Hypochondriasis

What Is It?

Hypochondriasis is a persistent fear of having a serious medical illness. A person with this disorder tends to interpret normal sensations, bodily functions and mild symptoms as a sign of an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be a sign of a serious disease.

A person with hypochondriasis may be especially concerned about a particular organ system, such as the cardiac or digestive system. A doctor's reassurance and even a complete medical evaluation often will not calm the person's fears. Or, if it does calm them, other worries may emerge days later.

Generally, people with this disorder do not become delusional. They may admit the possibility that their fears are exaggerated. They may, however, only accept being told they are ill, not that there is nothing wrong.

Up to 4-5 percent of patients in general medical practices may have hypochondriasis. There is a tendency to go from doctor to doctor, looking for one that will confirm the presumed illness. The patient and the doctors may become frustrated or angry. The intensive search for illnesses that cannot be found sometimes interferes with the person getting proper care if he or she develops a true medical illness.

Hypochondriasis is in some ways similar to obsessive-compulsive disorder. The person is obsessively preoccupied with thoughts of illness and feels compelled to do things (feel lumps, browse for medical information, visit the doctor) in order to quell the anxiety that results.

Some people with this disorder have had a serious illness in the past, particularly in childhood. Symptoms may become more intense after a stressful event, for example, the death of a loved one. Hypochondriasis can occur at any age, and in both men and women. Often the disorder starts in young adulthood and it can last many years.

Although being ill is uncomfortable, it can bring benefits, such as the attention and care of family members, friends and doctors, and relief from responsibilities. Sometimes, hypochondriasis is motivated by these advantages, although the individual is often not aware of that motivation.

Less often, a person is feigning illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. When someone consciously seeks such advantages, the condition is called malingering. Hypochondriasis is different from malingering. In hypochondriasis, the patient is not pretending, but believes the illness is real. He or she truly feels ill.

Symptoms

Symptoms of hypochondriasis include:

• Preoccupation with having serious illness
• Misinterpretation of body symptoms
• Persistent fear despite medical reassurance
• Absence of delusions or psychosis
• Clinical distress or functional impairment

Diagnosis

The diagnosis usually is suspected by a primary care physician and confirmed by a psychiatrist or other mental health professional. The diagnosis is based on a person's medical complaints and history, and a doctor's physical examination and laboratory tests. The disorder may be accompanied by severe anxiety symptoms or obsessive-compulsive symptoms. Fear or exaggerated concerns about medical illness also may appear as part of other mental disorders, such as the various forms of depression, schizophrenia or somatization disorder.

Expected Duration

Hypochondriasis is a chronic (long-lasting) condition that can begin at any time of life. It can last for years.

Prevention

There is no known way to prevent this disorder.

Treatment

Since people with hypochondriasis may also have depression, anxiety or psychosis, these conditions should be evaluated and treated.

The symptoms of hypochondriasis may be relieved by an antidepressant even when no other psychiatric illness is present. Experts who have noticed this disorder’s similarity to obsessive-compulsive disorder (OCD) have found that treatments for OCD — for example, serotonin specific reuptake inhibitors (SSRIs) like fluoxetine — can help.

In recent years, cognitive behavior therapy has been shown to help people with hypochondriasis. Therapists teach patients to focus less on their symptoms and talk about how stress, anxiety and depression can increase symptoms. They explain that the actions they usually take to relieve anxiety usually make things worse (feeling for lumps, reading about illness). They also teach distraction and relaxation techniques.

Hypochondriasis is so common that most good primary care physicians understand this disorder well. The medical complaints may never go away, so a regular schedule of short appointments, in which physical complaints are taken seriously, may help to contain the patient's anxiety. If a doctor attempts to limit contact with the patient by being dismissive, the patient's anxiety may get worse, or the patient will simply go to a new doctor.

Most people with the disorder are not eager to see a mental health professional, so — where possible — it helps to integrate mental health services with the medical practice.

In any event, doctors and therapists should take the physical symptoms seriously because the symptoms are real. While maintaining a serious and respectful attitude toward the medical complaints, doctors try to avoid unnecessary, intrusive, and sometimes risky medical tests and procedures, and provide support for coping with a real chronic illness.

When To Call A Professional

People with hypochondriasis tend to contact health care providers readily. However, they will not want to see mental health professionals, because they fear that people view their medical symptoms as "all in your head." However, early treatment by a mental health professional can be helpful.

Prognosis

Some patients respond well to medication, psychotherapy or both. If the person has anxiety or depression that responds to treatment with medication, the prognosis can be quite good. Otherwise, a person with hypochondriasis may be susceptible to chronic distress and problems functioning.

Additional Info

American Psychiatric Association

1400 K St., NW

Washington, DC 20005

Toll-Free: (888) 357-7924

Fax: (202) 682-6850

E-Mail: apa@psych.org

http://www.psych.org/

American Psychological Association

750 First St., NE

Washington, DC 20002-4242

Phone: (202) 336-5510

Toll-Free: (800) 374-2721

TTY: (202) 336-6123

Fax: (202) 336-5500

http://www.apa.org/

National Alliance for the Mentally Ill

Colonial Place Three

2107 Wilson Blvd.

Suite 300

Arlington, VA 22201-3042

Phone: (703) 524-7600

Toll-Free: (800) 950-6264

http://www.nami.org/

National Mental Health Association

2001 N. Beauregard St., 12th Floor

Alexandria, VA 22311

Phone: (703) 684-7722

Fax: (703) 684-5968

Toll-Free: (800) 969-6642

TTY: (800) 433-5959

http://www.nmha.org/