Health anxiety and illness worry

مِن شَرِّ ٱلۡوَسۡوَاسِ ٱلۡخَنَّاسِ

against the harm of the slinking whisperer––

لَّيۡسَ عَلَى ٱلضُّعَفَآءِ وَلَا عَلَى ٱلۡمَرۡضَىٰ وَلَا عَلَى ٱلَّذِينَ لَا يَجِدُونَ مَا يُنفِقُونَ حَرَجٌ إِذَا نَصَحُواْ لِلَّهِ وَرَسُولِهِۦۚ مَا عَلَى ٱلۡمُحۡسِنِينَ مِن سَبِيلࣲۚ وَٱللَّهُ غَفُورࣱ رَّحِيمࣱ‏

but there is no blame attached to the weak, the sick, and those who have no means to spend, provided they are true to God and His Messenger- there is no reason to reproach those who do good: God is most forgiving and merciful

وَلۡيَسۡتَعۡفِفِ ٱلَّذِينَ لَا يَجِدُونَ نِكَاحًا حَتَّىٰ يُغۡنِيَهُمُ ٱللَّهُ مِن فَضۡلِهِۦۗ وَٱلَّذِينَ يَبۡتَغُونَ ٱلۡكِتَٰبَ مِمَّا مَلَكَتۡ أَيۡمَٰنُكُمۡ فَكَاتِبُوهُمۡ إِنۡ عَلِمۡتُمۡ فِيهِمۡ خَيۡرࣰ اۖ وَءَاتُوهُم مِّن مَّالِ ٱللَّهِ ٱلَّذِيٓ ءَاتَىٰكُمۡۚ وَلَا تُكۡرِهُواْ فَتَيَٰتِكُمۡ عَلَى ٱلۡبِغَآءِ إِنۡ أَرَدۡنَ تَحَصُّنࣰ ا لِّتَبۡتَغُواْ عَرَضَ ٱلۡحَيَوٰةِ ٱلدُّنۡيَاۚ وَمَن يُكۡرِههُّنَّ فَإِنَّ ٱللَّهَ مِنۢ بَعۡدِ إِكۡرَٰهِهِنَّ غَفُورࣱ رَّحِيمࣱ‏

Those who are unable to marry should keep chaste until God gives them enough out of His bounty. If any of your slaves wish to pay for their freedom, make a contract with them accordingly, if you know they have good in them, and give them some of the wealth God has given you. Do not force your slave-girls into prostitution, when they themselves wish to remain honourable, in your quest for the short-term gains of this world, although, if they are forced, God will be forgiving and merciful to them

وَلِكُلࣲّ جَعَلۡنَا مَوَٰلِيَ مِمَّا تَرَكَ ٱلۡوَٰلِدَانِ وَٱلۡأَقۡرَبُونَۚ وَٱلَّذِينَ عَقَدَتۡ أَيۡمَٰنُكُمۡ فَـَٔاتُوهُمۡ نَصِيبَهُمۡۚ إِنَّ ٱللَّهَ كَانَ عَلَىٰ كُلِّ شَيۡءࣲ شَهِيدًا

We have appointed heirs for everything that parents and close relatives leave behind, including those to whom you have pledged your hands [in marriage], so give them their share: God is witness to everything

يَٰٓأَيُّهَا ٱلَّذِينَ ءَامَنُوٓاْ إِذَا جَآءَكُمُ ٱلۡمُؤۡمِنَٰتُ مُهَٰجِرَٰتࣲ فَٱمۡتَحِنُوهُنَّۖ ٱللَّهُ أَعۡلَمُ بِإِيمَٰنِهِنَّۖ فَإِنۡ عَلِمۡتُمُوهُنَّ مُؤۡمِنَٰتࣲ فَلَا تَرۡجِعُوهُنَّ إِلَى ٱلۡكُفَّارِۖ لَا هُنَّ حِلࣱّ لَّهُمۡ وَلَا هُمۡ يَحِلُّونَ لَهُنَّۖ وَءَاتُوهُم مَّآ أَنفَقُواْۚ وَلَا جُنَاحَ عَلَيۡكُمۡ أَن تَنكِحُوهُنَّ إِذَآ ءَاتَيۡتُمُوهُنَّ أُجُورَهُنَّۚ وَلَا تُمۡسِكُواْ بِعِصَمِ ٱلۡكَوَافِرِ وَسۡـَٔلُواْ مَآ أَنفَقۡتُمۡ وَلۡيَسۡـَٔلُواْ مَآ أَنفَقُواْۚ ذَٰلِكُمۡ حُكۡمُ ٱللَّهِ يَحۡكُمُ بَيۡنَكُمۡۖ وَٱللَّهُ عَلِيمٌ حَكِيمࣱ‏

You who believe, test the believing women when they come to you as emigrants- God knows best about their faith- and if you are sure of their belief, do not send them back to the disbelievers: they are not lawful wives for them, nor are the disbelievers their lawful husbands. Give the disbelievers whatever bride-gifts they have paid- if you choose to marry them, there is no blame on you once you have paid their bride-gifts- and do not yourselves hold on to marriage ties with disbelieving women. Ask for repayment of the bride-gifts you have paid, and let the disbelievers do the same. This is God’s judgement: He judges between you, God is all knowing and wise

