Hypochondriasis

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ICD9 = | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D006998 Hypochondriasis (or hypochondria, sometimes referred to as health anxiety/health phobia) refers to an excessive preoccupation or worry about having a serious illness. Often, hypochondria persists even after a physician has evaluated a person and reassured him/her that his/her concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, the concerns are far in excess of what is appropriate for the level of disease. Many people suffering from this disorder focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. The DSM-IV-TR defines this disorder, “Hypochondriasis,” as a somatoform disorder American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised, Washington, DC, APA, 2000. and one study has shown it to affect about 3% of the population.Hypochondria is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or un-lasting. Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends. Some hypochondriacal individuals are completely avoidant of any reminder of illness, whereas others are frequent visitors of doctors’ offices. Other hypochondriacs will never speak about their terror, convinced that their fear of having a serious illness will not be taken seriously by those in whom they confide.

Etymology and colloquial use

The term hypochondria comes from the Greek hypo- (below) and chondros (cartilage - of the breast bone), and is thought to have been originally coined by Hippocrates. It was thought by many Greek physicians of antiquity that many ailments were caused by the movement of the spleen, an organ located near the hypochondrium (the upper region of the abdomen just below the ribs on either side of the epigastrium). Later use in the 19th Century employed the term to mean, “illness without a specific cause,” and it is thought that around that time period the term evolved to be the male counterpart to female hysteria. In modern usage, the term hypochondriac is often used as a pejorative label for individuals who hold the belief that they have a serious illness despite repeated reassurance from physicians that they are perfectly healthy.

Manifestation and comorbidity

Hypochondriasis manifests in various ways. Some people have numerous intrusive thoughts and physical sensations that push them to check with family, friends and physicians. Other people are so afraid of any reminder of illness that they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Yet, some others live in despair and depression, certain that they have a life-threatening disease and no physician can help them, considering the disease as a punishment for past misdeeds. Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616. Hypochondriasis is often accompanied by other psychological disorders. Clinical depression, obsessive-compulsive disorder (also known as OCD), phobias and somatization disorder are the most common accompanying conditions in people with hypochondriasis, as well as a generalized anxiety disorder diagnosis at some point in their life. Barsky AJ: Hypochondriasis and obsessive-compulsive disorder. Psychiatr Clin North Am 1992; 15:791-801. Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of obsessive-compulsive disorder. However, while people with hypochondriasis are afraid of having an illness, patients with OCD worry about getting an illness or of transmitting an illness to others. Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616. Although some people might have both, these are distinct conditions. Patients with hypochondriasis often are not aware that depression and anxiety produce their own physical symptoms that might be mistaken for signs of a serious medical disease. For example, people with depression often experience changes in appetite and weight fluctuation, fatigue, decreased interest in sex and motivation in life overall. Intense anxiety is associated with rapid heart beat, palpitations, sweating, muscle tension, stomach discomfort, and numbness or tingling in certain parts of the body (hands, forehead, etc.).

Factors contributing to hypochondria

Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the internet. The media and the internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis (some of the common diseases hypochondriacs think they have) often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease. A simple suggestion of mental illness can often trigger one with hypochondria to obsess over the possibility.It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms. A majority of people who experience physical pains or anxieties over non-existent ailments are not actually "faking it", but rather, experience the natural results of other emotional issues, such as very high amounts of stress. Our emotions have cognitive, physiological and feeling components. For example, when one is sad, an individual may simultaneously experience muscle weakness and loss of energy. Whether it is an emotional memory, a vivid fantasy, or a present situation, the brain treats it the same. It is a real experience processed through neural paths.Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616. Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder). Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BAM, Grados, MA, Nestadt G: The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry 2000, 48:287-293. Many people with hypochondriasis point out a pattern of paying close attention to bodily sensations, preventative investigations, and checking with physicians, that they have learned from family members, but there is no definitive scientific support for this notion. Many people are aware that anxiety and depression are mediated by problems with brain chemicals such as serotonin and norepinephrine. The physical symptoms that people with anxiety or depression feel are indeed real bodily symptoms, and are in fact triggered by neurochemical changes. For example, too much norepinephrine will result in severe panic attacks with symptoms of increased heart rate and sweating, shortness of breath, and fear. Too little serotonin can result in severe depression, accompanied by an inability to sleep, severe fatigue, and needs fixing.

