Death anxiety as a potential cause or consequence of PSS

Death anxiety as a potential cause or consequence of PSS

Mortality awareness makes us vulnerable and can lead to a number of psychological defences. Fear of death can be simultaneously conscious and unconscious within the same person. Ten per cent of the general population has an above-average fear of dying and four per cent experiences severe fear of death. Despite these numbers, primary death anxiety has not yet been considered as a leading cause in the development of psychological disorders; the bulk of the literature on the subject has been philosophical and psychological in nature. Clinical research into the association between death anxiety and other symptoms or diseases is scarce and has mainly focused on terminally ill patients. Several years ago, a review was published describing the role of death anxiety in the development of disorders like anxiety, depression and obsessive compulsiveness (Iverach e.a., 2014).

Author: Birgit aan de Stegge

Based on clinical intuition, one could reason that death anxiety potentially plays an etiological role in the development of hypochondriasis and persistent somatic symptoms (PSS). The fear of bodily failure could lead to the development of a number of physical symptoms. Inversely, experiencing explained or unexplained physical symptoms could lead to a fear of deterioration and death.

Since the possible relationship between death anxiety and the development of PSS had not yet been studied, we decided to conduct a systematic review of the available literature (aan de Stegge e.a., 2018). Six studies on the association between death anxiety and hypochondriasis, and three studies on the association between death anxiety and PSS met the inclusion criteria. The results were robust: all studies showed a positive association between death anxiety and hypochondriasis and/or PSS. The results, however, should be interpreted with caution as the methodological quality of the studies included was low. Due to the cross-sectional design of the studies, no conclusions about causality can be drawn. In the review article, several death anxiety concepts were described; however these concepts were only partly identified in the included studies. The review article included several suggestions for future research.

Further research into the possible role of death anxiety in the development and maintenance of PSS is important, as this could lead to a personalisation of PSS treatment. PSS treatment focusing on the most significant perpetuating factors of the patient’s symptoms seems to be the most effective. These perpetuating factors are different for each patient and may include fear of death. Lack of acknowledgment of this factor may lead to less effective treatment results and therefore a lower chance of recovery and/or a higher chance of recurrence.


aan de Stegge, BM, Tak LM, Rosmalen JGM, Oude Voshaar RC. Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review. J. Psychosom. Res 2018; 115: 58-65.

Other references

Iverach, L, Menzies, RG, Menzies, RE. Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review 2014;34(7):580-593.

Category: PSS

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