فَإِذَا جَآءَتۡهُمُ ٱلۡحَسَنَةُ قَالُواْ لَنَا هَٰذِهِۦۖ وَإِن تُصِبۡهُمۡ سَيِّئَةࣱ يَطَّيَّرُواْ بِمُوسَىٰ وَمَن مَّعَهُۥٓۗ أَلَآ إِنَّمَا طَٰٓئِرُهُمۡ عِندَ ٱللَّهِ وَلَٰكِنَّ أَكۡثَرَهُمۡ لَا يَعۡلَمُونَ

then, when something good came their way, they said, ‘This is our due!’. When something bad came, they ascribed it to the evil omen of Moses and those with him, but their ‘evil omen’ was really from God, though most of them did not realize it

(And such of your slaves as seek a writing (of emancipation), write it for them�) [24:33]. This verse was revealed about a slave of Huwaytib ibn �Abd al-�Uzza who was called Subayh. The latter asked his master for a writing of emancipation but he refused. When Allah, exalted is He, revealed this verse, Huwaytib agreed to write a letter of emancipation in exchange for a hundred pieces of gold. Out of this sum, he offered him twenty pieces of gold which he paid. But he was killed in war at the Battle of Hunayn. (Force not your slave-girls to whoredom that ye may seek enjoyment of the life of the world, if they would preserve their chastity) [24:33]. Ahmad ibn al-Hasan al-Qadi informed us> the chamberlain of Ahmad al-Tusi> Muhammad ibn Hamdan> Abu Mu�awiyah> al-A�mash> Abu Sufyan> Jabir who said: ��Abd Allah ibn Ubayy used to say to a slave-girl of his: �Go and earn something for us from wh

(And unto each We have appointed heirs and near kindred �) [4:33]. Abu �Abd Allah Muhammad ibn �Abd Allah al-Farisi informed us> Muhammad ibn �Abd Allah ibn Hamawayh al-Harawi> �Ali ibn Muhammad al-Khuza�i> Abu�l-Yaman al-Hakam ibn Nafi�> Shu�ayb ibn Abi Hamzah> al-Zuhri> Sa�id ibn al-Musayyab who said: �The verse (And unto each We have appointed heirs) was revealed about those who used to adopt men who were not their natural sons and then make them inherit from them. Allah, exalted is He, revealed about them that something should be apportioned for them in the bequest while the division of estate He specifically allocated for the heirs who were immediate family relatives or close relatives. He denied a share of the estate to those who were adopted and, instead, allowed them to have a portion of the bequest�.

(O ye who believe! When believing women come unto you as fugitives, examine them. Allah is Best Aware of their faith�) [60:10]. Ibn �Abbas said: �On the year of Hudaybiyyah, the idolaters of Mecca signed a peace treaty with the Messenger of Allah, Allah bless him and give him peace. This treaty stipulated that whoever of the people of Mecca runs away to him from them should be returned to them, and whoever of his Companions runs away to the people of Mecca will not be returned. They wrote the treaty and sealed it. Just after signing the treaty, Subay�ah bint al-Harith al-Aslamiyyah went to the Prophet, Allah bless him and give him peace, while he was still at al-Hudaybiyyah. Her husband, who was an unbeliever came and said: �O Muhammad, return my wife to me, for you had agreed to return to us whoever runs away to you. The ink of the treaty has not dried yet�. Allah, exalted is He, then r

from the evil of the slinking whisperer Satan — he is referred to by the name of the action waswasa on account of his repeated engaging in it — who slinks away and recoils from the heart whenever God is mentioned

As for the weak such as the old and the sick the blind and the chronically ill and those who find nothing to expend for the struggle no blame no sin falls upon them should they stay away from it if they remain true to God and to His Messenger when they stay behind by not spreading false rumours or impeding others from joining the struggle but by adhering to obedience. There is no way of blame no way of reproach against those who are virtuous through such behaviour. And God is Forgiving Merciful to them by granting them such leeway in this matter.

There is no blame on those who are weak or ill or who find no resources to spend, if they are sincere and true (in duty) to Allah and His Messenger. No means (of complaint) can there be against the doers of good. And Allah is Oft-Forgiving, Most Merciful (91)Nor (is there blame) on those who came to you to be provided with mounts, when you said: "I can find no mounts for you," they turned back, with their eyes overflowing with tears of grief that they could not find anything to spend (92)The means (of complaint) is only against those who are rich, and yet ask exemption. They are content to be with (the women) who sit behind (at home) and Allah has sealed up their hearts so that they know not (what they are losing)(93) Legitimate Excuses for staying away from Jihad Allah mentions here the valid excuses that permit one to stay away from fighting. He first mentions the excuses that remain

حَدَّثَنِي عَبْدُ اللَّهِ بْنُ مُحَمَّدٍ، حَدَّثَنَا عَبْدُ الْمَلِكِ بْنُ عَمْرٍو، حَدَّثَنَا زُهَيْرُ بْنُ مُحَمَّدٍ، عَنْ مُحَمَّدِ بْنِ عَمْرِو بْنِ حَلْحَلَةَ، عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي سَعِيدٍ الْخُدْرِيِّ، وَعَنْ أَبِي هُرَيْرَةَ، عَنِ النَّبِيِّ صلى الله عليه وسلم قَالَ ‏ "‏ مَا يُصِيبُ الْمُسْلِمَ مِنْ نَصَبٍ وَلاَ وَصَبٍ وَلاَ هَمٍّ وَلاَ حُزْنٍ وَلاَ أَذًى وَلاَ غَمٍّ حَتَّى الشَّوْكَةِ يُشَاكُهَا، إِلاَّ كَفَّرَ اللَّهُ بِهَا مِنْ خَطَايَاهُ ‏"‏‏.‏

Narrated Abu Sa`id Al-Khudri and Abu Huraira:The Prophet (ﷺ) said, "No fatigue, nor disease, nor sorrow, nor sadness, nor hurt, nor distress befalls a Muslim, even if it were the prick he receives from a thorn, but that Allah expiates some of his sins for that

