Illness Behavior Questionnaire (IBQ)

Abstract

The Illness Behaviour Questionnaire (IBQ) is a widely recognized self-report instrument designed to measure psychological attitudes and behavioral responses related to perceived illness. Developed by Pilowsky and Spence, the scale aims to quantify the subjective experience of being ill, distinguishing between adaptive and maladaptive illness behaviors. It is particularly useful in clinical settings, such as pain clinics and general hospital psychiatry, for identifying patients whose symptoms may be amplified or maintained by psychological factors, including hypochondriacal concerns or affective disturbance. The IBQ provides clinicians with a structured method for assessing the extent to which a patient’s sickness role is endorsed or denied.

Keywords

Illness Behaviour Questionnaire, IBQ, Illness Behaviour, Hypochondriasis, Somatization, Disease Conviction, Affective Disturbance, Psychological Assessment, Pain Management, Psychosomatic Medicine

Authors

I. Pilowsky, N.D. Spence

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Purpose

The primary purpose of the Illness Behaviour Questionnaire (IBQ) is to provide a standardized, quantifiable measure of an individual’s psychological reaction to somatic symptoms and the adoption of the sick role. It serves as a crucial tool in differentiating between patients presenting with purely organic complaints and those whose symptoms are compounded by psychological distress or exaggerated illness concerns.

In clinical practice, the IBQ assists in the diagnosis and management of conditions where illness behaviour is disproportionate to the demonstrable pathology. This includes chronic pain syndromes, functional somatic syndromes, and cases of severe hypochondriasis. The scale helps clinicians categorize specific maladaptive patterns, such as intense preoccupation with symptoms or the tendency to deny illness-related distress.

Construct

The IBQ measures the construct of Illness Behaviour, defined by Pilowsky as the way in which individuals perceive, evaluate, and respond to their own symptoms, regardless of whether the symptoms are physical or psychological in origin. This construct encompasses a set of beliefs, attitudes, and coping mechanisms related to health status.

The scale operationalizes illness behaviour across several dimensions, moving beyond simple symptom reporting to assess underlying psychological components. Key facets measured include the conviction of having a serious disease (Disease conviction), the tendency to focus on somatic versus psychological explanations for symptoms, and the presence of anxiety and depressive features related to health status.

Validity

The validity of the IBQ has been extensively studied across diverse patient populations, particularly those experiencing chronic pain and somatoform disorders. Studies have consistently demonstrated construct validity through its ability to differentiate between groups of patients based on their level of psychological distress and illness preoccupation. For instance, patients diagnosed with somatoform disorders typically score higher on scales like Disease Conviction and General Hypochondriasis compared to those with confirmed organic disease.

Criterion validity is supported by research showing correlations between IBQ scores and clinical outcomes, such as utilization of healthcare services and adherence to treatment protocols. Research detailed in publications such as The Illness Behavior Questionnaire as an aid to clinical assessment (Pilowsky et al., 1984) and studies focusing on chronic low back pain (Main & Waddell, 1987) confirm its utility in clinical assessment and classification of illness patterns.

Reliability

The IBQ generally exhibits satisfactory internal consistency and test-retest reliability, although reliability estimates can vary significantly depending on the specific subscale and the population tested (e.g., general medical patients versus pain clinic patients). The subscales designed to measure stable personality traits, such as General Hypochondriasis and Disease conviction, typically show higher reliability coefficients over time.

The scale’s reliability supports its use in tracking changes in illness behavior over the course of treatment, particularly in therapeutic interventions aimed at reducing maladaptive coping strategies. However, clinicians must be mindful that scales measuring transient affective states (like Affective Disturbance) may show lower test-retest stability compared to the core cognitive dimensions.

Factor Analysis

Initial development and subsequent revisions of the IBQ utilized factor analysis to delineate distinct dimensions of illness behavior. The structure has evolved slightly across different editions and translations, but the core measurement structure typically resolves into seven primary factors, or subscales, derived from the 62 items.

These factors allow for a nuanced profile of the patient’s illness experience, rather than a single global score. The seven established subscales are:

• General (phobic) Hypochondriasis
• Disease conviction
• Psychological vs. somatic focusing
• Affective inhibition
• Affective disturbance
• Denial scale
• Irritability

Instrument

Test Type: Self-report questionnaire / Psychological rating scale

Format: 62 items, Dichotomous (Yes/No) response format

Language Available: English (Original), various translations available (e.g., German, Spanish, Dutch)

Population Group: Clinical populations (e.g., patients in general medical settings, pain clinics, and psychiatric facilities)

Age Group: Adults

Population Details: Originally developed and validated on patients attending general hospitals and psychiatric facilities, particularly those with chronic pain or suspected somatoform disorders.

Test Methodology: Respondents answer 62 questions regarding their attitudes, feelings, and beliefs about their health and illness experience using a simple “Yes” or “No” format. Scoring involves summing responses for the seven identified subscales, providing a dimensional profile of the individual’s illness behaviour. The scale is easily administered in a paper-and-pencil format.

Keywords

Somatic Symptoms, Chronic Pain, Clinical Assessment, Rating Scales, Factor Analysis, Denial, Affective States, Psychosomatic Research

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Authors

Author ORCID Identifier: Not publicly provided in source materials.

