.initials: E
authors.lastname: Silber
authors.affiliation: Department of Psychology, King's College, Institute of Psychiatry, London, UK.
authors.forename: Robin G
authors.initials: RG
authors.lastname: Morris
mesh_terms: D000328:Adult; D001007:Anxiety / Q000209:etiology* / Q000523:psychology; D016022:Case-Control Studies; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis; D003863:Depression / Q000209:etiology* / Q000523:psychology; D004185:Disability Evaluation; D005221:Fatigue / Q000209:etiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000150:complications* / Q000523:psychology*; D009483:Neuropsychological Tests; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance / Q000502:physiology; D011788:Quality of Life / Q000523:psychology*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Multiple Sclerosis; cognitive behavioural therapy; cognitive biases; health anxiety; illness perceptions; quality of life