حَدَّثَنَا إِبْرَاهِيمُ بْنُ الْمُنْذِرِ، قَالَ حَدَّثَنِي مُحَمَّدُ بْنُ فُلَيْحٍ، قَالَ حَدَّثَنِي أَبِي، عَنْ هِلاَلِ بْنِ عَلِيٍّ، مِنْ بَنِي عَامِرِ بْنِ لُؤَىٍّ عَنْ عَطَاءِ بْنِ يَسَارٍ، عَنْ أَبِي هُرَيْرَةَ ـ رضى الله عنه ـ قَالَ قَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم ‏ "‏ مَثَلُ الْمُؤْمِنِ كَمَثَلِ الْخَامَةِ مِنَ الزَّرْعِ مِنْ حَيْثُ أَتَتْهَا الرِّيحُ كَفَأَتْهَا، فَإِذَا اعْتَدَلَتْ تَكَفَّأُ بِالْبَلاَءِ، وَالْفَاجِرُ كَالأَرْزَةِ صَمَّاءَ مُعْتَدِلَةً حَتَّى يَقْصِمَهَا اللَّهُ إِذَا شَاءَ ‏"‏‏.‏

Narrated Abu Huraira:Allah's Messenger (ﷺ) said, "The example of a believer is that of a fresh tender plant; from whatever direction the wind comes, it bends it, but when the wind becomes quiet, it becomes straight again. Similarly, a believer is afflicted with calamities (but he remains patient till Allah removes his difficulties.) And an impious wicked person is like a pine tree which keeps hard and straight till Allah cuts (breaks) it down when He wishes." (See Hadith No. 558, Vol)

حَدَّثَنَا مُحَمَّدُ بْنُ يَحْيَى، قال حَدَّثَنَا إِسْحَاقُ بْنُ مُحَمَّدٍ الْفَرْوِيُّ، قال حَدَّثَنَا إِسْمَاعِيلُ بْنُ جَعْفَرٍ، عَنْ عُمَارَةَ بْنِ غَزِيَّةَ، عَنْ عَاصِمِ بْنِ عُمَرَ بْنِ قَتَادَةَ، عَنْ مَحْمُودِ بْنِ لَبِيدٍ، عَنْ قَتَادَةَ بْنِ النُّعْمَانِ، أَنَّ رَسُولَ اللَّهِ صلى الله عليه وسلم قَالَ ‏ "‏ إِذَا أَحَبَّ اللَّهُ عَبْدًا حَمَاهُ الدُّنْيَا كَمَا يَظَلُّ أَحَدُكُمْ يَحْمِي سَقِيمَهُ الْمَاءَ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى وَفِي الْبَابِ عَنْ صُهَيْبٍ وَأُمِّ الْمُنْذِرِ ‏.‏ وَهَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ ‏.‏ وَقَدْ رُوِيَ هَذَا الْحَدِيثُ عَنْ مَحْمُودِ بْنِ لَبِيدٍ عَنِ النَّبِيِّ صلى الله عليه وسلم مُرْسَلاً ‏.‏ حَدَّثَنَا عَلِيُّ بْنُ حُجْرٍ، قال أَخْبَرَنَا إِسْمَاعِيلُ بْنُ جَعْفَرٍ، عَنْ عَمْرِو بْنِ أَبِي عَمْرٍو، عَنْ عَاصِمِ بْنِ عُمَرَ بْنِ قَتَادَةَ، عَنْ مَحْمُودِ بْنِ لَبِيدٍ، عَنِ النَّبِيِّ صلى الله عليه وسلم نَحْوَهُ وَلَمْ يَذْكُرْ فِيهِ عَنْ قَتَادَةَ بْنِ النُّعْمَانِ ‏.‏ قَالَ أَبُو عِيسَى وَقَتَادَةُ بْنُ النُّعْمَانِ الظَّفَرِيُّ هُوَ أَخُو أَبِي سَعِيدٍ الْخُدْرِيِّ لأُمِّهِ وَمَحْمُودُ بْنُ لَبِيدٍ قَدْ أَدْرَكَ النَّبِيَّ صلى الله عليه وسلم وَرَآهُ وَهُوَ غُلاَمٌ صَغِيرٌ ‏.‏

Qatadah bin An-Nu'man narrated that the Messenger of Allah (s.a.w) said:"When Allah loves a slave, He prevents him from the world, just as one of you prevents his sick from water." Another chain reports a similar narration

