Hypochondriasis: Difference between revisions

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== Introduction  ==
== Introduction  ==


Illness anxiety disorder (formerly known as hypochondriasis, a name that has been updated in the DSM-5<ref>Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8.</ref> due to its negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition.<ref name=":0">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.</ref> 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.<ref name="(2)">Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis</ref> 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.<ref>Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407.</ref> 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.<ref name=":0" />
Illness anxiety disorder (formerly known as hypochondriasis, a name that has been updated in the DSM-5<ref>Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8.</ref> due to its negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition.<ref name=":0">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.</ref> 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.<ref name="(2)">Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis</ref> 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.<ref name=":1">Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407.</ref> 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.<ref name=":0" />


== Prevalence    ==
== Prevalence    ==
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<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>
<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 name=":2">French JH, Hameed S. Illness Anxiety Disorder. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.</ref>


== Associated Co-morbidities  ==
== Associated Co-morbidities  ==
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* 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)" />


== Medical Management  ==
== Treatment/Management  ==
[[Image:Doctor patient.png|right|175x125px]]It is essential to note that psychotherapy is the first-line treatment of IAD, while pharmacological drugs are second-line.<ref name=":0" /><ref name=":1" />However, The majority of patients require both psychotherapy and pharmacological treatment.<ref name=":2" />


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]]
* Cognitive-behavioral therapy (CBT) is a type of psychotherapy that involves behavioural modification strategies to cure the patient's dysfunctional maladaptive cognitive beliefs. It may address the patient's habit of excessively monitoring his or her body for indicators of sickness. CBT also includes instruction on common bodily feelings and their variations.<ref name=":0" />
* Acceptance and commitment therapy, group therapy, and mindfulness-based cognitive therapy may also be used.<ref name=":2" />


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>  
* Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be beneficial in this condition.<ref name=":1" />


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)" />
Some other things to note:


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.<ref name="(2)" />  
# Primary care providers should strive to build rapport and a therapeutic relationship with their patients so that they feel at ease addressing their health concerns.
# Patients' concerns and fears must be acknowledged.
# If necessary, the patient may be referred to other healthcare specialists.
 
<ref name=":0" /><ref name=":2" />


It is recommended that individuals avoid alcohol and any recreational drugs, as well as limiting reading any medical books and websites.<ref name="(3)" />
== Physiotherapy Management  ==
== Physiotherapy Management  ==


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.<ref name="(3)" /><ref name="(8)">[Internet]. 2016 [cited 11 April 2016]. Available from: http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf</ref>
Current evidence on Physical Therapy Management of hypochondriasis is limited. However, there has been a growing amount of research in the field of exercise-based and somatic therapies for the treatment of anxiety disorders in recent years.<ref>KOVAČ AM, UMEK DP, KRESAL DF. The role of physiotherapy in the treatment of anxiety disorders.</ref> Some of these are:
 
* Movement therapy, particularly aerobic exercise and strength training, appears promise because it has been shown to have anxiolytic benefits.  
* Scandinavian physiotherapists have developed approaches for treating mental health illnesses such as Basic Body Awareness Therapy (BBAT) and Norwegian Psychomotor Therapy (NPMT). Both approaches aim to enhance the body-mind connection and help patients acquire physical and psychological flexibility and strength.
* Passive treatments, on the other hand, such as manual therapy, have only been proved to be useful in the short term.


== Differential Diagnosis  ==
== Differential Diagnosis  ==

Revision as of 21:01, 21 November 2023

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

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

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]

Treatment/Management[edit | edit source]

Doctor patient.png

It is essential to note that psychotherapy is the first-line treatment of IAD, while pharmacological drugs are second-line.[2][4]However, The majority of patients require both psychotherapy and pharmacological treatment.[7]

  • Cognitive-behavioral therapy (CBT) is a type of psychotherapy that involves behavioural modification strategies to cure the patient's dysfunctional maladaptive cognitive beliefs. It may address the patient's habit of excessively monitoring his or her body for indicators of sickness. CBT also includes instruction on common bodily feelings and their variations.[2]
  • Acceptance and commitment therapy, group therapy, and mindfulness-based cognitive therapy may also be used.[7]
  • Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be beneficial in this condition.[4]

Some other things to note:

  1. Primary care providers should strive to build rapport and a therapeutic relationship with their patients so that they feel at ease addressing their health concerns.
  2. Patients' concerns and fears must be acknowledged.
  3. If necessary, the patient may be referred to other healthcare specialists.

[2][7]

Physiotherapy Management[edit | edit source]

Current evidence on Physical Therapy Management of hypochondriasis is limited. However, there has been a growing amount of research in the field of exercise-based and somatic therapies for the treatment of anxiety disorders in recent years.[9] Some of these are:

  • Movement therapy, particularly aerobic exercise and strength training, appears promise because it has been shown to have anxiolytic benefits.
  • Scandinavian physiotherapists have developed approaches for treating mental health illnesses such as Basic Body Awareness Therapy (BBAT) and Norwegian Psychomotor Therapy (NPMT). Both approaches aim to enhance the body-mind connection and help patients acquire physical and psychological flexibility and strength.
  • Passive treatments, on the other hand, such as manual therapy, have only been proved to be useful in the short term.

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 2.4 2.5 2.6 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 Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis
  4. ↑ 4.0 4.1 4.2 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. ↑ 7.0 7.1 7.2 7.3 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. ↑ KOVAČ AM, UMEK DP, KRESAL DF. The role of physiotherapy in the treatment of anxiety disorders.
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