Affiliation Email addresses: [email protected] (Associated with I. Pilowsky)

Correspondence Address: Department of Psychiatry, University of Adelaide (as cited in manual editions).

Permissions & Fee and Test Year

The IBQ was initially developed in the late 1970s, with the second edition manual published in 1983 and the third edition manual published by Pilowsky and Spence in 1994. Researchers generally need to obtain permission from the copyright holders (typically the authors or the University of Adelaide) for clinical or large-scale research use. The test year cited for the manual revision is 1993/1994.

The instrument can be found in reference guides such as Measuring Health: A Guide to Rating Scales and Questionnaires. The original PDF for one such guide can be downloaded here: Measuring Health: A Guide to Rating Scales and Questionnaires and also here: www.a4ebm.org/sites/default/files/Measuring Health.pdf.

Reference’s

• Pilowsky I, Spence ND. (1983) Manual for the illness behaviour questionnaire (IBQ). 2nd ed. Adelaide: University of Adelaide.

• Pilowsky I, Spence N, Cobb J, Katsikitis M. 1984 The Illness Behavior Questionnaire as an aid to clinical assessment. Gen Hosp Psychiatry, 6(2):123-30.

• Main, C.J., & Waddell, G. (1987). Psychometric construction and validity of the Pilowsky Illness Behaviour Questionnaire in British patients with chronic low back pain. Pain, 28, 13-25.

• Pilowsky, I., Smith, Q., & Katsikitis, M. (1987). Illness behavior and general practice utilization: A prospective study. Journal of Psychosomatic Research, 37, 177-183.

• Pilowsky, I., & Katsikitis, M. (1994). A classification of illness behavior in pain clinic patients. Pain, 57, 91-94.

• Pilowsky, I., & Spence, N. (1994). Manual for the Illness Behaviour Questionnaire (3^rd ed.). Department of Psychiatry, University of Adelaide.

• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires. Oxford University Press (3rd ed.), 508-514.

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Items of the Illness Behaviour Questionnaire (IBQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

1. Do you worry a lot about your health?
2. Do you think there is something wrong with your body?
3. Does your illness interfere with your life a great deal?
4. Are you easy to get along with when you are ill?
5. Does your family have history of illness?
6. Do you think you are more liable to illness than other people?
7. If the doctor told you that he could find nothing wrong with you, would you believe him?
8. Is it easy for you to forget about yourself and think about all sorts of other things?
9. If you feel ill and someone tell you that you are better, do you become annoyed?
10. Do you find that you are often aware of various things happening in your body?
11. Do you ever think of your illness as a punishment for something you have done wrong in the past?
12. Do you have trouble with your nerves?
13. If you fill ill or worried, can you be easily cheered up by the doctor?
14. Do you think that other people realize what it’s like to be sick?
15. Does it upset you to talk to the doctor about your illness?
16. Are you bothered by many pains and aches?
17. Does your illness affect the way you get on with your family or friends a great deal?
18. Do you find that you get anxious easily?
19. Do you know anybody who was had the same illness as you?
20. Are you more sensitive than other people?
21. Are you afraid of illness?
22. Can you express your personal feelings easily to other people?
23. Do people fill sorry for you when you are ill?
24. Do you think that you worry about health more than other people?
25. Do you find that your illness affects your sexual relations?
26. Do you experience a lot of pain with your illness?
27. Except for your illness, do you have any problems in your life?
28. Do you care whether or not people realise that you are sick?
29. Do you find that you get jealous of other peoples good health?
30. Do you ever have silly thoughts about your health which you can’t get out of your mind, no matter how hard you try?
31. Dou you have any financial problem?
32. Are you upset by the way people take your illness?
33. Is it hard for you to believe the doctor when he tells you there is nothing for you to worry about?
34. Do you often worry about the possibility that you have got a serious illness?
35. Are you sleeping well?
36. When you are angry, do you tend to bottle up your feelings?
37. Do you often think that you might suddenly fall ill’?
38. If a disease is brought to your attention (through the radio, television, newspapers or someone you know) do you worry about getting it yourself?
39. Do get the feeling that people are not taking your illness seriously enough?
40. Are you upset about the appearance of your face or body?
41. Do you find that you are bothered by many different symptoms?
42. Do you frequently try to explain to others how your feelings are?
43. Do you have any family problems?
44. Do you think that there is something the matter with your mind?
45. Are you eating well?
46. Is your bad health the biggest difficulty of your life?
47. Do you find that you get sad easily?
48. Do you worry or fuss over small details that seem unimportant to others?
49. Are you always a co-operative patient?
50. Do you often have the symptoms of a very serious disease?
51. Do you find that you get angry easily?
52. Do you have any work problems?
53. Do you prefer to keep your feelings to yourself?
54. Do you find that you get depressed?
55. Would all your worries be over if you were physically healthy?
56. Are you more irritable towards other people?
57. Do you think that your symptoms may be caused by worry’?
58. Is it easy for you to let People know when you are Cross with them?
59. Is it hard for you to relax?
60. Do you have personal worries that are not caused by physical illness?
61. Do you often find that you lose patience with other people?
62. Is it hard for you to show people your personal feelings?