حَدَّثَنَا عَبَّاسُ بْنُ مُحَمَّدٍ الدُّورِيُّ، قال حَدَّثَنَا يُونُسُ بْنُ مُحَمَّدٍ، قال حَدَّثَنَا فُلَيْحُ بْنُ سُلَيْمَانَ، عَنْ عُثْمَانَ بْنِ عَبْدِ الرَّحْمَنِ التَّيْمِيِّ، عَنْ يَعْقُوبَ بْنِ أَبِي يَعْقُوبَ، عَنْ أُمِّ الْمُنْذِرِ، قَالَتْ دَخَلَ عَلَىَّ رَسُولُ اللَّهِ صلى الله عليه وسلم وَمَعَهُ عَلِيٌّ وَلَنَا دَوَالٍ مُعَلَّقَةٌ قَالَتْ فَجَعَلَ رَسُولُ اللَّهِ صلى الله عليه وسلم يَأْكُلُ وَعَلِيٌّ مَعَهُ يَأْكُلُ ‏.‏ فَقَالَ رَسُولُ اللَّهِ صلى الله عليه وسلم لِعَلِيٍّ ‏"‏ مَهْ مَهْ يَا عَلِيُّ فَإِنَّكَ نَاقِهٌ ‏"‏ ‏.‏ قَالَ فَجَلَسَ عَلِيٌّ وَالنَّبِيُّ صلى الله عليه وسلم يَأْكُلُ ‏.‏ قَالَتْ فَجَعَلْتُ لَهُمْ سِلْقًا وَشَعِيرًا فَقَالَ النَّبِيُّ صلى الله عليه وسلم ‏"‏ يَا عَلِيُّ مِنْ هَذَا فَأَصِبْ فَإِنَّهُ أَوْفَقُ لَكَ ‏"‏ ‏.‏ قَالَ أَبُو عِيسَى هَذَا حَدِيثٌ حَسَنٌ غَرِيبٌ لاَ نَعْرِفُهُ إِلاَّ مِنْ حَدِيثِ فُلَيْحٍ ‏.‏ وَيُرْوَى عَنْ فُلَيْحٍ عَنْ أَيُّوبَ بْنِ عَبْدِ الرَّحْمَنِ ‏.‏ حَدَّثَنَا مُحَمَّدُ بْنُ بَشَّارٍ، قال حَدَّثَنَا أَبُو عَامِرٍ، وَأَبُو دَاوُدَ قَالاَ حَدَّثَنَا فُلَيْحُ بْنُ سُلَيْمَانَ، عَنْ أَيُّوبَ بْنِ عَبْدِ الرَّحْمَنِ، عَنْ يَعْقُوبَ، عَنْ أُمِّ الْمُنْذِرِ الأَنْصَارِيَّةِ، فِي حَدِيثِهِ قَالَتْ دَخَلَ عَلَيْنَا رَسُولُ اللَّهِ صلى الله عليه وسلم فَذَكَرَ نَحْوَ حَدِيثِ يُونُسَ بْنِ مُحَمَّدٍ إِلاَّ أَنَّهُ قَالَ ‏"‏ أَنْفَعُ لَكَ ‏"‏ ‏.‏ وَقَالَ مُحَمَّدُ بْنُ بَشَّارٍ وَحَدَّثَنِيهِ أَيُّوبُ بْنُ عَبْدِ الرَّحْمَنِ ‏.‏ هَذَا حَدِيثٌ جَيِّدٌ غَرِيبٌ ‏.‏

Umm Al-Mundhir said:"The Messenger of Allah (ﷺ) entered upon me, while `Ali was with him, and we had a cluster of unripe dates hanging." She said: "The Messenger of Allah (ﷺ) began eating, and `Ali ate with him. The Messenger of Allah (ﷺ) said to `Ali: 'Stop, stop, for you are still recovering.' So `Ali sat and the Prophet (ﷺ) ate." She said: "I made some chard and barley for them, so the Prophet (ﷺ) said: 'O `Ali eat from this, for indeed it will be more suitable for you." Another chain reports a similar narration

أما ما ذكرتم من أن النبي كان يعجبه الفأل الحسن فلا ريب في ثبوت ذلك عنه وقد قرن ذلك بإبطال الطيرة كما في الصحيحين من حديث الزهري عن عبيد بن عبدالله عن أبى هريرة رضى الله عنه قال قال رسول الله صلى عليه وسلم لاطيرة وخيرها الفأل قالوا وما الفأل يا رسول الله قال الكلمة الصالحة يسمعها أحدكم فابتدأهم النبي بإزالة الشبهة وأبطال الطيرة لئلا يتوهموها عليه في إعجابه بالفأل الصالح وليس في الإعجاب بالفأل ومحبته شىء من الشرك بل ذلك إبانة عن مقتضى الطبيعة وموجب الفطرة الإنسانية التي تميل إلى مايلائمها ويوافقها مما ينفعها كما أخبرهم أنه حبب إليه من الدنيا النساء والطيب 00

وقد قال رسول الله إذا كان بالبلد الذي أنتم فيه فلا تخرجوا منه وقال إن كان ببلد فلا تدخلوه يريد بقوله لا تخرجوا من البلد أذا كان فيه كأنكم تظنون أن الفرار من قدر الله ينجيكم من الله ويريد إن كان ببلد فلا تدخلوه فإن مقامكم في الموضع الذي لا طاعون فيه أسكن لأنفسكم وأطيب لمعيشتكم ومن ذلك المرأة تعرف بالشؤم والدار فينال الرجل مكروه أو جائحة فيقول أعدتني بشؤمها فهذا هو العدوى الذي قال فيه رسول الله لا عدوى فأما الحديث الذي رواه أبو هريرة رضى الله عنه أنه قال الشؤم في المرأة والدار والدابة فإن هذا الحديث يتوهم فيه الغلط على أبى هريرة وأنه سمع فيه شيئا من رسول الله فلم يعه حدثني محمد بن القطعي حدثنا عبد الأعلى عن سعيد عن قتادة عن أبى حسان الأعرج أن رجلين دخلا على عائشة فقالا إن أبا هريرة رضى الله عنه يحدث عن رسول الله أنه قال إنما الطيرة في المرأة والدار والدابة فطارت شفقا ثم قالت كذب والذي أنزل الفرقان على أبى القاسم من حدث بهذا عن رسول الله إنما قال رسول الله كان أهل الجاهلية يقولون إن الطيرة

