Hypochondriasis

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

Illness anxiety disorder (formerly known as hypochondriasis, a name that has been updated in the DSM-5 due to its negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition. 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. 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. 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.

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.

Clinical Presentation

• 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.

Associated Co-morbidities

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

Treatment/Management

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

• 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.
• Acceptance and commitment therapy, group therapy, and mindfulness-based cognitive therapy may also be used.

• Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be beneficial in this condition.

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.

Physiotherapy Management

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. 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

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

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