Hypochondriasis

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For the anatomical term, see Hypochondrium.
Hypochondrisis
Classification and external resources
ICD-10 F45.2
ICD-9 300.7
MedlinePlus 001236
MeSH D006998

Hypochondriasis or hypochondria (sometimes referred to as health phobia or health anxiety) refers to excessive preoccupancy or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence of an actual medical condition.[1] An individual suffering from hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter how minor the symptom may be, and are convinced that they have, or are about to be diagnosed with, a serious illness.[2]

Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. To qualify for the diagnosis of hypochondria the symptoms must have been experienced for at least 6 months.[3]

The DSM-IV-TR defines this disorder, "Hypochondriasis", as a somatoform disorder[4] and one study has shown it to affect about 3% of the visitors to primary care settings.[5] The newly published DSM-5 replaces the diagnosis of hypochondriasis with the diagnosis of "illness anxiety disorder".[6]

Hypochondria is often characterized by fears that minor bodily or mental symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or short-lasting. Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome". Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends.[7] Some hypochondriacal individuals completely avoid any reminder of illness, whereas others frequently visit medical facilities, sometimes obsessively. Other hypochondriacs will never speak about their terror, convinced that their fear of having a serious illness will not be taken seriously by those in whom they confide.

Characteristics[edit]

Hypochondriasis is categorized as a somatic amplification disorder—a disorder of "perception and cognition"[1]—that involves a hyper-vigilance of situation of the body or mind and a tendency to react to the initial perceptions in a negative manner that is further debilitating. Hypochondriasis manifests in many ways. Some people have numerous intrusive thoughts and physical sensations that push them to check with family, friends, and physicians. For example, a person who has a minor cough may think that they have tuberculosis.[8] Or sounds produced by organs in the body, such as those made by the intestines, might be seen as a sign of a very serious illness to patients dealing with hypochondriasis.[9]

Other people are so afraid of any reminder of illness that they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Yet others live in despair and depression, certain that they have a life-threatening disease and no physician can help them. Some consider the disease as a punishment for past misdeeds.[10]

Hypochondriasis is often accompanied by other psychological disorders. Bipolar disorder, clinical depression, obsessive-compulsive disorder (OCD), phobias, and somatization disorder are the most common accompanying conditions in people with hypochondriasis, as well as a generalized anxiety disorder diagnosis at some point in their life.[11]

Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of obsessive-compulsive disorder. However, while people with hypochondriasis are afraid of having an illness, patients with OCD worry about getting an illness or of transmitting an illness to others.[10] Although some people might have both, these are distinct conditions.

Patients with hypochondriasis often are not aware that depression and anxiety produce their own physical symptoms, and mistake these symptoms for manifestations of another mental or physical disorder or disease. For example, people with depression often experience changes in appetite and weight fluctuation, fatigue, decreased interest in sex and motivation in life overall. Intense anxiety is associated with rapid heartbeat, palpitations, sweating, muscle tension, stomach discomfort, dizziness, and numbness or tingling in certain parts of the body (hands, forehead, etc.).[citation needed]

In some cases, hypochondriasis responds well to antipsychotics, particularly the newer atypical antipsychotic medication.[12][13]

If a person is ill with a medical disease such as diabetes or arthritis, there will often be psychological consequences, such as depression. Some even report being suicidal. In the same way, someone with psychological issues such as depression or anxiety will sometimes experience physical manifestations of these affective fluctuations, often in the form of medically unexplained symptoms. Common symptoms include headaches; abdominal, back, joint, rectal, or urinary pain; nausea; fever and/or night sweats; itching; diarrhea; dizziness; or balance problems. Many people with hypochondriasis accompanied by medically unexplained symptoms feel they are not understood by their physicians, and are frustrated by their doctors’ repeated failure to provide symptom relief.

Diagnosis[edit]

The ICD-10 defines hypochondriasis as follows:

A. Either one of the following:
  • A persistent belief, of at least six months' duration, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient).
  • A persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder).
B. Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigations (or equivalent help from local healers).
C. Persistent refusal to accept medical advice that there is no adequate physical cause for the symptoms or physical abnormality, except for short periods of up to a few weeks at a time immediately after or during medical investigations.
D. Most commonly used exclusion criteria: not occurring only during any of the schizophrenia and related disorders (F20-F29, particularly F22) or any of the mood disorders (F30-F39).

The DSM-IV defines hypochondriasis according to the following criteria:[4]

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
B. The preoccupation persists despite appropriate medical evaluation and reassurance.
C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).
D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The duration of the disturbance is at least 6 months.
F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

The newly published DSM-5 replaces the diagnosis of hypochondriasis with "illness anxiety disorder".[14]

Cause[edit]

Hypochondria is currently considered a psychosomatic disorder, as in a mental illness with physical symptoms.[15] Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. The media and the Internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis (some of the diseases hypochondriacs commonly think they have)[citation needed] often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.

Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease. A simple suggestion of medical illness can often trigger one with hypochondria to obsess over the possibility.[citation needed]

Overly protective caregivers and an excessive focus on minor health concerns have been implicated as a potential cause of hypochondriasis development.[16]

It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.

Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families.[10] Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder).[17]

Treatment[edit]

Common to the different approaches to the treatment of hypochondriasis is the effort to help each patient find a better way to overcome the way his/her medically unexplained symptoms and illness concerns rule her/his life. Current research makes clear that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy.

