Hypochondriasis

 

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

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

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

Definition/Description

Hypochondriasis, or hypochondria, has recently been coined the new term 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. (3) 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. (2) The excessive anxiety, not whether there is a presence or absence of illness, tends to be the most disabling.

Prevalence

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Characteristics/Clinical Presentation

• Excessive worry or fear over having or getting a serious illness for at least six months (1)

• Persons concern of mild or non-symptoms are out of proportion (1)

• Misinterpreting normal body symptoms (3)

• Persistent fear of illness despite reassurance of health status by health care providers (3)

• Frequently scheduling doctor appointments for reassurance or avoiding medical care due to fear of being diagnosed (2)

• High Level of anxiety over personal health status (1)

• Repeatedly checking body for signs of illness (2)

• Avoiding people, places or activities for fear of health risks (2)

• Overly excessive worry about a specific disease/illness because it runs in the family (2)

• Frequently searching the Internet for causes/symptoms of possible severe illness (2)

• Difficulty maintaining a job, keeping relationships, and performing daily activities due to anxiety and distress (3)

Associated Co-morbidities

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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) (2,3)

Diagnostic Tests/Lab Tests/Lab Values

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Etiology/Causes

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

• Major life stress event (1)

• History of abuse or neglect as a child (1)

• History of childhood illness (1)

• Family history of hypochondriasis or anxiety issues (2)

• Disturbance in perception that magnifies normal sensations (2)

• Having another mental disorder (e.g. major depression, obsessive compulsive disorder, psychotic disorders) (2)

Systemic Involvement

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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.

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. (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. (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. (2)

Physical Therapy Management (current best evidence)

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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 doctor is unable to identify any underlying medical basis for the reported symptoms or only minor concerns.

According to The Diagnostic and Statistical Manual of Mental Disorders, the following points are emphasized in the diagnosis of illness anxiety disorder:

• You're preoccupied with having or getting a serious illness. • You're easily alarmed about your personal health status. • You don't have physical symptoms, or if you do, they're only mild. • If you have another medical condition or a strong family history of a medical condition, your preoccupation about this is excessive. • You perform excessive health-related behaviors, such as repeatedly checking your body for signs of disease, or you avoid medical appointments for fear of being diagnosed with a serious illness. • Your illness preoccupation has lasted for at least six months, even though the specific illness you fear may change during that time. • Your illness preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder or generalized anxiety disorder. (2)

Case Reports/ Case Studies

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Resources

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Recent Related Research (from Pubmed)

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References

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