Hypochondriasis

 

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Definition/Description

Hypochondriasis, or hypochondria, is also referred to as Illness Anxiety Disorder (IAD).[1] IAD is an overwhelming fear that you have a serious disease or life-threatening illness even though health care providers confirm to you that you have only mild symptoms or no symptoms at all.[2] IAD can also make people misinterpret normal body sensations as signs of a serious illness or generate worries in people who do have a physical illness that they are sicker than they truly are.[1] It is normally a long-term condition that can vary in severity. Severity typically increases in times of stress and with increasing age. Most common age of onset is early adulthood.[3] The excessive anxiety, not whether there is a presence or absence of illness, tends to be the most disabling.

[4]Prevalence

  • Primary Hypochondriasis- 0.8-4.5% in primary care settings
  • 10-20% of healthy individuals demonstrate different levels of preoccupation with disease
  • 45% of people without a diagnosis of a major psychiatric disorder have intermittent unsubstantiated concerns about illness

Characteristics/Clinical Presentation

• Excessive worry or fear over having or getting a serious illness for at least six months[1]
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• Persons concern of mild or non-symptoms are out of proportion[1]

• Misinterpreting normal body symptoms[2]

• Persistent fear of illness despite reassurance of health status by health care providers[2]

• Frequently scheduling doctor appointments for reassurance or avoiding medical care due to fear of being diagnosed[3]

• High Level of anxiety over personal health status[1]

• Repeatedly checking body for signs of illness[3]

• Avoiding people, places or activities for fear of health risks[3]

• Overly excessive worry about a specific disease/illness because it runs in the family[3]

• Frequently searching the Internet for causes/symptoms of possible severe illness[3]

• Difficulty maintaining a job, keeping relationships, and performing daily activities due to anxiety and distress[2]

Associated Co-morbidities

Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.[2]

Substance abuse and dependence is also common among this population.[5]

A study at a general medicine outpatient clinic demonstrated that 88% of patients with hypochondriasis also had one or more other psychiatric disorders.  These included general anxiety disorder (71%), Dysthymic disorder (45.2%), major depression (42.9%), Somatization disorder (21.4%) and panic disorder (16.7%).  This study also stated that patients are 3 times more likely to have a personality disorder than the general population.[5]

Medications

Doctors typically don’t like to use drugs to treat hypochondriasis but may prescribe medication for the anxiety aspect of the disease.

• Antidepressants – such as Selective Serotonin Reuptake Inhibitors (Sertraline, Fluoxetine, Fluvoxamine, or Paroxetine)[3][2]

Diagnostic Criteria

Diagnosis of Hypochondriasis is dependent upon presentation of symptoms and the patients behavior. These symptoms can be observed by a healthcare provider or it can be reported by people who are close to the patient such as family and friends.  The patient can report these symptoms as well.  It is important to note the frequency, duration, and severity of the symptoms.[1] Other signs to be aware of are frequent doctor's visits without significant findings, seeing multiple physicians or specialists for the same condition without significant findings, objective findings that do not match the patient's complaints, and previous losses of function that resolved spontaneously.[6]

Characteristics of Hypochondriasis, now referred to as Illness Anxiety Disorder, as described by the DSM 5 are as follows:

  • A preoccupation of having or getting a serious medical condition.[7]
  • The preoccupation of illness lasts up to or more than six months.  The medical condition in question may change during this time.[7]
  • Becoming easily worried about your health.[7]
  • Lack of physical symptoms. If physical symptoms are present they are mild.[7]
  • Excessive health related behaviors such as repeated checking for symptoms of a disease, or avoidance of medical examination due to a fear of being diagnosed with a serious condition.[6][7]
  • Excessive preoccupation of a current medical condition, or of a family history of a condition to the point of significant distress or impairment.[6][7]
  • The excessive preoccupation can not be better explained by other mental disorders.[7]

Etiology/Causes

True cause is unknown, but several factors may increase the risk of developing disease including:                                                                 

• Major life stress event[1]
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• History of abuse or neglect as a child[1]

• History of childhood illness[1]

• Family history of hypochondriasis or anxiety issues[3]

• Disturbance in perception that magnifies normal sensations[3]

• Having another mental disorder (e.g. major depression, obsessive compulsive disorder, psychotic disorders)[3]


Systemic Involvement

Though hypochondriasis is a psychological condition patients will perceive that they have a serious medical condition affecting them. Any normal bodily function or minor medical condition can be perceived as a serious medical condition by someone who presents with hypochondriasis.[3] This fear of illness can manifest in all regions and systems of the body whether symptoms of illness or dysfunction are present or not.[1]  Typically patients complain of pain in the trunk, head, and neck.[2]

Medical Management (current best evidence)  

It is recommended and ideal that the patient’s primary care provider (PCP) continues to be a vital role in the patient’s medical care. The individual should continue to see the PCP on a normal, regular basis (every three to six months) to address any ongoing concerns.[1] It is recommended that the patient should find one doctor that they are comfortable with and stick with them and not go back and forth between multiple doctors.

