Hypochondriasis Disease

BASICS

DESCRIPTION
Hypochondriasis is a mental disorder associated with an excessive worry about one's health and a preoccupation with a variety of symptoms whereby the person is convinced he/she is suffering from some sort of disease. Patients suffering from this condition mostly seek medical attention searching for the physician that will diagnose them with a physical illness to explain their symptoms. This often leads to a variety of excessive work-ups, including many repetitive and expensive lab tests and diagnostic procedures. Even though these are necessary to rule out some serious physical disease, this diagnosis should not be made by exclusion alone, but should also be made by using inclusive criteria as mentioned below.
  • System(s) affected: Nervous
  • Genetics: Some studies show an increase prevalence of hypochondriasis in families, especially among identical twins and first degree relatives.
  • Incidence/Prevalence in USA:
    • Some studies point out that hypochondriasis is present in 3-14% of patients seen by primary care physicians.
    • Some surveys show that 10-20% of the general population worry about illness from time to time. About 45% of patients seen by mental health professionals worry about illness from time to time.
  • Predominant age: The peak incidence is believed to happen during the fourth or fifth decade of life, although all age groups can be affected, including children, adolescents, and the elderly.
  • Predominant sex: It is found equally in men and women; however, women tend to seek help more often than men
SIGNS AND SYMPTOMS
  • Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms
  • The preoccupation persists despite appropriate medical evaluation and reassurance
  • The belief 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)
  • The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
  • The duration of the disturbance is at least 6 months
  • 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
CAUSES
  • Biological: There is some evidence suggesting that patients with hypochondriasis may be born with a tendency to amplify somatic sensations and that they have lower threshold and a lower tolerance of physical discomfort
  • Life events: Medical diseases may predispose a patient to hypochondriasis, such as certain patients being highly sensitive to certain physical symptoms following an acute stroke, myocardial infarction, intensive treatment following malignant illness, organ transplantation, etc. These may be experienced by the patient or by a close family member or friend
  • Childhood events: The experience of numerous or serious actual medical illnesses during one's childhood may predispose the individual to hypochondriasis later on in life
  • Psychological: Many authors view hypochondriasis as the patient's psychodynamic defense against guilt, shame, low self-esteem, and a narcissistic over-indulgence with one's self. Other authors view it as the patient's way of seeking attention by overly identifying with the sick role which offers the patient a way to alleviate symptoms of anxiety and seek reassurance
  • Sociocultural: Some societies and cultures view mental symptoms in a pejorative and stigmatized way, blaming the patient for his/her illness, however, if the patient has physical symptoms and a bona fide medical diagnosis, he/she is treated with greater empathy, dignity, and respect and is not blamed for causing their illness
RISK FACTORS
Exposure to life-threatening medical conditions and procedures in one's childhood, adolescence, or in adult life

DIAGNOSIS

LABORATORY
  • Lab tests are used to rule out organic diseases

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS
N/A
SPECIAL TESTS

N/A

IMAGING
N/A
DIAGNOSTIC PROCEDURES
  • Thorough mental status examination
  • Psychological testing is used to rule out other psychiatric disorders and specifically confirm the diagnosis of hypochondriasis

TREATMENT

APPROPRIATE HEALTH CARE

Outpatient

GENERAL MEASURES
  • Treatment of choice is individual psychotherapy delivered on an outpatient basis
  • Many patients do better with supportive psychotherapy and behavior modification focused on the alleviation of their symptoms
  • Group therapy: Some patients do better in a group setting where they get social support and interaction with others
  • Reassuring the patient by repeating lab tests is only short-lived and does not solve the underlying problem
SURGICAL MEASURES

N/A

ACTIVITY

Regular exercise in moderation

DIET

Good nutrition

PATIENT EDUCATION

Providing cognitive knowledge about the condition strengthens the patient's intellectual capacities and provides a structure for better response to somatic symptoms, cognitive behavioral and other psychotherapeutic interventions.

FOLLOW UP

PREVENTION/AVOIDANCE

N/A

POSSIBLE COMPLICATIONS
  • Risks of repeated and unnecessary lab and diagnostic procedures
  • Narcotic and other drug addictions
EXPECTED COURSE AND PROGNOSIS
  • The natural history of this condition is usually chronic
  • It has fluctuations in intensity with periods of relative remission and exacerbation of acuity that may create disruption in the patient's life
  • Prognosis varies depending on the patient's personality structure, education, social support system, intelligence, and motivation for change
  • Many psychiatrists consider this condition to have a poor prognosis for psychoanalytic treatment

MISCELLANEOUS

ASSOCIATED CONDITIONS

Somatization disorder, conversion disorder, depressive disorder NOS, anxiety disorder NOS

AGE-RELATED FACTORS

Pediatric: Early childhood exposure to serious medical illness and diagnostic procedures predisposes these patients to develop hypochondriasis in adult life
Geriatric: Elderly patients usually have a higher frequency for chronic medical illness which may co-exist with hypochondriasis and complicates the treatment of hypochondriasis
Others: N/A

PREGNANCY

N/A

OTHER NOTES

N/A

ABBREVIATIONS

N/A

Clinical Investigations

ROLE OF HOMOEOPATHY

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