Recent scientific studies have shown that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine and paroxetine) are effective treatment options for hypochondriasis as demonstrated in clinical trials.[18][19][20][21][22] CBT, a talking therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is found helpful in reducing the intensity and frequency of troubling bodily symptoms. SSRIs can reduce obsessive worry through adjusting neurotransmitter levels and have been shown to be effective as treatments for anxiety and depression as well as for hypochondriasis.

Another treatment that has proved effective in the treatment of hypochondriasis is exposure therapy. In one study, this was shown to be equally as effective as cognitive therapy and the improvements in condition were maintained after the study.[23]

Etymology[edit]

The hypochondrium is the upper part of the abdomen inferior to the lowest ribs of the thorax. The word derives from the Greek term ὑποχόνδριος hupochondrios, meaning "of the soft parts between the ribs and navel". Use of the term hypochondriasis for a state of disease without real cause reflects the ancient belief that the viscera of the hypochondria were the seat of melancholy and sources of the vapor that caused such morbid feelings.

See also[edit]

References[edit]

  1. ^ a b Avia, M. D., and M. A. Ruiz. "Recommendations for the Treatment of Hypochondriac Patients." Journal of Contemporary Psychotherapy. 35.3 (2005): 301-313. Print.
  2. ^ Kring A.M. et al. 2007. Abnormal Psychology. 10th ed. USA: Wiley
  3. ^ Goldberg R.J. MD.2007 Practical Guide to the Care of the Psychiatric Patient 3rd ed. Mosby-Elsevier: USA.
  4. ^ a b American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised, Washington, DC, APA, 2000.
  5. ^ Escobar JI, Gara M, Waitzkin H, Silver RC, Holman A, Compton W (1998). "DSM-IV hypochondriasis in primary care". Gen Hosp Psychiatry 20 (3): 155–9. doi:10.1016/S0163-8343(98)00018-8. PMID 9650033. 
  6. ^ http://www.mayoclinic.org/medical-professionals/clinical-updates/psychiatry-psychology/diagnostic-statistical-manual-mental-disorders-redefines-hypochondriasis
  7. ^ Olatunji, B. O., Etzel, E. N., Tomarken, A.J., Ciesielski, B. G., & Deacon, B. (2011). "The effects of safety behaviors on health anxiety: An experimental investigation". Behaviour Research and Therapy (49): 719–728. 
  8. ^ Daniel L. Schacter, Daniel T. Gilbert, Daniel M. Wegner.(2011).Generalized Anxiety Disorder.Psychology second edition.
  9. ^ "Hypochondriasis". CareNotes. Thomson Healthcare, Inc., 2011. Retrieved 6 April 2012. 
  10. ^ a b c Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616.
  11. ^ Barsky AJ: Hypochondriasis and obsessive-compulsive disorder. Psychiatr Clin North Am 1992; 15:791-801.
  12. ^ Wenning MT, Davy LE, Catalano G, Catalano MC (2003). "Atypical antipsychotics in the treatment of delusional parasitosis". Annals of Clinical Psychiatry 15 (3–4): 233–9. doi:10.3109/10401230309085693. PMID 14971869. 
  13. ^ Harth, Wolfgang; Uwe Gieler; Daniel Kusnir; Francisco A. Tausk (2008). Clinical Management of Psychodermatology. Springer. p. 36. ISBN 9783540347187. In delusional cutaneous hypochondriasis, atypical neuroleptics are the therapy of first choice (for example, risperidone and olanzapine or aripiprazole). 
  14. ^ http://www.mayoclinic.org/medical-professionals/clinical-updates/psychiatry-psychology/diagnostic-statistical-manual-mental-disorders-redefines-hypochondriasis
  15. ^ Ford, Allison. "Hypochondria: Can You Worry Yourself Sick?". divine caroline. divine caroline. Retrieved 19 November 2012. 
  16. ^ "Hypochondriasis." CareNotes. Thomson Healthcare, Inc., 2011. Health Reference Center Academic. Retrieved April 5, 2012.
  17. ^ Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BAM, Grados, MA, Nestadt G: The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry 2000, 48:287-293.
  18. ^ Barsky AJ, Ahern DK: Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004; 291:1464-1470.
  19. ^ Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell M, Ludgate J, Ahmand S, Richards HC, Gelder M: Two psychological treatments for hypochondriasis, a randomized controlled trial. Br J Psychiatry 1998; 173:218-225.
  20. ^ Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz D, Liebowitz MR: The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 1996; 32:607-611.
  21. ^ Fallon BA, Qureshi AI, Schneiner FR, Sanchez-Lacay A, Vermes D, Feinstein R, Connelly J, Liebowitz MR: An open trial of fluvoxamine for hypochondriasis. Psychosomatics 2003; 44:298-303.
  22. ^ Greeven A, Van Balkom AJ, Visser S, Merkelbach JW, Van Rood YR, Van Dyck R, Van der Does AJ, Zitman FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007; 164:91-99.
  23. ^ Visser, S.; Bouman, T. K. (2001). "The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy". Behaviour research and therapy 39 (4): 423–442. doi:10.1016/S0005-7967(00)00022-X. PMID 11280341.  edit

External links[edit]

Further reading[edit]

  • Belling, Catherine. 2012. "A Condition of Doubt: The Meanings of Hypochondria." New York: Oxford University Press. ISBN 978-0199892365.