وقالت طائفة أخرى معنى الحديث إخباره عن الأسباب المثيرة للطيرة الكامنة في الغرائز يعنى أن المثير للطيرة في غرائز الناس هي هذه الثلاثة فأخبرنا بهذا لنأخذ الحذر منها فقال الشؤم في الدار والمرأة والفرس أي أن الحوادث التي تكثر مع هذه الأشياء والمصائب التي تتوالى عندها تدعو الناس إلى التشاؤم بها فقال الشؤم فيها أي أن الله قد يقدره فيها على قوم دون قوم فخاطبهم بذلك لما استقر عندهم منه من إبطال الطيرة وإنكار العدوى ولذلك لم يستفهموا في ذلك عن معنى ما أراده كما تقدم لهم في قوله لا يورد الممرض على المصح فقالوا عنده وما ذاك يا رسول الله فأخبرهم أنه خاف في ذلك الأذى الذي يدخله الممرض على المصح لا العدوى لأنه أمر بالتوادد وإدخال السرور بين المؤمنين وحسن التجاوز ونهى عن التقاطع والتباغض والأذى فمن اعتقد أن رسول الله نسب الطيرة والشؤم إلى شيء من الأشياء على سبيل إنه مؤثر بذلك دون الله فقد أعظم الفرية على الله وعلى رسوله وضل ضلالا بعيدا والنبي ابتداهم بنفي الطيرة والعدوى ثم قال الشؤم في ثلاث قطعا لتوهم

واقد بن عبد الله الحضري والحضرمي حضرت الحرب فكذب عليه وإنما قال ذلك أعداؤه من اليهود فتطيروا بذلك وتفاءلوا به فكانت الطيرة عليهم و وقدت الحرب عليهم

| الفصل الثامن والخمسون في الفأل والطيرة

فإن قلت : فلم نهى عن الخروج من البلد الذي فيه الوباء وسبب الوباء في الطب الهواء وأظهر طرق التداوي الفرار من المضر والهواء هو المضر وترك التوكل في أمثال هذا مباح وهذا لا يدل على المقصود ولكن الذي ينقدح فيه والعلم عند الله تعالى أن الهواء لا يضر من حيث إنه يلاقى ظاهر البدن بل من حيث دوام الاستنشاق له فانه اذا كان فيه عفونة ووصل إلى الرئة والقلب وباطن الأحشاء أثر فيها بطول الاستنشاق فلا يظهر الوباء على الظاهر إلا بعد طول التأثير في الباطن فالخروج من البلد لا يخلص غالبا من الأثر الذي استحكم من قبل ولكن يتوهم الخلاص فيصير هذا من جنس الموهومات كالرقي والطيرة وغيرهما ولو تجرد هذا المعنى لكان مناقضا للتوكل ولم يكن منهيا عنه ولكن صار منهيا عنه لانه انضاف اليه أمر آخر وهو أنه لو رخص للأصحاء في الخروج لما بقي في البلد إلا المرضى الذين أقعدهم الطاعون فانكسرت قلوبهم وفقدوا المتعهدين ولم يبق في البلد من يسقيهم الماء ويطعمهم الطعام وهم يعجزون عن مباشرتهما بأنفسهم فيكون ذلك سعيا في اهلاكهم تحقيقا وخلاصه

Exposure-based cognitive-behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial.: Background: In DSM-5 two new diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), have replaced DSM-IV hypochondriasis. There are no previous treatment studies for these disorders. Cognitive-behavioural therapy (CBT) delivered as therapist-guided or unguided internet treatment or as unguided bibliotherapy could be used to increase treatment accessibility. Aims: To investigate the effect of CBT delivered as guided internet treatment (ICBT), unguided internet treatment (U-

Interoceptive accuracy and bias in somatic symptom disorder, illness anxiety disorder, and functional syndromes: A systematic review and meta-analysis.: Somatic symptom disorder, illness anxiety disorder, and functional syndromes are characterized by burdensome preoccupation with somatic symptoms. Etiological models propose either increased interoceptive accuracy through hypervigilance to the body, or decreased and biased interoception through top-down predictions about sensory events. This systematic review and meta-analysis summarizes findings of 68 studies examining interoceptive accuracy and 8 studies examining response biases in clinical or

A randomized trial of treatments for high-utilizing somatizing patients.: Background: Somatization and hypochondriacal health anxiety are common sources of distress, impairment, and costly medical utilization in primary care practice. A range of interventions is needed to improve the care of these patients. Objective: To determine the effectiveness of two cognitive behavioral interventions for high-utilizing, somatizing patients, using the resources found in a routine care setting. Design: Patients were randomly assigned to a two-step cognitive behavioral treatment pr

Cognitive and perceptual variables in hypochondriasis and health anxiety: a systematic review.: This review examined (a) whether hypochondriacal/health-anxious individuals hold distinct assumptions about health and illness, (b) if triggering these assumptions leads to increased hypochondriacal concerns, and (c) whether these individuals perceive their bodily sensations differently from others (i.e., experience greater somatosensory amplification). There was clear evidence that health anxiety is related dysfunctional health-related beliefs. Few studies have examined how hypochondriacal conc

Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review.: Objective: To study the course of medically unexplained symptoms (MUS), somatisation disorder, and hypochondriasis, and related prognostic factors. Knowledge of prognostic factors in patients presenting persistent MUS might improve our understanding of the naturalistic course and the identification of patients with a high risk of a chronic course. Methods: A comprehensive search of Medline, PsycInfo, CINAHL, and EMBASE was performed to select studies focusing on patients with MUS, somatisation d

Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework.: Background: Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. Methods: We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published betwe

Computerized attention retraining for individuals with elevated health anxiety.

Background and objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outpe…

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Previous experiences with illness and traumatic experiences: a specific risk factor for hypochondriasis?

