A PhD project from Aarhus University shows that mothers with health anxiety are significantly more concerned about their children's health than healthy mothers and mothers with rheumatoid arthritis. It would be an advantage to include this health anxiety by proxy in the treatment of parents suffering from health anxiety, according to MD and PhD Mette Viller Thorgaard, who is behind the study.

2017.02.10 | Nanna Jespersgård

Even though women with health anxiety consistently rate their children as having significantly more symptoms of illness and also think that their children are more sensitive, this study does not contain anything to suggest that the children also 'inherit' this.

Mothers with health anxiety assess that their children have significantly more signs of illness such as e.g. back pain, headaches and stomach aches than when healthy mothers and mothers with rheumatoid arthritis assess their children's health.

This is shown by a larger study of the symptoms of health anxiety and related disorders in children and young people, with the latest research results recently being published in the European journal European Child & Adolescent Psychiatry.

In the study, Medical Doctor and PhD Mette Viller Thorgaard has examined both whether the women's health anxiety also covers their children aged 8-17 years, and whether the children assume their mother’s exaggerated concern of suffering from life-threatening conditions.

Even though women with health anxiety consistently rate their children as having significantly more symptoms of illness and also think that their children are more sensitive, this study does not contain anything to suggest that the children also 'inherit' this. Children of women with health anxiety do not report concern about their health to a noticeably greater degree than children of healthy women, and this is something that has surprised the researchers.

Health anxiety in mothers is not noticeably contagious

"Based on clinical intuition, the hypothesis was that children who grow up in a situation where symptoms and illnesses are considered dangerous and something that must be checked, would be affected or would assume their mother’s mindset, whereby common temporary signals from the body are construed as important signs that something is very wrong. But it is not that simple," says Mette Viller Thorgaard.

She emphasises that the children were compared on a group basis, and that it is therefore not possible to rule out that there may be particularly sensitive children who can be susceptible to parental “health anxiety by proxy”, which is the researchers' specialist terminology for demonstrating health anxiety on behalf of one’s own children.

Mette Viller Thorgaard is currently working at the Department for Depression and Anxiety Disorders at Aarhus University Hospital, Risskov, which belongs under the Department of Clinical Medicine at Aarhus University. However, the study stems from the Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, which also belongs under Aarhus University.

Genetics or social learning?

Mette Viller Thorgaard explains that relatively little is currently known about how genetics and social learning affect the development of health anxiety. The disorder is characterised by a person worrying excessively and developing anxiety about symptoms which the vast majority of people experience. This could be e.g. dizziness, buzzing in the ears, fatigue, stomach ache of muscular pain. But whereas most people simply register the signals, which usually disappear again, people with health anxiety are plagued by a fear of the worst possible outcomes, such as the symptoms being signs of cancer, multiple sclerosis or a brain tumour.

Methodically, the researchers behind the study have compared 50 children of woman with health anxiety with 51 children of healthy women and 49 children of mothers with chronic rheumatoid arthritis. Both children and mothers have completed a long battery of different questionnaires, though of course individually and without any possibility of influencing each other’s answers.

Ought to be included in treatment

Even though the children as a collective group do not appear to be affected by mothers with health anxiety, there are still good reasons for including the result of the study in the treatment of health anxiety – simply to minimise stress levels in the family.

"At the department for functional disorders, a certain type of psychological treatment is offered called Acceptance and Commitment Therapy, which is a further development of cognitive behavioural therapy. It would be obvious for the treatment groups of adults with severe health anxiety to talk about what it means, and maybe in particular, what it does not mean, when your child has some small pain," she says.

As a researcher, she also believes that health anxiety by proxy is interesting for general practitioners and in the medical speciality field of paediatrics, where medical personal continually meet children who are examined again and again due to the concerns of their parents.

The physically ill are least worried

On the other hand, it seems to match the physical ill women diagnosed with rheumatoid arthritis. This was also an area where the research group were surprised – in this case by the replies from mothers with often painful chronic arthritis:

"It turned out that the mothers who have chronic rheumatoid arthritis were significantly less concerned about their children's health than the mothers with health anxiety. They were not more worried than healthy mothers, which was something we had not expected," says Mette Viller Thorgaard.

"We do not know why this is the case, but we can establish that having rheumatoid arthritis does not in fact increase the risk of health anxiety by proxy, even though you might expect that it would. Quite the contrary, as it appears that the woman suffering from rheumatoid arthritis perceive their children to be more robust, which is the opposite of those with health anxiety," says Mette Viller Thorgaard.

The research results – more information

• The study is a family-based case-control study, in which mothers, children and fathers were asked to complete different questionnaires. Schools were also contacted in order to obtain information about the children's levels of absenteeism due to illness.
• Partners: Professor, Consultant Charlotte Ulrikka Rask, Research Clinic for Functional Disorders and Psychosomatics, as well as the Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov; Senior Researcher, Psychologist, PhD Lisbeth Frostholm, Research Clinic for Functional Disorders and Psychosomatics; Professor Lynn Walker, Vanderbilt University, Nashville, USA; and Professor, Consultant Kristian Stengaard-Pedersen, Department of Rheumatology, Aarhus University Hospital.
• The study is externally financed by the Trygfonden Foundation, the Lundbeck Foundation and the Jascha Foundation.
• The abstract of the article ”Effects of maternal health anxiety on children's health complaints, emotional symptoms, and quality of life”, published in European Child & Adolescent Psychiatry: www.ncbi.nlm.nih.gov/pubmed/27909834

Contact:

MD, PhD Mette Viller Thorgaard
Aarhus University, Department of Clinical Medicine
Aarhus University Hospital, Risskov, Department for Depression and Anxiety Disorders
Email: metthg@rm.dk