Skip to main content
Original Article

Anxiety Sensitivity or Interoceptive Sensitivity

An Analysis of Feared Bodily Sensations

Published Online:https://doi.org/10.1027/1015-5759/a000269

Abstract. The construct of anxiety sensitivity (AS) – the fear of anxiety-related symptoms – has been highly influential in current conceptualizations of anxiety disorders in general, and panic disorder specifically. However, given documented associations between AS and both non-anxiety psychological disorders as well as medical/health conditions, the extent to which measures of AS are assessing a specific fear or anxiety symptoms versus a broader fear of interoceptive or bodily sensations is unclear. Confirmatory factor analysis of data from 373 participants failed to suggest whether fears of anxiety-related symptoms were factorially distinct from fears of non-anxiety-related bodily sensations, although analyses indicated that while fears of anxiety-related symptoms were more closely associated with panic disorder severity than were fears of non-anxiety-related symptoms, both were similarly and strongly associated with hypochondriacal fears. Implications for the construct of AS, and the broader construct of somatic fears, are discussed.

References

  • Abdel-Khalek, A. M. (2003). The Somatic Symptoms Inventory (SSI): Development, parameters, and correlates. Current Psychiatry, 10, 114–129. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author. First citation in articleGoogle Scholar

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. First citation in articleCrossrefGoogle Scholar

  • Andersson, G. & Vretblad, P. (2000). Tinnitus and anxiety sensitivity. Scandinavian Journal of Behaviour Therapy, 29, 57–64. First citation in articleCrossrefGoogle Scholar

  • Asmundson, G. J. G., Norton, P. J. & Norton, G. R. (1999). Beyond pain: The role of fear and avoidance in chronicity. Clinical Psychology Review, 19, 97–119. First citation in articleCrossrefGoogle Scholar

  • Asmundson, G. J. G., Norton, P. J. & Veloso, F. (1999). Anxiety sensitivity and fear of pain in patients with recurring headaches. Behaviour Research and Therapy, 37, 703–713. First citation in articleCrossrefGoogle Scholar

  • Asmundson, G. J. G. & Taylor, S. (1996). Role of anxiety sensitivity in pain-related fear and avoidance. Journal of Behavioral Medicine, 19, 573–582. First citation in articleCrossrefGoogle Scholar

  • Asmundson, G. J. G., & Wright, K. D. Hadjistavropoulos. (2000). Anxiety sensitivity and disabling chronic health conditions: State of the art and future directions. Scandinavian Journal of Behavioral Therapy, 29, 100–117. First citation in articleCrossrefGoogle Scholar

  • Bernstein, A. B., Zvolensky, M. J., Norton, P. J., Schmidt, N. B., Taylor, S., Forsyth, J. P., … Leen-Feldner, E. (2007). Taxometric and factor analytic models of anxiety sensitivity: Integrating approaches to latent structural research. Psychological Assessment, 19, 74–87. First citation in articleCrossrefGoogle Scholar

  • Browne, M. W. & Cudeck, R. (1993). Alternative ways of assessing model fit. In K. A. BollenJ. S. LongEds., Testing Structural Equation Models (pp. 136–162). Beverly Hills, CA: Sage. First citation in articleGoogle Scholar

  • Carr, R. E., Lehrer, P. M. & Hochron, S. M. (1995). Predictors of panic-fear in asthma. Health Psychology, 14, 421–426. First citation in articleCrossrefGoogle Scholar

  • Carr, R. E., Lehrer, P. M., Rausch, L. L. & Hochron, S. M. (1994). Anxiety sensitivity and panic attacks in an asthmatic population. Behaviour Research and Therapy, 32, 411–418. First citation in articleCrossrefGoogle Scholar

  • Cox, B. J., Borger, S. C. & Enns, M. W. (1999). Anxiety sensitivity and emotional disorders: Psychometric studies and their theoretical implications. In S. TaylorEd., Anxiety sensitivity (pp. 115–148). Mahwah, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Cox, B. J., Fuentes, K., Borger, S. C. & Taylor, S. (2001). Psychopathological correlates of anxiety sensitivity: Evidence from clinical interviews and self-report measures. Anxiety Disorders, 15, 317–332. First citation in articleCrossrefGoogle Scholar

  • Derogatis, L. R., Lipman, R. S., Rickels, K., Chlenhuth, E. H. & Covi, L. (1974). The Hopkins symptom checklist (HSCL): A self-report inventory. Behavioral Science, 19, 1–15. First citation in articleCrossrefGoogle Scholar

  • Fergus, T. A. (2014). Health-related dysfunctional beliefs and health anxiety: Further evidence of cognitive specificity. Journal of Clinical Psychology, 70, 248–259. First citation in articleCrossrefGoogle Scholar