Background: Previous experiences with illness and traumatic experiences are considered as important risk factors for the development of health anxiety and hypochondriasis. However, empirical research is insufficient and lacks adequate comparison groups. Objective: Therefore, we sought to determine whether experiences with illness and traumatic experiences are really specific risk factors for hypochondriasis. Method: In the current study, patients with the diagnosis of hypochondriasis (n = 80), patients with a primary anxiety disorder (n = 80), and healthy controls (n = 83) were investigated regarding their previous experiences with illness (self and other) and traumatic childhood experiences. Results: We found that patients with hypochondriasis reported a higher level of experience with illness and with traumatic childhood experiences than healthy controls. However, no differences were f…

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Specific and differential prediction of health anxiety by disgust sensitivity and propensity.

Current models of health anxiety suggest that fear resulting from false alarms to perceived threats to one's health results in the development of hypochondriasis and related disorders. Disgust has been proposed as an affective response that may function as an etiological and maintenance mechanism in health anxiety. Moreover, the way in which an individual perceives the disgust response (disgust sensitivity) may affect health anxiety, separately from their likelihood of experiencing disgust (disgust propensity). The present study utilized multiple hierarchical regression analysis to investigate the degree to which self-reported disgust sensitivity and disgust propensity differentially predict elevated health anxiety in a sample of 620 non-treatment-seeking undergraduates. Further, this effect is tested in comparison to that of anxiety sensitivity, a construct demonstrated to be strongly r…

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Cyberchondria: towards a better understanding of excessive health-related Internet use.

Looking for information about symptoms and illnesses on the Internet is common and often serves useful purposes. However, a number of people who are overly distressed or anxious about their health perform excessive or repeated health-related searches on the Internet, only to become more distressed or frightened - a pattern defined here as cyberchondria. This behavior, which can also be construed as a form of reassurance seeking and occurs as a manifestation of health anxiety and hypochondriasis, is the focus of this article. The antecedents of cyberchondria, factors that maintain it and its consequences are examined conceptually and in light of the relatively little research that has been performed so far. Managing cyberchondria poses a challenge, and several approaches as part of the treatment of health anxiety and hypochondriasis are described. The article makes suggestions for further…

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Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis.

Background: The cognitive model and empirical research underline the importance of dysfunctional beliefs about bodily symptoms and illness in health anxiety and hypochondriasis. However, specificity of such beliefs has not yet been adequately demonstrated for patients with hypochondriasis. Objective: This study examined whether dysfunctional beliefs about bodily symptoms and illness are elevated in comparison to patients with anxiety disorders and, therefore, specific for patients with hypochondriasis. Method: Patients with hypochondriasis (n = 38), patients with anxiety disorders (n = 40), and healthy controls (n = 42) completed the Symptom and Outcomes Scale (SOS) measuring participants' estimation of the likelihood of various symptoms being indicative of a particular illness. Additionally, participants' general psychopathology (Brief Symptom Inventory), depressive (Beck Depression Inv…

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Intolerance of uncertainty, hypochondriacal concerns, obsessive-compulsive symptoms, and worry.

Intolerance of uncertainty (IU) has been found to be involved in several anxiety disorders, including generalized anxiety disorder and obsessive-compulsive disorder (OCD). Few studies have examined the role of IU in health anxiety (HA)/hypochondriacal concerns (HC). We conducted two studies exploring the associations between IU and HA/HC. The first study included undergraduates (n = 114) and indicated an association between IU and several HA/HC indices. When controlling for neuroticism, worry about illness was the single index of HA/HC that remained associated with IU. In the second study among bereaved adults (n = 126), IU was associated with one index of HA/HC but not when neuroticism and anxiety sensitivity were controlled. In both studies, IU was found to be more strongly associated with OCD symptoms and worry than with HA/HC.

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Prevalence of health anxiety problems in medical clinics.

Objectives: To determine the prevalence of significant health anxiety (hypochondriasis) in patients aged 16-75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire. Method: The Health Anxiety Inventory (HAI) (short form) was administered to patients attending the five clinics over a 21 month period and all those who scored 20 or more invited to take part in a further assessment for a randomised controlled trial. Results: Of 43,205 patients attending the clinics 28,991 (67.1%) were assessed and of these, after exclusion of ineligible patients 5747 (19.8%) had significant health anxiety. 444 subsequently agreed to take part in a randomised controlled trial of treatment. The prevalence levels varied by clinic with neurology (24.7%) having the highest prevalence followed by respiratory me…

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Irrational health beliefs and health anxiety.

The Irrational Health Belief Scale (IHBS) assesses the tendency to appraise health-related information in an irrational manner. Despite the central role that dysfunctional assumptions about health play in the cognitive-behavioral model of hypochondriasis and health anxiety, researchers have not examined the relation between health anxiety and the types of irrational health beliefs assessed by the IHBS. Two samples (n = 198, n = 295) of students completed the IHBS and measures of anxiety and health anxiety. In both studies, the IHBS was correlated with health anxiety, and this association was mediated by anxiety. These findings suggest that the range of dysfunctional beliefs associated with health anxiety is greater than was initially described by the cognitive-behavioral model.

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Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles.

Increased understanding of the nature and role of intrusive imagery has contributed to the development of effective treatment protocols for some anxiety disorders. However, intrusive imagery in severe health anxiety (hypochondriasis) has been comparatively neglected. Hence, the current study investigates the prevalence, nature and content of intrusive imagery in 55 patients who met DSM-IV-TR (APA, 2000) criteria for the diagnosis of hypochondriasis. A semi-structured interview was used to assess the prevalence, nature and possible role of intrusive imagery in this disorder. Over 78% of participants reported experiencing recurrent, distressing intrusive images, the majority (72%) of which either were a memory of an earlier event or were strongly associated with a memory. The images tended to be future orientated, and were reliably categorised into four themes: i) being told 'the bad news'…

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Disease phobia and disease conviction are separate dimensions underlying hypochondriasis.

