Hypochondriasis: Difference between revisions

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== Prevalence    ==
== Prevalence    ==
The prevalence of IAD is mainly unclear because this diagnosis is new. However, in the general population, the estimated prevalence of IAD is 0.1%, whereas in the medical outpatient setting, it is approximately 0.75 percent. Adolescents without a gender majority are prone to IAD, which usually gets worse with age. Less educated and unemployed people are more likely to suffer from IAD.<ref name=":0" /><ref>Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015 Sep;17(3):327-35.</ref>
The prevalence of IAD is mainly unclear because this diagnosis is new. However, in the general population, the estimated prevalence of IAD is 0.1%, whereas in the medical outpatient setting, it is approximately 0.75 percent. Adolescents without a gender majority are prone to IAD, which usually gets worse with age. Less educated and unemployed people are more likely to suffer from IAD.<ref name=":0" /><ref>Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015 Sep;17(3):327-35.</ref>
== Aetiology  ==


== Clinical Presentation  ==
== Clinical Presentation  ==


• Excessive worry or fear over having or getting a serious illness for at least six months<ref name="(1)">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</ref>[[Image:Laptop.jpg|right|300x250px]]
* Patients continue to have a significant crippling concern and anxiety about an underlying dangerous medical illness, despite a normal physical examination, laboratory testing, and repeated reassurance
 
* Even if another medical condition is present, the worry with their health is plainly excessive and disproportionate to the severity of the problem
• Persons concern of mild or non-symptoms are out of proportion<ref name="(1)" />
* Patient is dissatisfied with negative assessments and consult many physicians for the same medical concern
 
* Patients may also indicate that they inspect their bodies frequently for skin blemishes, hair loss, or physical abnormalities
• Misinterpreting normal body symptoms<ref name="(2)" />
* They may also obsess with death and disability
* They may have concerns about their health, including the possibility that their social and occupational functioning will be considerably hampered


• Persistent fear of illness despite reassurance of health status by health care providers<ref name="(2)" />
NOTE:


• Frequently scheduling doctor appointments for reassurance or avoiding medical care due to fear of being diagnosed<ref name="(3)">[Internet]. 2016 [cited 8 April 2016]. Available from: ) http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064</ref>
* People suffering from illness anxiety disorder frequently seek initial assistance from their primary care provider rather than a mental health care professional.
* Most patients with IAD are in this two groups:


• High Level of anxiety over personal health status<ref name="(1)" />
# A care-seeking type. These patients often use the health-care system and change doctors. They may request a number of studies and therapies.
# A care-avoidant type. These patients avoid seeking medical attention. They are terrified that the primary doctor or laboratory testing would disclose a life-threatening illness.


• Repeatedly checking body for signs of illness<ref name="(3)" />


• Avoiding people, places or activities for fear of health risks<ref name="(3)" />  
<ref name=":0" /><ref>Almalki M, Al-Tawayjri I, Al-Anazi A, Mahmoud S, Al-Mohrej A. A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System. Case Rep Psychiatry. 2016;2016:6073598.</ref><ref>French JH, Hameed S. Illness Anxiety Disorder. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.</ref>
 
• Overly excessive worry about a specific disease/illness because it runs in the family<ref name="(3)" />  
 
• Frequently searching the Internet for causes/symptoms of possible severe illness<ref name="(3)" />  
 
• Difficulty maintaining a job, keeping relationships, and performing daily activities due to anxiety and distress<ref name="(2)" />


== Associated Co-morbidities  ==
== Associated Co-morbidities  ==


Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.<ref name="(2)" /><br>  
* Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.<ref name="(2)" />
 
* Substance abuse and dependence is also common among this population.<ref name="(5)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall</ref>
Substance abuse and dependence is also common among this population.<ref name="(5)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall</ref>  
* 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.<ref name="(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.<ref name="(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)<ref name="(3)" /><ref name="(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.&nbsp; The patient can report these symptoms as well.&nbsp; It is important to note the frequency, duration, and severity of the symptoms.<ref name="(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.<ref name="(6)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-clinical</ref>
 
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.<ref name="(7)">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</ref>
*The preoccupation of illness lasts up to or more than six months.&nbsp; The medical condition in question may change during this time.<ref name="(7)" />
*Becoming easily worried about your health.<ref name="(7)" />
*Lack of physical symptoms. If physical symptoms are present they are mild.<ref name="(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.<ref name="(6)" /><ref name="(7)" />
*Excessive preoccupation of a current medical condition, or of a family history of a condition to the point of significant distress or impairment.<ref name="(6)" /><ref name="(7)" />
*The excessive preoccupation can not be better explained by other mental disorders.<ref name="(7)" />
 
== Etiology/Causes  ==
 
True cause is unknown, but several factors may increase the risk of developing disease including:
 