                                                                                                 
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Psychotherapy, in particular Cognitive Behavioral Therapy (CTB) can be helpful for those with illness anxiety disorder when dealing with health anxiety. CTB is a common type of talk therapy that helps those patients cope with the fear and anxiety that is common with IAD. It can also be an effective way to learn strategies to live a more productive lifestyle and to function independently on a day-to-day basis.[3]

Behavior stress management therapy is another resource that has been shown to be helpful in regards to learning relaxation techniques and how to handle stress and anxiety. Doctors may suggest using this in combination with Cognitive Based Therapy.[2]

It is also suggested that individuals should be physically active and have a set routine for exercise as well as to stay involved in work, social and family activities. Other possible resources that may have some benefits when trying to manage symptoms include proper nutrition, acupuncture, and massage.[2]

It is recommended that individuals avoid alcohol and any recreational drugs, as well as limiting reading any medical books and websites.[3]

Physical Therapy Management (current best evidence)

Current evidence on Physical Therapy Management of hypochondriasis is limited.  Due to the psychological nature of the disease there are often no physical symptoms that would benefit from physical therapy.  If a patient is not improving with traditional therapeutic intervention, objective findings do not match the patient's complaints, and the patient fits the diagnostic criteria for hypochondriasis a referral to their primary care physician would be appropriate. 

[3][8]Differential Diagnosis

IAD can be difficult to diagnosis. To be diagnosed, the patient needs to be able to accurately describe the symptoms that they perceive as well as help from family members or individuals close to the patient who pick up on any symptoms that the individual may not be aware of.

The following diagnoses need to be screened for when discussing hypochondriasis:

  • Briquet’s Syndrome
  • Conversion Disorder
  • Body Dysmorphic Disorder
  • Malingering and Factitious Illness
  • Depression
  • Histrionic personality disorder
  • Schizophrenia

There is always the possibility that the minor symptoms perceived do in fact indicate a serious disease. Each possible disease related to reported symptoms would need to be screened for.

Case Reports/ Case Studies

add links to case studies here (case studies should be added on new pages using the case study template)

1) Anandkumar S. Effect of Pain Neuroscience Education and dry needling on chronic elbow pain as a result of cyberchondria: a case report. Physiotherapy Theory & Practice [serial on the Internet]. (2015, Mar), [cited April 7, 2016]; 31(3): 207-213. Available from: Academic Search Complete.

http://eds.b.ebscohost.com/ehost/command/detail?vid=17&sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&hid=127&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=102076641&db=a9h


2) Hadjistavropoulos H, Hadjistavropoulos T, Quine A. Health anxiety moderates the effects of distraction versus attention to pain. Behaviour Research And Therapy [serial on the Internet]. (2000, May), [cited April 7, 2016]; 38(5): 425-438. Available from: MEDLINE

http://eds.b.ebscohost.com/ehost/command/detail?vid=19&sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&hid=127&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=10816903&db=cmedm


3) Weck F, Neng J, Richtberg S, Jakob M, Stangier U. Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial. Journal Of Consulting And Clinical Psychology [serial on the Internet]. (2015, Aug), [cited April 7, 2016]; 83(4): 665-676. Available from: PsycARTICLES.

http://eds.b.ebscohost.com/ehost/detail/detail?vid=28&sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&hid=127&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=pdh&AN=2014-55446-001

Resources

OCD Center of Los Angelas [9]

University of Maryland Medical Center

Mayo Clinic

Cleveland Clinic



References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Hypochondriasis | Center for Behavioral Health | Cleveland Clinic [Internet]. My.clevelandclinic.org. 2016 [cited 8 April 2016]. Available from: https://my.clevelandclinic.org/services/neurological_institute/center-for-behavioral-health/disease-conditions/hic-hypochondriasis
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 [Internet]. 2016 [cited 8 April 2016]. Available from: ) http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064
  4. Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#a6
  5. 5.0 5.1 Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall
  6. 6.0 6.1 6.2 Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-clinical
  7. 7.0 7.1 7.2 7.3 7.4 7.5 7.6 Illness anxiety disorder Tests and diagnosis - Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 8 April 2016]. Available from: http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/tests-diagnosis/con-20124064
  8. [Internet]. 2016 [cited 11 April 2016]. Available from: http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf
  9. Angeles O. Hypochondria / Health Anxiety - Symptoms and Treatment [Internet]. OCD Center of Los Angeles. 2016 [cited 16 April 2016]. Available from: http://ocdla.com/hypochondriasis