The current study uses data from a large nonclinical college student sample (N = 503) to examine a structural model of hypochondriasis (HC). This model predicts the distinctiveness of two dimensions (disease phobia and disease conviction) purported to underlie the disorder, and that these two dimensions are differentially related to variables important to health anxiety and somatoform disorders, respectively. Results were generally consistent with the hypothesized model. Specifically, (a) body perception variables (somatosensory amplification and anxiety sensitivity - physical) emerged as significant predictors of disease phobia, but not disease conviction; (b) emotion dysregulation variables (cognitive avoidance and cognitive reappraisal) emerged as significant predictors of disease conviction, but not disease phobia; and (c) both disease phobia and disease conviction independently pred…

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The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health.

Background: Hypochondriasis is prevalent in primary care, but the diagnosis is hampered by its stigmatizing label and lack of valid diagnostic criteria. Recently, new empirically established criteria for Health anxiety were introduced. Little is known about Health anxiety's impact on longitudinal outcome, and this study aimed to examine impact on self-rated health and health care costs. Methodology/principal findings: 1785 consecutive primary care patients aged 18-65 consulting their family physicians (FPs) for a new illness were followed-up for two years. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with mild (N = 21) and severe Health anxiety (N = 81) and Hypochondriasis according to the DSM-IV (N = 59) were compared with a comparison group of patients who had a well-defined medical condition accordi…

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Measuring health anxiety: moving past the dichotomous response option of the original Whiteley Index.

The Whiteley Index [WI; Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 89-93] is a widely used self-report measure of health anxiety, hypochondriasis, and illness phobia; however, the factor structure of the WI has proven unstable. Moreover, factorial investigations of the WI persist in the original true/false response format despite criticisms of dichotomous scales and the availability of a Likert scale version [Barsky, A. J., Cleary, P. D., Wyshak, G., Spitzer, R. L., Williams, J. B. W., & Klerman, G. L. (1992). A structured diagnostic interview for hypochondriasis: a proposed criterion standard. The Journal of Nervous and Mental Disease, 180, 20-27]. The current investigation explores the factor structure of the 5-point Likert scale version of the WI using a sample of 287 students (64 men, ages 18-34 [M=20.6; SD=3.2]; 223 women ages 18-45 [M=20…

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Health anxiety, hypochondriasis, and the anxiety disorders.

Although clinical observations suggest that health-related anxiety is present, to some extent, in a number of anxiety disorders, this relationship has not been examined empirically. The present study therefore utilized the Short Health Anxiety Inventory (SHAI) to elucidate the structure of such symptoms among patients with anxiety disorders and to empirically investigate the presence of health anxiety in various anxiety disorders. Confirmatory factor analysis yielded equivalent support for either a 2-factor or 3-factor model of the SHAI's latent structure. The measure demonstrated good reliability, convergent validity, and discriminant validity. Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. Receiver operatin…

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Hypochondriasis and health anxiety in the German population.

Epidemiologic studies on hypochondriasis are very rare and have not been included in large North American community surveys until now. In order to gain information on the prevalence as well as the socio-demographic characteristics of hypochondriasis, the following community study was carried out. Analyses are based on an assessment of 1575 subjects selected by socio-demographic representation criteria for the German community. All subjects completed the Illness Attitude Scales (IAS) and responded to several additional questions on sociodemographics and diagnostic criteria pertaining to Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) hypochondriasis. The IAS is internationally one of the best-established self-rating questionnaires for the assessment of hypochondriasis and health anxiety. Results reveal a 0.4% point prevalence rate of DSM-IV hypochondriasis. …

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Health anxiety levels in chronic pain clinic attenders.

Objective: An application of the cognitive-behavioural model of health anxiety (hypochondriasis) to chronic pain depends on the extent to which high levels of health anxiety occur in chronic pain, which has yet to be established. Methods: The occurrence of health anxiety in consecutively recruited chronic pain patients (n=161) and nonclinical controls with (n=34) and without pain (n=70) was investigated using a questionnaire measure of health anxiety. Results: Conservative figures estimated a frequency of 36.7% for hypochondriasis and 51.1% of severe and disabling health anxiety in the chronic pain sample. Conclusion: The current finding that high levels of health anxiety are indeed very common in chronic pain indicates the potential value of an application of the cognitive-behavioural health anxiety model to at least the subgroup of highly health-anxious chronic pain patients.

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Using controlled comparisons in disgust psychopathology research: the case of disgust, hypochondriasis and health anxiety.

The present paper describes the results of a study investigating the relationship between measures of disgust and measures of hypochondriasis and health anxiety. The results indicated that (1) there were highly significant correlations between measures of trait disgust and disgust sensitivity and measures of hypochondriasis and health anxiety, (2) the relationship between disgust sensitivity measures and hypochondriasis and health anxiety were still significant even when levels of trait anxiety were controlled for, but (3) controlled comparisons revealed that the measures of disgust also predicted scores on measures of disgust-irrelevant control psychopathologies (claustrophobia and height phobia)--even after trait anxiety had been partialled out. In addition, the series of multiple regressions carried out clearly indicated that trait anxiety and disgust sensitivity appear to be independ…

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Transition from Illness Anxiety Disorder to Delusional Disorder: A Case Series.

