Published online Mar 19, 2021. doi: 10.5498/wjp.v11.i3.73
Peer-review started: December 1, 2020
First decision: December 12, 2020
Revised: December 23, 2020
Accepted: January 28, 2021
Article in press: January 28, 2021
Published online: March 19, 2021
Illness anxiety disorder (IAD) is a common, distressing, and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders. Because eye movements are guided by visual-spatial attention, eye-tracking technology is a comparatively direct, continuous measure of attention direction and speed when stimuli are oriented. Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly.
To examine the association between IAD and biased processing of illness-related information.
A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories (illness-related, socially threatening, positive, and neutral images). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category.
The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures. There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images. Patients with IAD had an attention bias at the early stage and overall attentional avoidance. In addition, this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing.
Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.
Core Tip: This is the first study which has examined patients with illness anxiety disorder (IAD) having an attention bias that is mainly manifested as attentional avoidance at the early stage and overall attentional maintenance when presented with illness-related stimuli. They also have demonstrated vigilance of attention at the early attention stage and overall attentional maintenance when presented with disease and positive/neutral stimuli. In addition, this study found that patients with suspected disorders with significant anxiety symptoms show attention bias in the late stage of attention processing and struggle to dismiss the stimulus, showing delayed detachment. This study suggests that patients with IAD have attention bias and this may have provided a new way of identification of IAD symptoms using an eye-tracking evaluation method.