Hypochondriasis or hypochondria 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.
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.
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.
The DSM-IV-TR defines this disorder, "Hypochondriasis", as a somatoform disorder and one study has
shown it to affect about 3% of the visitors to primary care settings.
The newly published DSM-5 replaces the diagnosis of hypochondriasis with "illness anxiety disorder".
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.
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 Hypochondriasis is categorized as a somatic
amplification disorder—a disorder of "perception and cognition"—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.
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.
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.
Hypochondriasis is often accompanied by other psychological disorders.
Bipolar disorder, clinical depression, obsessive-compulsive disorder, 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.
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.
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.
In some cases, hypochondriasis responds well to antipsychotics, particularly the newer
atypical antipsychotic medication.
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 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.
A persistent preoccupation with a presumed deformity or disfigurement.
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.
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 or any of the mood disorders.
The DSM-IV defines hypochondriasis according to the following criteria:
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 and is not restricted to a circumscribed
concern about appearance.
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".
Cause Hypochondria is currently considered a psychosomatic
disorder, as in a mental illness with physical symptoms.
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 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.
Overly protective caregivers and an excessive focus on minor health concerns have been implicated
as a potential cause of hypochondriasis development.
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.
Other studies have shown that the first degree relatives of patients with OCD have a higher
than expected frequency of a somatoform disorder.
Treatment 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 and selective
serotonin reuptake inhibitors are effective treatment options for hypochondriasis as demonstrated
in clinical trials.
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.
Etymology The hypochondrium is the upper part of the
abdomen inferior to the lowest ribs of the thorax.
The word derives from the Greek term ὑποχονδρος hupochondros, meaning abdomen, or literally
"under cartilage".
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 Cyberchondria
Mithridatism Münchausen syndrome
Nocebo Psychosomatic medicine
Sickness behavior Somatoform disorder
Somatopsychic Somatosensory amplification
Medical students' disease Man flu
Valetudinarian The Imaginary Invalid
References
External links Hypochondriasis at DMOZ