  • Hiller, W., Leibbrand, R., Rief, W. & Fichter, M. M. (2005). Differentiating hypochondriasis from panic disorder. Journal of Anxiety Disorders, 19, 29–49. First citation in articleCrossrefGoogle Scholar

  • Hoaglin, D. C., Mosteller, F. & Tukey, J. W. (1983). Understanding robust and exploratory data. New York, NY: Wiley. First citation in articleGoogle Scholar

  • Houck, P. R., Spiegel, D. A., Shear, M. K. & Rucci, P. (2002). Reliability of the self-report version of the Panic Disorder Severity Scale. Depression and Anxiety, 15, 183–185. First citation in articleCrossrefGoogle Scholar

  • Kellner, R., Abbott, P., Winslow, W. W. & Pathak, D. (1987). Fears, beliefs, and attitudes in DSM-III hypochondriasis. The Journal of Nervous and Mental Disease, 176, 20–25. First citation in articleCrossrefGoogle Scholar

  • Kellner, R., Wiggins, R. G. & Pathak, D. (1986). Hypochondriacal fears and beliefs in medical and law students. Archives of General Psychiatry, 43, 487–489. First citation in articleCrossrefGoogle Scholar

  • Keogh, E. & Mansoor, L. (2001). Investigating the effects of anxiety sensitivity and coping strategy on the perception of cold pressor pain in healthy women. European Journal of Pain, 5, 11–25. First citation in articleCrossrefGoogle Scholar

  • Lewis, A. R., Zinbarg, R. E., Mineka, S., Craske, M. G., Epstein, A. & Griffith, J. W. (2010). The relationship between anxiety sensitivity and latent symptoms of emotional problems: A structural equation modeling approach. Behaviour Research and Therapy, 48, 761–769. First citation in articleCrossrefGoogle Scholar

  • Maller, R. G. & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6, 241–247. First citation in articleCrossrefGoogle Scholar

  • Marsh, H. W. & Lau, K.-T. (1996). Assessing goodness of fit: Is parsimony always desirable? The Journal of Experimental Education, 64, 364–390. First citation in articleCrossrefGoogle Scholar

  • Muthén, L. K. & Muthén, B. (2013). Mplus user’s guide (Version 7.1). Los Angeles, CA: Muthén & Muthén. First citation in articleGoogle Scholar

  • Norton, G. R., Norton, P. J., Asmundson, G. J. G., Thompson, L. A. & Larsen, D. K. (1999). Neurotic butterflies in my stomach: The role of anxiety, anxiety sensitivity, and depression in functional gastrointestinal disorders. Journal of Psychosomatic Research, 47, 233–240. First citation in articleCrossrefGoogle Scholar

  • Norton, P. J., Sexton, K. A., Walker, J. R. & Norton, G. R. (2005). Hierarchical model of vulnerabilities for anxiety: Replication and extension with a clinical sample. Cognitive Behaviour Therapy, 34, 49–63. First citation in articleCrossrefGoogle Scholar

  • Olatunji, B. O. & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychological Bulletin, 135, 974–999. First citation in articleCrossrefGoogle Scholar

  • Otto, M. W., Demopulos, C. M., McLean, N. E., Pollack, M. H. & Fava, M. (1998). Additional findings on the association between anxiety sensitivity and hypochondriacal concerns: Examination of patients with major depression. Journal of Anxiety Disorders, 12, 225–232. First citation in articleCrossrefGoogle Scholar

  • Otto, M. W., Pollack, M. H., Fava, M., Uccello, R. & Rosenbaum, J. F. (1995). Elevated Anxiety Sensitivity Index scores in patients with major depression: Correlates and changes with antidepressant treatment. Journal of Anxiety Disorders, 9, 117–123. First citation in articleCrossrefGoogle Scholar

  • Otto, M. W., Pollack, M. H., Sachs, G. S. & Rosenbaum, J. F. (1992). Hypochondriacal concerns, anxiety sensitivity, and panic disorder. Journal of Anxiety Disorders, 6, 93–104. First citation in articleCrossrefGoogle Scholar

  • Reiss, S. (1987). Theoretical perspectives on the fear of anxiety. Clinical Psychology Review, 7, 585–596. First citation in articleCrossrefGoogle Scholar

  • Reiss, S. (1991). The expectancy model of fear, anxiety and panic. Clinical Psychology Review, 11, 141–153. First citation in articleCrossrefGoogle Scholar

