Introduction

Health Anxiety, Obsessive–Compulsive Symptoms and Cyberchondria

Cyberchondria: The Role of Self-Esteem

The Present Study

Method

Participants and Procedure

Measures

Analytical Approach

Results

Preliminary Analysis

Main Mediation Model

Reverse Mediation Model

Discussion

Implications

Limitations and Future Research

Conclusions

References

Abstract

Cyberchondria refers to the excessive and repeated searching for medical information on the Internet and may be considered as health-related problematic Internet use. Previous findings indicated that cyberchondria is positively associated with health anxiety and obsessive–compulsive symptoms. Also, research suggests that excessive or problematic Internet use as well as health worries and compulsive behaviors are present among individuals with low self-esteem. This study sought to examine: (1) the association between self-esteem and cyberchondria, and (2) the mediating role of health anxiety and obsessive– compulsive symptoms in the relationship between self-esteem and cyberchondria. Participants (N = 207) from a community sample completed self-report measures assessing global self-esteem, health anxiety, obsessive–compulsive symptoms, and cyberchondria. We found that self-esteem directly predicted cyberchondria and that health anxiety and obsessive–compulsive symptoms parallelly mediated the relationship between self-esteem and cyberchondria. These findings suggest that low selfesteem, health anxiety and obsessive–compulsive symptoms can be considered vulnerability factors for cyberchondria. In addition, the reverse mediation model indicated that cyberchondria potentially predicts self-esteem both directly and through health anxiety and obsessive–compulsive symptoms. The bidirectional relationship among the analyzed variables are discussed in the context of potential psychological predictors and consequences of cyberchondria and possible mechanisms explaining cyberchondria. The current study provides further insight into the conceptualization of cyberchondria and the feasibility of specific treatment directions.

Introduction

Excessive searching for health-related information on the Internet accompanied by health worry has become increasingly prevalent among adult Internet users. This phenomenon, referred to as Bcyberchondria^, is characterized by frequent and repetitive seeking for medical information online, and associated with the exacerbation of anxious thoughts and feelings about health (Starcevic and Berle 2013, 2015). If anxiety intensifies, it may result in ceasing the search or, quite the opposite it may stimulate further online investigation. This behavioral pattern, which appears to resemble compulsive behaviors, is a form of reassurance seeking that is intended to reduce fear of illness and to restore confidence about good health. Paradoxically, however, it may become a source of even greater anxiety (Starcevic and Berle 2013). Cognitiveaffective components like worrying about health and behavioral factors, such as excessive and repeated online searching for medical information, can be regarded as the most salient characteristics of cyberchondria (Starcevic 2017). Apparently, cyberchondria may have negative consequences, such as the exacerbation of a fear of illnesses, confusion about conflicting medical information, preoccupation with online searching for health-related content at the expense of personal, social and other activities, and potentially a disruption of the relationship with primary care physicians (Starcevic and Berle 2013; McElroy and Shevlin 2014). Recent research has linked cyberchondria to excessive or problematic Internet use (PIU; Fergus and Dolan 2014; Fergus and Spada 2017) and even Internet addiction (Ivanova 2013; Selvi et al. 2018; Durak-Batigun et al. 2018). PIU as a form of maladaptive behavior may lead to significant distress and impairment of daily functioning (Young 1998; Davis 2001; Shapira et al. 2003; Weinstein and Aboujaoude 2015; Laconi et al. 2017).