Illness anxiety disorder (IAD) is characterized by intense anxiety around having or acquiring a serious illness, as well as frequently engaging in behaviors aimed at reassurance that are ultimately ineffective and maladaptive. This disorder, often under-recognized and under-treated, leads to significant loss of function for patients and substantial cost to the health care system. In this Clinical Applications article, Scarella et al. present a comprehensive review of the basic psychopathology, assessment, epidemiology, and natural history of IAD. The review also summarizes treatment options and strategies for fostering a useful therapeutic alliance between patients, medical providers, and mental health providers.
Pages 398–407; http://doi.org/10.1097/PSY.0000000000000691
In an article based on her American Psychosomatic Society presidential address, Dr. Suzanne C. Segerstrom considers how different formulations of personality—stable traits, stable signals in a noisy or variable measure, within-person changes, and within-person variability—relate to health and particularly to immune function. Adopting a view of personality as a changing, dynamic quality can enrich the traditional view of personality as a stable individual-difference characteristic. This view also poses methodological and theoretical challenges, such as differentiating between variability and flexibility of psychological factors that are relevant to health and disease.
Pages 408–414; http://doi.org/10.1097/PSY.000000000000070
Bereavement is associated with increased risk for morbidity and all-cause mortality. In a systematic review of 33 studies, Knowles et al. examine the association between bereavement and immune system functioning. Results demonstrate associations between bereavement and lower antibody response to vaccination, higher systemic inflammation, and maladaptive immune cell gene expression. Results also suggest that bereaved people may have lower levels of cellular immunity and that psychological responses to bereavement (e.g., depression, grief) may influence the association between bereavement and immune function.
Pages 415–433; http://doi.org/10.1097/PSY.0000000000000693
Depression and somatic symptoms are common factors associated with worse health outcomes; neural mechanisms are still unclear. Because of the significance of the centromedial amygdala (CMA) in depression and somatic processing, Zu et al. explored the relationship between functional connectivity of the CMA and somatic symptoms in depression. CMA-insula connectivity was decreased and associated with somatic symptoms in individuals who were depressed in comparison to the control group. The findings may help to explain the neural substrate of somatic symptoms in depression.
Pages 434–440; http://doi.org/10.1097/PSY.0000000000000697
Patients with functional somatic syndrome have a reduced correspondence between induced physiological changes and self-reported symptoms. Van Den Houte et al. compared responses to two challenge paradigms (re-breathing and exposure to affect-inducing pictures) in patients with fibromyalgia or chronic fatigue syndrome. They found no relationship between the symptom report biases across the two paradigms. The results suggest that distortions in symptom perception in patients with functional somatic syndromes are not a trait-like, cross-situationally stable condition but are dependent on context.
Pages 441–448; http://doi.org/10.1097/PSY.0000000000000692
Children exposed to institutional rearing often exhibit problems across a broad array of developmental domains. Slopen et al. compared the consequences of long-term high-quality foster care versus standard institution-based care that began in early childhood. Early institutional rearing was not associated with differences in cardiometabolic or immune system markers, or their effects do not become evident until later in development. These findings provide new insights into the biological embedding of adversity and how it varies developmentally and across regulatory systems and adversity type.
Pages 449–457; http://doi.org/10.1097/PSY.0000000000000696
Horsley et al. assessed self-reported depressive symptoms and state anxiety in order to determine whether such symptoms of depression or state anxiety changed the strength or nature of the association between hypertensive disorders of pregnancy (HDP) and gestational age at birth. Results suggest that depressive symptoms and state anxiety may add to the increased risk for shortened gestation associated with HDP. Women at high risk of cardiovascular complications during pregnancy may benefit from additional resources to manage symptoms of depression or anxiety.
Pages 458–463; http://doi.org/10.1097/PSY.0000000000000695
A decline in resting blood pressure (BP) followed by an upward climb is well documented as a sign of a healthy pregnancy course. Although BP is associated with psychological distress and BP is also clinically important in pregnancy, little is known about its trajectory in association with birth outcomes. In pregnant adolescents, a group at risk for poor birth outcomes, Spicer et al. found results that replicated adult BP trajectories, indicating that the degree to which the trajectory emerges in adolescence may be associated with variation in birth outcomes.
Pages 464–476; http://doi.org/10.1097/PSY.0000000000000698
For older adults, depression is associated with an increased risk of death after acute hospitalization. Depression is heterogeneous in its presentation of symptoms, and individual depressive symptoms may differ in predicting mortality. Reichardt et al. showed that symptoms of apathy were most frequently reported in response to acute hospitalization. However, feelings of hopelessness about their situation were the strongest cognitive-affective predictor of mortality within 3 months post discharge. These results imply that the hopelessness symptom is important in identifying patients who are in the last phase of their lives and for whom palliative care may be important.
Pages 477–485; http://doi.org/10.1097/PSY.0000000000000694