Research Article: Development of the Hypochondriasis-YBOCS-Modified APPENDIX: ILLNESS-RELATED CHECKLIST Instructions: Please answer yes or no regarding cach ofthe illness-reated concerns, behaviors, and avoidance that you might experience Please circle Yor yes and N for no and please rate both curtent and those that were present only in che pas. Thank you, Firs, wha illneses do you worry about y 1 2 3 4 5. 6 7 8 8 1" 1 illness-related concerns Belief that you have a serious illness ‘Worry that you might havea serio illness yo jst heard abot ‘Worry that when you have a physical symptom it could indicate a serious disease “Though that you beter get your symptom checked out or els it might be too late ‘Thowghe that doctors/family members aren't taking our gmaptoms seriously Worry that you might gets seriows disease Worry that doctors aren't telling you the tuth about your symproms Worry that if you vist someone who ie sick you wil get sick Othe Other Othe illness-related behaviors (Thete ae ations simed at reducing anxiety or worry). H Reassurance secking (ether overt subile) that gimptoms ate ots of serious illes or one i ne ill ‘With family members With Fiend With Internet sources, chat rooms or health hot lines With medical books With medical professionals Checking of one's bony for signs of disease {List-making of one's symptoms tobe sure alls communicated to the doctor Calling back the doctor or health professional to make sure he/she understood what you were conveying or ‘ondered al ofthe necessary ers Finding another doctor who may repeat or do more ests (Obtaining additional medial tests (tore than your primary dactor would want you to ge) Oshe Othe Other unhealthy avoidance behaviors Avoiding doctor's appoinaments “Avoiding going into hospitals or other places where people are sick ‘Avoiding listening to conversations or stories about disease (TV, radio, frends, aly) ‘Avoiding reading information about disease (Internet, news media, medical books) ‘Avoiding reading obituaries or going to funerals, Avoiding visitng sick or dying friend/reatves ‘Avoiding activities (eg, exercise) chat bring on the physical symptoms that remind you of disease ‘Avoiding touching your own body ar examining yourself Avoiding medical tests or exams by helth profesional Avoiding postive pro-socal activites hesuxe ane feels that symptoms & illness eanceras should be the primary focus Oxhe Othe Other 9 Coment —Pastonly YN YN YON YN yYoN ¥ ON YON YON YON YN YON YN Yo oN ¥ ON YON ¥ N YON YN YON YON YON YON YON YON YO oN YN YON YON YON YON YN YN YON YN yYoN ¥ ON YON YON YON yy oN Yo oN ¥ oN YON YON YN YN YON YON YN YN YON YN yoN ¥ ON YON YON YN YN YON YN yYoN ¥ oN YON YON YON YN YON YON YON YN YON Y N YON YON Depreion and Ansty10 Skritskaya etal. H-YBOCS.M RATING INTERVAL —THE LAST 2 WEEKS ILLNESS THOUGHTS OR WORRIES Gitems 1-6) “Lam now going to ask several questions about your concerns that you have or might havea serious illness or disease.” (Make specific reference to the patients arg lines worries and thoughts) 1. "Time occupied by worries related to illness o disease (Q: When you have day with worries tha you have ar might have a serious disease or worry about a symptom suggestive of serious disease, how mich ime do these worries ls, if you add up all he inst worries of the day? What's the average total worry curation if you look st cach of the days afieted by worry? 0=None Mild amount of dime: less than 1 h/day Movderate amount of time Ito 3 hr/day jevere amount of time: greater than 3and up to 8 hr/day 44 Bxteme amount of time: greater chan 8 h/day or nearly constant 2. Frequency of worries related to illness or disease (Q; How often have you had thoughts chat you have or might have an illness or serious disease or worried shout a symptom suggestive to you ofa serious disease in last 2 weeks)? 3. Tntererence due to thoughts related to illness or disease (Q: How much do your worries about illness or serious disease interfere with your social or work (or role) functioning? Is there anything that you don't do because your mind isso preoccupied with thoughts about illness? [If currently not working desermine how much performance would be affected if patent were employed) None Mid light interference wit social or occupational activites, but overall performance notmmplted ‘Moderate, definite interference with social or occupational performance, but till manageable Severe, causes substantial impairment in social or occupational performance 4 = Exweme, neapacating 1 2 3 4. Distress associated wih thoughts related to illness or disease (Q; How much distress do your thoughts abou illaes or serious disease cause you? [In most cases, distress is equated with ansety. Only rate snxigy that seems triggered by illness/diseae thoughts, not generalized anietyoransety associated sith other conditions| ‘None Mild, not too disturbing Moderate, disturbing, but sill manageable Severe, very disturbing treme, near constant and disabling distress 5. Resistance against thoughts related tillnes or disease (Q: When you havea symptom suggestive af a serious diseae or the thought of having an illness, how much ofan effre do you make to resist che thoughts abou illnes oF serious discase-to pur them out of your mind-to dstact yourself [Only rate effort made to ress, not successor failure in