Health Psychology 1993, Vol. 12, No. 2,103-109 Copyright 1993 by the American Psychological Association, Inc., and the Division of Health Psychology/0278-6133/93/$3.00 Hypochondriasis and Somatization in College Women: A Personal Projects Analysis Paul Karoly and Len Lecci Although the descriptive features of hypochondriasis and Somatization have been widely studied, the motivational correlates (goal representations) of individuals manifesting abnormal illness patterns have not been considered. The Personal Projects Analysis method (Little, 1983) was used to contrast the health and nonhealth goals of female undergraduates. Subjects selected 10 goals for evaluation along a series of dimensions. When health pursuits alone were examined, hypochondri- asis on the Minnesota Multiphasic Personality Inventory was found to correlate directly with goal appraisal dimensions subsumed by an anxiety-absorption factor and inversely with dimensions characterizing rewardingness, thus suggesting a negativity of health goal construal. Somatizers also pursued more health-related projects than did nonsomatizers; nonhealth goal cognition did not relate as strongly to hypochondriasis. Finally, using discriminant function analysis, goal representa- tions were shown to significantly and substantially differentiate somatizers from nonsomatizers. Key words: hypochondriasis, Somatization, goal cognition, Personal Projects Analysis Patients with somatic complaints of uncertain origin con- tinue to vex and fascinate social scientists and medical profes- sionals alike (e.g., Bianchi, 1973; Kellner, 1986; Leventhal, 1986; McHugh & Vallis, 1986; Mechanic, 1982; Pilowsky, 1969; Warwick, 1989). Variously called hypochondriacs, somatizers, conversion hysterics, the "worried well," and a host of more prosaic descriptors (e.g., crocks and Gomers), the somatically sensitive are of concern because they (a) tend to overuse the medical system (Monson & Smith, 1983; Wagner & Curran, 1984) and (b) represent a subtype of psychopathology that has proven resistant to reliable classification and intervention (Barsky & Klerman, 1983; Gask, Goldberg, Porter, & Creed, 1989; Hoffman & Koran, 1984; Kenyon, 1964; Shipko, 1982). The Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R), for example, distinguishes among sev- eral subtypes of somatoform disorder. The differentiation pivots on whether patients are worried about illness (hypochon- driasis) or have had actual symptoms of illness (somatization) or whether a functional loss (like blindness or deafness) has occurred (conversion disorder). The usefulness of these distinc- tions and the ability of diagnosticians to reliably make them is subject to question (cf. Barsky & Klerman, 1983; Kirmayer & Paul Karoly and Len Lecci, Department of Psychology, Arizona State University. Portions of this study were presented at the 99th Annual Conven- tion of the American Psychological Association, August 19,1991, San Francisco, California. We are indebted to Catherine Briggs and Cindy Anderson for their help in the conduct of this study and the coding of the data. We also extend special thanks to Morris Okun, Linda Ruehlman, George Knight, Arthur Stone, and two anonymous reviewers for their helpful comments on a draft of this article. Correspondence concerning this article should be addressed to either Paul Karoly or Len Lecci, Department of Psychology, Arizona State University, Tempe, Arizona 85287-1104. Robbins, 1991). We therefore use the terms hypochondriasis and somatization interchangeably in this article. By far, the vast majority of research has been epidemiologic or descriptive in nature, with occasional attempts (typically retrospective and correlational) to establish etiologic links to such factors as stress, conflict, or family pathology (cf. Baur, 1988; Brown, 1986; Kellner, 1988; Kenyon, 1978). Without denying the necessity of the descriptive pathology perspective, it is clearly insufficient in addressing either differential suscep- tibility or motivational dynamics—factors that might explain why hypochondriacal patterns persist despite their seeming inappropriateness and openness to medical disconfirmation. Recently, however, a number of intriguing formulations have been put forth that may prove helpful in articulating poten- tially predisposing and enabling conditions surrounding vari- ous manifestations of abnormal illness behavior. Some individuals may be especially tuned to interoceptive signals of physiological arousal (Hanback & Revelle, 1978; Miller, Murphy, & Buss, 1981). Primed to detect bodily signals, somatizers may amplify vague sensations or overinterpret transient signs and dysfunctions (pain and fatigue) to the point of establishing a new internal representation or schema (an organized cognitive structure) that defines "normal" (expect- ed) functioning. The body schema is believed capable of guiding subsequent attention (and other aspects of daily self-regulation) thereby providing the assumptive support for erroneous somatic beliefs or perceptions (cf. Leventhal & Nerenz, 1985; Pennebaker, 1982; Skelton & Croyle, 1992). Warwick (1989) has suggested that erroneous beliefs about health and illness in combination with medically relevant fears provide the building blocks for the development of hypochon- driasis. Furthermore, once health issues assume the focus in a person's life, other concerns of daily living are minimized. Thus, somatic apprehension becomes experientially (a) salient by virtue of the individual's investment of time, energy, and 103 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.