Background: Illness anxiety disorder, also known as hypochondriasis, is characterized by excessive worry about having or developing a serious medical condition and has rarely been associated with delusional disorder. Case series presentation: Two middle-aged patients with illness anxiety disorder gradually developed somatic-type delusional disorder. The first, a 45-year-old woman, had a two-and-a-half-year history of health-related fears involving her throat - an ulcer for six months, a cyst for one year and a tumor for one year. She initially showed improvement with fluoxetine over two months, but after discontinuing the medication for three months, developed a fixed delusion that she had throat cancer, accompanied by aggression and poor self-care. She responded to risperidone within three weeks, though symptoms relapsed after discontinuing the treatment at six months. The second patien…

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Severe Illness Anxiety Treated by Integrating Inpatient Psychotherapy With Medical Care and Minimizing Reassurance.

Illness anxiety disorder (IAD, formerly hypochondriasis) is characterized by preoccupation with fear of serious illness despite medical reassurance. IAD is common, debilitating, challenging to treat, and results in high healthcare utilization. Outpatient management of IAD is challenging because patients can compulsively seek reassurance from numerous providers, which interferes with learning more productive coping skills. We present the case of a woman with severe IAD who presented to the emergency room with increasing frequency over several months, despite regular outpatient medical visits and escalating psychiatric care. We made the unusual decision to hospitalize her for IAD for 1 month, in the absence of typical hospitalization criteria. This hospitalization allowed us to consolidate all medical and psychiatric care into a single provider team and train all staff and family to commun…

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Illness-related intrusive thoughts and illness anxiety disorder.

Introduction: Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. Methods: Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage  = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage  = 3…

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Health Behavior in Hypochondriasis.

The relationship between health behavior and hypochondriasis has not yet been sufficiently examined, as previous studies investigated only individual dimensions of health behavior. In the present study, we extend current literature by examining multiple dimensions of health behavior. One hundred twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and other measures for the evaluation of general psychopathology, illness anxiety, depression, and general anxiety. Patients with hypochondriasis revealed a less active way of life (d = 0.89) and lower hygiene (d = 0.60) than healthy controls, but did not differ from healthy controls regarding their compliance to medical recommendati…

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Hypochondriasis: considerations for ICD-11.

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g…

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Self-reported and Agency-Notified Child Abuse as a Contributor to Health Anxiety in a Population-Based Birth Cohort Study at 30-Year Follow-up.

Background: Health anxiety is a subtype of the older term hypochondriasis, in which there is worry rather than conviction of having an illness. Information on the association between childhood maltreatment and health anxiety in adulthood often comes from retrospective questionnaires that may be subject to recall bias. There are no prospective data studies using reports to statutory agencies. Objective: We therefore assessed the effect on these outcomes at 30-year follow-up using both prospective agency notifications of child abuse and retrospective self-reports in the same birth cohort. Methods: At follow-up, there were 2458 adults with data on health anxiety as measured by the Whiteley Index. We also collected details on self-reported abuse with the Child Trauma Questionnaire and linked this to child maltreatment notifications to statutory agencies. Results: The prevalence of self- and …

matched on Hypochondriasis (keyword), health anxiety (text), somatic symptom (text)

Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms.

Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment. Methods: This exploratory study used a unique database from a prior trial of 193 individuals with DSM-IV hypochondriasis who had been randomly assigned to either cognitive behavioral therapy, fluoxetine, combined therapy, or placebo. Two subgroups were newly defined-no/low somatic burden (n = 42) and prominent somatic burden (n = 151). Response was defined by ≥30% improvement in hypochondriasis. Results: Among high somatic hypochondriacal participants, compared to placebo, the odds of being a responder were significantly greater among those who received fluoxetine, either alone (OR = 4.46; 95% CI: 1.38, 14.41) or with cognitive…

matched on Hypochondriasis (keyword), health anxiety (text), somatic symptom (text)

Correlates of worry and functional somatic symptoms in generalized anxiety disorder.

Background: Worry and functional somatic symptoms (FSS) are important clinical features of generalized anxiety disorder (GAD). Although there is literature on the prevalence of worry and FSS in GAD, there is limited data on psychological correlates of worry and somatic symptoms in patients with GAD. Objective: The purpose of this research was to evaluate the relationship of worry and FSS with somatosensory amplification, health anxiety (hypochondriasis), and alexithymia in patients with GAD. Methods: Forty patients with the diagnosis of GAD were assessed with Penn State Worry Questionnaire, Bradford Somatic Inventory (BSI), GAD-7 Scale, somatosensory amplification Scale (SSAS), Whiteley Index (WI), and Toronto Alexithymia Scale-20 Hindi version (TAS-H-20). Results: Worry had significant positive correlation with total scores of BSI, GAD-7 scale, TAS-H-20 subscale 1, SSAS, and WI. Younger…

matched on Hypochondriasis (keyword), health anxiety (text), somatic symptom (text)

Hypochondriasis: Clinical Profile in a Tertiary Care Psychiatry and Neurosciences Hospital in Southern India - A Retrospective Chart Review.

Background: Hypochondriasis is a complex disorder in the realm of psychosomatic medicine, yet understudied in India. The aim of this study was to assess the clinical profile of patients diagnosed with hypochondriasis. Materials and methods: Retrospective chart review was done in a tertiary care psychiatry and neurosciences hospital in southern India. Medical records of adults diagnosed with hypochondriasis between 2000 and 2010 were analyzed. These patients were also rediagnosed retrospectively using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for illness anxiety disorder (IAD) and Diagnostic Criteria for Psychosomatic Research (DCPR) criteria for health anxiety and illness phobia. Data were organized and analyzed using PSPP for descriptive statistics of different variables. Results: There were 114 patients with hypochondriasis, with the most com…

matched on Hypochondriasis (keyword), health anxiety (text), illness anxiety (text)