patting them out of mind?) Makes an efor to always resist, symptoms so minimal dae’ ned to actively resist Testo resit most ofthe time Makes some efor to seis the thoughts Yields to almostallshoughts without attempting to distract oneself, but does so with some reluctance Completely ad willingly focuses on the thoughts of possibly having a serious disease 1 2 3 an 6, Degree of control over thoughts related to illness or disease (Q: When you think you have or might havea serious illnese or experience a symptom that males you worry you might havea serious illness, how much control da you have over your illes thoughts? How succesful are you in stopping or diverting your concerns abou ines? Can you dismiss chem? ‘Complete control ‘Much contro, usuilly able wo stop or diver illness choughts with some effort and concentation ‘Moderate contra sometimes abe to stop or diver illness thoughts Litde control, rarely success in stopping or dismissing thoughts about illess, can only divert attention with diculy nea alter wories about lle and symptoms 1 2 3 4 = No contol, experienced as completely involuntary, rarely able to ever ‘Total for ilness-related thoughts Depron and AnsietyResearch Article: Development of the Hypochondriasis-YBOCS-Modified ” ILLNESS-RELATED BEHAVIORS “The next several questions are about behaviors that you perform in response to your concerns that you ave or might have a serious ines or disease” (Reminder: Make specific reference to the patent's arget illness behaviors. Make a clear distinction berween aedive purpose Jbchaviors and avoidance. Do not include avoidance) 17. Time occupied by behaviors related to illness concerns (Q: When you have a day when illness concerns arise, on average i you pu al ofthe illness related behaviors together for that particular ay, how much time wold it take? [These mast he obserble behaviors. For this eae silent mental reviewing does not eount as & ‘compulsive behavior) O=None Mild amount of time: ess than 1 hr/day Moderate amount of time: [to 3 kr/day 4 Severe amount of time: greater than 3 and up to & he/day [Extreme amount of time: greater than # he/day or nearly constant 4, Frequency of behaviors related ro your illness concerns (Qs Tlow often have you had behaviors related to your concerns that you have or might have serious illness? None 1 = Seldom: les than 1x week 44> Very often: Daily 9. Inerference due to behaviors in respons t illness concerns (Q: How much does your behavior in response to illness concerm interfere with your social or work or roe) functioning? [currently not ‘working determine how much performance would be acted if patent were employed, None Mil, slight interference with social or occupational acsivitis, but overall performance not impaired Moderate, definite imerfrence wit soci or occupational performance, but sll manageable vere, causes substintl impairment in sail or occupational performance Extreme, incapacitating 10, Distress associated with behaviors in response to illness concerns (Q: How would you feel f you were prevented from performing an illness related behavior? How would you fel if you were prevented fr checking or from seeking reassurance? How anxious would you become? None ‘ld, only slighty anxious i ihaviors were prevented 2.= Moderate anxiety would moune but ernain manageable 45 Severe and very disturbing increase in anxiety if behaviors were prevented or interrupted [Exeme, incapacitating anxicy from any intervention aimed at preventing behaviors or reassurance secking 11, Resistance against behaviors related to illness concerns (Q: How mach of an effort do you make to resist the illness related behaviors? [Only rate efort made to resist not success or flue in sctally controlling the behavio? ‘O= Makes an effort always resis, or symptoms so minimal doesn't need to atively resist ‘Tries to resist most of the sme Males some efor to resist elds o almost all behaviors without attempting ta comtrl them, but daes so with some reluctance (Completely and willing yield to all behaviors aimed a reducing ines concerns is 12, Degree of control over behavior elated t illness concerns ‘Qi Tlow strong is the drive to perform the illness-related behavior? How much control do you have over your illness-related behaviors? ow syocesful are you in stopping or diverting your behaviors? ‘0= Complete contral Much contol, experiences pressure to perform behavior but usually able to excrcse voluntary contol over it ‘Moderate contro, strong pressure to perform behavior, can contro it ony with dificuly Lite control, very strong deve to perform the behavior. Must he carried to completion, but sometimes the behavior ean be delayed [No control experienced at completely involuntary, rarely able to even momentarily divert the behavior “Total for illness-related behaviors: Depreion and Ansty12 Skritskaya etal. ILLNESS-RELATED UNHEALTHY AVOIDANCE, "The remaining questions are about avoidance of situations following ffom fears or conviction of illness. Please note that ti refirs to unbealtby _roiden, In other words, this is avoidance stemming from fear of exposure to siations that a healthy person would not avoid. If avoidance isa healthy behavior for the patieng, then it should nos be considered “unhealthy avoidance” au should no berated here. If feared situation isnot normally encountered, please ask te patent a ate the following items asi the opportunity for exposure to tha situation wis present on a daily basis (Make spite references co the patent's avoidance behaviors) 13. Excent of avoidance related to illness concerns (Q: How many diferent sinations would you curenty avoid (if placed in that sisaton) that are related to your concerns that you might havea serious illness or disease [See the checks for typical avoidance. Situations are overall themes, eg, avoidance of physical exertion would be one theme chat includes not taking the stars, avoiding exercise or running after a bus, et] ‘= None Minimal: no more than one station 2.