 
• Major life stress event<ref name="(1)" />[[Image:Stress.jpg|right]]
 
 
• History of abuse or neglect as a child<ref name="(1)" />
 
• History of childhood illness<ref name="(1)" />
 
• Family history of hypochondriasis or anxiety issues<ref name="(3)" />
 
• Disturbance in perception that magnifies normal sensations<ref name="(3)" />
 
• Having another mental disorder (e.g. major depression, obsessive compulsive disorder, psychotic disorders)<ref name="(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.<ref name="(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.<ref name="(1)" /> Typically patients complain of pain in the trunk, head, and neck.<ref name="(2)" />


== Medical Management  ==
== Medical Management  ==


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.<ref name="(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. [[Image:Doctor patient.png|right|175x125px]]  
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.<ref name="(1)">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</ref> 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. [[Image:Doctor patient.png|right|175x125px]]  


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.<ref name="(3)" />  
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.<ref name="(3)">[Internet]. 2016 [cited 8 April 2016]. Available from: ) http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064</ref>  


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.<ref name="(2)" />  
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.<ref name="(2)" />  

Revision as of 22:24, 19 November 2023

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Michael Fauser, Patrick Bailey, David Olukayode, Elaine Lonnemann, WikiSysop, Simisola Ajeyalemi and Rujuta Naik

Introduction[edit | edit source]

Illness anxiety disorder (formerly known as hypochondriasis, a name that has been updated in the DSM-5[1] due to its negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition.[2] 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.[3] Illness anxiety disorder (IAD) is characterised by ongoing worry or fear of getting a significant medical condition that would negatively impact one's daily activities. Despite normal physical examination findings and laboratory test results, the fear persists.[4] People with IAD overreact to normal physical sensations (such as digestion or sweating) and misunderstand these sensations as symptoms of serious disease. IAD is often a long-term condition.[2]

Prevalence[edit | edit source]

The prevalence of IAD is mainly unclear because this diagnosis is new. However, in the general population, the estimated prevalence of IAD is 0.1%, whereas in the medical outpatient setting, it is approximately 0.75 percent. Adolescents without a gender majority are prone to IAD, which usually gets worse with age. Less educated and unemployed people are more likely to suffer from IAD.[2][5]

Aetiology[edit | edit source]

Clinical Presentation[edit | edit source]

  • Patients continue to have a significant crippling concern and anxiety about an underlying dangerous medical illness, despite a normal physical examination, laboratory testing, and repeated reassurance
  • Even if another medical condition is present, the worry with their health is plainly excessive and disproportionate to the severity of the problem
  • Patient is dissatisfied with negative assessments and consult many physicians for the same medical concern
  • Patients may also indicate that they inspect their bodies frequently for skin blemishes, hair loss, or physical abnormalities
  • They may also obsess with death and disability
  • They may have concerns about their health, including the possibility that their social and occupational functioning will be considerably hampered

NOTE:

  • People suffering from illness anxiety disorder frequently seek initial assistance from their primary care provider rather than a mental health care professional.
  • Most patients with IAD are in this two groups:
  1. A care-seeking type. These patients often use the health-care system and change doctors. They may request a number of studies and therapies.
  2. A care-avoidant type. These patients avoid seeking medical attention. They are terrified that the primary doctor or laboratory testing would disclose a life-threatening illness.


[2][6][7]

Associated Co-morbidities[edit | edit source]

  • Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.[3]
  • Substance abuse and dependence is also common among this population.[8]
  • 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.[8]

Medical Management[edit | edit source]

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.[9] 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.

Doctor patient.png

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.[10]

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.[3]

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.[3]

It is recommended that individuals avoid alcohol and any recreational drugs, as well as limiting reading any medical books and websites.[10]

Physiotherapy Management[edit | edit source]

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.[10][11]

Differential Diagnosis[edit | edit source]

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[edit | edit source]

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

References[edit | edit source]

  1. ↑ Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8.
  2. ↑ 2.0 2.1 2.2 2.3 Newby JM, Hobbs MJ, Mahoney AEJ, Wong SK, Andrews G. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res. 2017;101(5):31-37.
  3. ↑ 3.0 3.1 3.2 3.3 Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis
  4. ↑ Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407.
  5. ↑ Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015 Sep;17(3):327-35.
  6. ↑ Almalki M, Al-Tawayjri I, Al-Anazi A, Mahmoud S, Al-Mohrej A. A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System. Case Rep Psychiatry. 2016;2016:6073598.
  7. ↑ French JH, Hameed S. Illness Anxiety Disorder. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  8. ↑ 8.0 8.1 Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall
  9. ↑ 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
  10. ↑ 10.0 10.1 10.2 [Internet]. 2016 [cited 8 April 2016]. Available from: ) http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064
  11. ↑ [Internet]. 2016 [cited 11 April 2016]. Available from: http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf
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