Psychometric Properties of Cyberchondria Severity Scale (CSS) in Iranian َAdult Population

Document Type : Original Article


1 Assistant Professor, Department of Clinical Psychology, Shiraz University, Shiraz, Iran.

2 PhD Student, Department of Clinical Psychology, Shiraz University, Shiraz, Iran.

3 M.Sc., Department of Clinical Psychology, Shiraz University, Shiraz, Iran.


Introduction: Cyberchondria is a new form of hypochondria in that repetitive searching of online medical information increases anxiety and distress in people and continues with repetitive and inconclusive tries in reassurance seeking. Cyberchondria Severity Scale (CSS) designed to diagnose this phenomenon in non-Iranian sample, but this scale not studied from validation view in Iranian population yet, so aim of this study was to evaluation of CSS psychometric properties in Iranian sample.

Methods: 200 persons were chosen by convenience sampling method and answered to Cyberchondria Severity Scale (CSS), Depression, Anxiety and Stress Scale (DASS 21) and Short Health Anxiety Inventory (SHAI).

Findings: Exploratory factor analysis (EFA) revealed 4 Factors that except one of factors (reassurance/mistrust), other factors was same as original version of the scale. Internal consistency and validations of scale was approved (p < 0/001).

Conclusion: Based on findings, this scale recognize 4 factors in Iranian population: compulsion, reassurance/mistrust, excessiveness and distress and is useable in Iranian research and clinical cases.


1. Health Online 2013 [Internet]. Pew Research Center’s Internet & American Life Project. 2013 [cited November 9, 2017].
2. Google trends: Google; 2017 [updated 2017; cited 2017 November 9].
3. Starcevic V, Berle D. Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert RevNeurother [Internet]. 2013 Feb1; 13(2): 205–13.
4. McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord [Internet]. 2014; 28(2): 2565.
5. Dobransky K, Hargittai E. Inquiring Minds Acquiring Wellness: Uses of Online and Offline Sources for Health Information. Health Commun [Internet]. 2012 May 1; 27(4): 331–43.
6. Huberty J, Dinkel D, Beets MW, Coleman J. Describing the Use of the Internet for Health, Physical Activity, and Nutrition Information in Pregnant Women. Matern Child Health J [Internet]. 2013; 17(8): 1363–72.
7. Lemire M, Sicotte C, Paré G. Internet use and the logics of personal empowerment in health. Health Policy (New York) [Internet]. 2008; 88(1): 130–40.
8. Lauckner C, Hsieh G. The presentation of health-related search results and its impact on negative emotional outcomes. Proceedings of the SIGCHI Conference on Human Factors in Computing Systems; Paris, France. 2470702: ACM; 2013. p. 333-42.
9. White R, Horvitz E. Cyberchondria: Studies of the Escalation of Medical Concerns in Web Search. ACM Transactions on Information Systems. 2009; 27(4): 23: 1-:37.
10. Baumgartner SE, Hartmann T. The Role of Health Anxiety in Online Health Information Search. Cyberpsychology, Behav Soc Netw [Internet]. 2011May 6; 14(10): 613–8.
11. Eastin MS, Guinsler NM. Worried and Wired: Effects of Health Anxiety on Information-Seeking and Health Care Utilization Behaviors. CyberPsychology Behav [Internet]. 2006 Aug 1; 9(4): 494–8.
12. Starcevic V, Berle D. Cyberchondria: An old phenomenon in a new guise. Ment Heal Digit age Grave dangers, Gt promise. 2015; 106–17.
13. Starcevic V, Baggio S, Berle D, Khazaal Y, Viswasam K. Cyberchondria and its Relationships with Related Constructs: a Network Analysis. Psychiatr Q [Internet]. 2019; 90(3): 491–505.
14. Starcevic V. Cyberchondria: Challenges of Problematic Online Searches for Health-Related Information. Psychother Psychosom [Internet]. 2017; 86(3): 129–33.
15. Muse K, McManus F, Leung C, Meghreblian B, Williams JMG. Cyberchondriasis: Fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. J Anxiety Disord [Internet]. 2012; 26(1): 189–96.
16. Doherty-Torstrick ER, Walton KE, Fallon BA. Cyberchondria: Parsing Health Anxiety From Online Behavior. Psychosomatics [Internet]. 2016; 57(4): 390–400.
17. Eysenbach G, Powell J, Kuss O, Sa E-R. Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. JAMA. 2002 May; 287(20): 2691–700.
18. Fergus TA. The Cyberchondria Severity Scale (CSS): An examination of structure and relations with health anxiety in a community sample. J Anxiety Disord [Internet]. 2014; 28(6): 504–10.
19. Norr AM, Allan NP, Boffa JW, Raines AM, Schmidt NB. Validation of the Cyberchondria Severity Scale (CSS):Replication and extension with bifactor modeling. J Anxiety Disord [Internet]. 2015; 31: 58–64.
20. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther. 1995; 33(3): 335–43.
21. Osman A, Wong JL, Bagge CL, Freedenthal S, Gutierrez PM, Lozano G. The Depression Anxiety Stress Scales—21 (DASS-21): Further Examination of Dimensions, Scale Reliability, and Correlates. J Clin Psychol [Internet]. 2012 Dec 1; 68(12): 1322–38.
22. Henry JD, Crawford JR. The short-form version of the Depression Anxiety Stress Scales (DASS-21): Construct validity and normative data in a large non-clinical sample. Br J Clin Psychol [Internet]. 2005 Jun 1; 44(2): 227–39.
23. Norton PJ. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety, Stress Coping [Internet]. 2007 Sep 1; 20(3): 253–65.
24. Sahebi A, Asghari MJ, Salari RS. Validation of depression anxiety and stress scale (DASS-21) for an Iranian population. Iran Psychol. 2005; 4(1): 299–313.
25. Salkovskis PM, RIMES KA,WARWICK HMC. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002; 32(5): 843.
26. Alberts NM, Sharpe D, Kehler MD, Hadjistavropoulos HD. Health anxiety: Comparison of the latent structure in medical and non-medical samples. J Anxiety Disord [Internet]. 2011; 25(4): 612–4.
27. Abramowitz JS, Deacon BJ, Valentiner DP. The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cognit Ther Res. 2007; 31(6): 871–83.
28. Karimi J, Najafabadi AH, Najafabadi FH. [Evaluation of Psychometric Properties of Health nxety Inventory]. J Tahghighat-e- Nezam-e- Salamat Hakim. 2014; 4: 297-305. [Persia