Treatment

To treat hypochondriasis, one must acknowledge the interplay of body and mind. If a person is sick with a medical disease such as diabetes or arthritis, there will often be psychological consequences, such as depression. Some even report being suicidal. In the same way, someone with psychological issues such as depression or anxiety will sometimes experience physical manifestations of these affective fluctuations, often in the form of medically unexplained symptoms. Common symptoms include headaches, abdominal, back, joint, rectal, or urinary pain, nausea,itching, diarrhea, dizziness, or balance problems. Many people with hypochondriasis accompanied by medically unexplained symptoms feel they are not understood by their physicians, and are frustrated by their doctors’ repeated failure to provide symptom relief. Common to the different approaches to the treatment of hypochondriasis is the effort to help each patient find a better way to overcome the way his/her medically unexplained symptoms and illness concerns rule her/his life. Current research makes clear that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy. For a long time, hypochondriasis was considered untreatable. However, recent scientific studies show that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs, e.g., fluoxetine and paroxetine) are effective treatment options for hypochondriasis as demonstrated in clinical trials Barsky AJ, Ahern DK: Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004; 291:1464-1470. Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell M, Ludgate J, Ahmand S, Richards HC, Gelder M: Two psychological treatments for hypochondriasis, a randomized controlled trial. Br J Psychiatry 1998; 173:218-225. Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz D, Liebowitz MR: The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 1996; 32:607-611. Fallon BA, Qureshi AI, Schneiner FR, Sanchez-Lacay A, Vermes D, Feinstein R, Connelly J, Liebowitz MR: An open trial of fluvoxamine for hypochondriasis. Psychosomatics 2003; 44:298-303. Greeven A, Van Balkom AJ, Visser S, Merkelbach JW, Van Rood YR, Van Dyck R, Van der Does AJ, Zitman FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007; 164:91-99.. CBT, a psycho-educational "talk" therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is found helpful in reducing the intensity and frequency of troubling bodily symptoms. SSRIs can reduce obsessional worry through readjusting neurotransmitter levels, have been shown to be effective as treatments for anxiety and depression, as well as for hypochondriasis.NIH-funded studies are now underway to compare different treatment approaches for hypochondriasis: a study in the NYC area and a study in the Boston area. In these studies, patients will be given one of four treatments: supportive therapy with fluoxetine, supportive therapy with placebo, cognitive behavior therapy, or cognitive behavior therapy with fluoxetine. For more information you can also visit external links. In Norway a clinic specializing in the treatment of hypochondria has been opened.

Tips for hypochondriacs

If one is worried about having a serious medical illness despite receiving reassurance to the contrary by a physician during a comprehensive evaluation, it might be beneficial to put these techniques into practice:

Keeping a journal describing symptoms or events that led to your episodes of illness should allow one to see the illness more clearly.

Trying to restrict or put a time limit on one's internet medical research, reading of medical books, or self-checking behaviors, as they tend to increase illness worries.

Maintaining a healthy lifestyle, including a good night sleep, well-balanced diet and a positive outlook. A good tip is to follow the PEAS tool sometimes used to combat depression: Pleasure, Exercise, Achievement and Socializing - try to add an aspect of each to daily activities.

Practicing relaxation techniques, such as breathing, meditation or other methods may help to decrease anxiety and the effects of stress.

Trying to interrupt one's worries with activities that will fully engage one's attention and shift it away from illness; for example, hobbies, word or number games, exercise or walking, talking with a humorous friend, or recalling happy memories.

Thinking about alternative explanations for one's physical sensations that might include stress or normal bodily changes.

Cultural references

(1960) In the film The Little Shop of Horrors, Seymour's mother is a hypochondriac to the extent that Seymour is unfamiliar with foods with no medicinal purpose; presumably all the food his mother had prepared was some form of a cure.

(1986) In the hit film Ferris Buellers Day Off, Ferris friend Cameron Frye (portrayed by Alan Ruck) was displaying some symptoms of hypochondria throughout the movie, notably when he is lying in bed thinking he is sick, until Ferris convinces him that it's all in his head.

(1986) In the book It, Eddie Kaspbrak's mother is a hypochondriac who convinces her son that he is frail and has asthma, even though he does not. She even argues with doctors regarding her son's health.

(1991) In the film My Girl the leading character Vada is a hypochondriac most likely due to her being raised in a funeral home.

(2000) In the TV series, Boy Meets World Cory is diagnosed with hypochondria and sees it as a real illness. (Episode "I'm Gonna Be Like You, Dad", season 7)

(2001) In the film Le Fabuleux Destin dAmélie Poulain (The Fabulous Life of Amélie Poulain), Isabelle Nantys character Georgette is a hypochondriac.

(2001) In the film, Bandits, one of the bank robbers (portrayed by Billy Bob Thornton), Terry, is a hypochondriac. The other bank robber, Joe, used this to an advantage once, and claimed that his brother received a brain tumor from smelling burning feathers as a joke to get Terry to worry.

(2003) In the TV series, Scrubs, recurring character Harvey Korman, portrayed by actor Richard Kind, is a hypochondriac that appears in several episodes. His most notable appearance being in the episode, "My New Old Friend".

(2005) In the 2005 DreamWorks Animation film Madagascar, a giraffe (Melman) is portrayed as a hypochondriac.

(2005) On the show South Park, Stan Marsh's father, Randy Marsh, is described by his son as a hypochondriac in the episode "Bloody Mary".

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