= Moderate: wo or tree situations 53 = Severe: many sinations freme: every situation that had any reminder of illness, death, or disease 14, Frequency of avoidance related to illness concerns (Q; How many days daring the weck wold you now seek ro ao ilnes-related siations or reminder? [If the sisaton snot normally encountered, sk if avoidance would occur if encountered (hypothetical)P] "None Seldom: less than 1x week ‘Very often daily (as offen ss possible) [5 Interference due to avoidance {Q: How much do your avoidance behaviors related to concerns about serious illness or disease interfere with your social or wotk or tole) fnctioning or with obtaining appropriate medical monitoring? In other words, by avoiding or not doing tings, re you limiting your social or work lf or potentially hamming your own health? [Rate the avoidance that causes the most interference] ‘None Mil slight interference with social or occupational activities or medical monitoring, but overall performance or health evaluations not impaired Moderate, definite interference with social or occupational performance or medical monitoring, but ill manageable and does get medical check-ups every few years or if absolutely needed Severe, causes substantial impairment in social or occupational performance or medical monitoring is impaired (because person avoid geting tests that ae recommended or needed) Extreme, incapacitating interference with social or work fanctioning or medical eare(e, would not go for meal ear even ifone were quite ill if there was strong suspicion one were meialy il... or would not go toa hospital if that were par of one’s job) 16, Distress associated with exposure to the avoided situation (Q: How would you feel if you were prevented rom avoiding these situations or if you were asked not to avoid? How anxious would you become? [Rate degree of distress patent would experience exposed to the avoided situation without being able to get reassurance. Rate the situation moet feared or associated with che greatest distress] ‘None iid only slightly anxious if exposed tothe avoided situation Moderate, reports that ansiety would mount bu remain manageable if exposed to the avoided situation or that anxiety increases but remains manageable Severe, prominent and very disturbing increas in ansiety if exposed tothe avoided situation 4 = Extreme, incapacitating anvety if exposed tothe avoided svat 17, Resistance aginst avoidance (Q; How much ofan effort do you make to resist che avoidance (ie, allow exposure of oneself othe illness related stations)? [Only rate Hlore made to resist the avoidance, not succes or failuee in acualycontelling the avoidance) Makes an eflort to aluuy resist, or symptoms so minimal doesn't need to actively resist, ‘Tries to resis the avoidance ofillness-related scetions mt f these 2.5 Maker ome er 0 rest the avoidance of ilines- related stsations| 45 Vid to almer all evedenc without attempting to contrl it, but does so with some reluctance (Le, would avoid exposure to feared situation but wit some reluctance) 44 = Completely and willingly yells to allillnes-rlated avoidance 18 Degree of control over illnes-related unhealthy avoidance (Q: How tong is the drive to avoid exposute tothe fare situation? How much control do you have over the avoidance? 0 = Complete contol Much control experiences presur, but usualy able tallow exposure Movderate contol, strong pressure to avoid exposure, ean prevent it only with dificlty Litde control, very strong dive to avoid exposure, can only allow i with exreme diiclty [No contol, he need to avoid exposure is completly overpowering ‘Total for illness-related avoidance: Depron and AnsietyResearch Article: Development of the Hypochondriasis-YBOCS-Modified 18 19. Insight int illness related obsessive thoughts ‘Q: How often do you think your concerns or behaviors are unreasonable? What part of the time do you relize your illness worries are unreasonable? Excellent insight, evaluates illness related obsessive thoughts always as unreasonable Sood insight, evaluates illness related obsessive thoughts a unreasonable most ofthe time (= 75% ofthe 2 = Faie insight, evaluates iines-related obscesive thoughts as unteasonable much ofthe time (250%, but <75% ofthe dime) Poor insight, evaluates illes-rlated obsessive thoughts ss unreasonable nly some ofthe time (=25%, but <50% of the ne) “4 Rave insight, rarely evaluates the illnes-relted obsessive thoughts as unreasonable (=25% of the time) “Tota or illness shoughts/concerns (ema): ‘Total for illnessrelated behaviors items “Tota for item 1-12 ‘Vota for illness-related avoidance tems 13-18): Grand sotal (items 1-18) 2) Depreion and Ansty