  • Reiss, S. (1999). The sensitivity theory of aberrant motivation. In S. TaylorEd., Anxiety Sensitivity (pp. 35–58). Mahwah, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Reiss, S. & McNally, R. J. (1985). Expectancy model of fear. In S. ReissR. R. BootzinEds., Theoretical issues in behavior therapy (pp. 107–121). San Diego, CA: Academic Press. First citation in articleGoogle Scholar

  • Reiss, S., Peterson, R. A. & Gursky, D. M. (1988). Anxiety sensitivity, injury sensitivity, and individual differences in fearfulness. Behaviour Research and Therapy, 26, 341–345. First citation in articleCrossrefGoogle Scholar

  • Reiss, S., Peterson, R. A., Gursky, D. M. & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. First citation in articleCrossrefGoogle Scholar

  • Schmidt, N. B., Lerew, D. R. & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106, 355–364. First citation in articleCrossrefGoogle Scholar

  • Schmidt, N. B., Lerew, D. R. & Jackson, R. J. (1999). Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: Replication and extension. Journal of Abnormal Psychology, 108, 532–537. First citation in articleCrossrefGoogle Scholar

  • Schmidt, N. B., Zvolensky, M. J. & Maner, J. K. (2006). Anxiety sensitivity: Prospective prediction of panic attacks and Axis I pathology. Journal of Psychiatric Research, 40, 691–699. First citation in articleCrossrefGoogle Scholar

  • Sexton, K. A., Norton, P. J., Walker, J. R. & Norton, G. R. (2003). Hierarchical model of generalized and specific vulnerabilities in anxiety. Cognitive Behaviour Therapy, 32, 82–94. First citation in articleCrossrefGoogle Scholar

  • Shear, K. M., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154, 1571–1575. First citation in articleCrossrefGoogle Scholar

  • Shear, K. M., Frank, E., Rucci, P., Williams, J., Grochocinski, V. J., Vander Bilt, J., … Wang, T. (2001). Reliability and validity of the panic disorder severity scale: Replication and extension. Journal of Psychiatric Research, 35, 293–296. First citation in articleCrossrefGoogle Scholar

  • Sirri, L., Grandi, S. & Fava, G. A. (2008). The Illness Attitude Scales. Psychotherapy and Psychosomatics, 77, 337–350. First citation in articleCrossrefGoogle Scholar

  • Speckens, A. E. M., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95–104. First citation in articleCrossrefGoogle Scholar

  • Tabachnick, B. G. & Fidell, L. S. (2001). Using multivariate statistics. New York, NY: Harper Collins. First citation in articleGoogle Scholar

  • Taylor, S. (1994). Comment on Otto et al. (1992): Hypochondriacal concerns, anxiety sensitivity, and panic disorder. Journal of Anxiety Disorders, 8, 97–99. First citation in articleCrossrefGoogle Scholar

  • Taylor, S. (1996). Nature and measurement of anxiety sensitivity: Reply to Lilienfeld, Turner, and Jacob (1996). Journal of Anxiety Disorders, 10, 425–451. First citation in articleCrossrefGoogle Scholar

  • Taylor, S. & Cox, B. J. (1998). An expanded Anxiety Sensitivity Index: Evidence for a hierarchic structure in a clinical sample. Journal of Anxiety Disorders, 12, 463–483. First citation in articleCrossrefGoogle Scholar

  • Taylor, S. & Fedoroff, I. C. (1999). The expectancy theory of fear, anxiety, and panic: A conceptual and empirical analysis. In S. TaylorEd., Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety (pp. 17–33). Mahwah, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Taylor, S., Koch, W. J. & McNally, R. J. (1992). How does anxiety sensitivity vary across the anxiety disorders? Journal of Anxiety Disorders, 6, 249–259. First citation in articleCrossrefGoogle Scholar

  • Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Jurado, S. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the anxiety sensitivity index-3. Psychological Assessment, 19, 176–188. First citation in articleCrossrefGoogle Scholar

  • Watt, M. C. & Stewart, S. H. (2008). Overcoming the fear of fear: How to reduce anxiety sensitivity. Oakland, CA: New Harbinger. First citation in articleGoogle Scholar

  • Watt, M. C., Stewart, S. H. & Cox, B. J. (1998). A retrospective study of the learning history origins of anxiety sensitivity. Behaviour Research and Therapy, 36, 505–525. First citation in articleCrossrefGoogle Scholar

  • Zinbarg, R. E., Brown, T. A., Barlow, D. H. & Rapee, R. M. (2001). Anxiety sensitivity, panic, and depressed mood: A reanalysis teasing apart the contributions of the two levels in the hierarchical structure of the anxiety sensitivity index. Journal of Abnormal Psychology, 3, 372–377. First citation in articleCrossrefGoogle Scholar