hypochondriasis

Hypochondriasis 

Definition

Hypochondriasis is a mental disorder characterized by excessive fear of or preoccupation with a serious illness, despite medical testing and reassurance to the contrary. It was formerly called hypochondriacal neurosis.

Description

Although hypochondriasis is often considered a disorder that primarily affects adults, it is now increasingly recognized in children and adolescents. In addition, hypochondriasis may develop in elderly people without previous histories of health-related fears. The disorder accounts for about 5% of psychiatric patients and is equally common in men and women.

Causes and symptoms

The causes of hypochondriasis are not precisely known. Children may have physical symptoms that resemble or mimic those of other family members. In adults, hypochondriasis may sometimes reflect a self-centered character structure or a wish to be taken care of by others; it may also have been copied from a parent's behavior. In elderly people, hypochondriasis may be associated with depression or grief. It may also involve biologically based hypersensitivity to internal stimuli.

Most hypochondriacs are worried about being physically sick, although some express fear of insanity. The symptoms reported can range from general descriptions of a specific illness to unusual complaints. In many instances the symptoms reflect intensified awareness of ordinary body functions, such as heartbeat, breathing, or stomach noises. It is important to understand that a hypochondriac's symptoms are not "in the head" in the sense of being delusional. The symptoms are real, but the patient misinterprets bodily functions and attributes them to a serious or even lethal cause.

Diagnosis

The diagnosis is often complicated by the patient's detailed understanding of symptoms and medical terminology from previous contacts with doctors. If a new doctor suspects hypochondriasis, he or she will usually order a complete medical workup in order to rule out physical disease.

Psychological evaluation is also necessary to rule out other disorders that involve feelings of anxiety or complaints of physical illness. These disorders include depression, panic disorder, and schizophrenia with somatic (physical) delusions. The following features are characteristic of hypochondriasis:

• The patient is not psychotic (out of touch with reality or hallucinating).
• The patient gets upset or blames the doctor when told there is "nothing wrong," or that there is a psychological basis for the problem.
• There is a correlation between episodes of hypochondriacal behavior and stressful periods in the patient's life.
• The behavior has lasted at least six months.

Evaluation of children and adolescents with hypochondriasis should include the possibility of abuse by family members.

Treatment

The goal of therapy is to help the patient (and family) live with the symptoms and to modify thinking and behavior that reinforces hypochondriacal symptoms. This treatment orientation is called supportive, as distinct from insight-oriented, because hypochondriacs usually resist psychological interpretations of their symptoms. Supportive treatment may include medications to relieve anxiety. Some clinicians look carefully for "masked" depression and treat with antidepressants.

Follow-up care includes regular physical check-ups, because about 30% of patients with hypochondriasis will eventually develop a serious physical illness. The physician also tries to prevent unnecessary medical testing and "doctor shopping" on the patient's part.

Prognosis

From 33-50% of patients with hypochondriasis can expect significant improvement from the current methods of treatment.

Resources

Books

Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis and Treatment, 1998, edited by Stephen McPhee, et al., 37th ed. Stamford: Appleton & Lange, 1997.

Key terms

Somatoform disorder — A category of psychiatric disorder characterized by conversion of emotional distress into physical symptoms or by symptoms of physical illness that have no discernible organic cause. Hypochondriasis is classified as a somatoform disorder.

Supportive therapy — Any form of treatment intended to relieve symptoms or help the patient live with them rather than attempt changes in character structure.

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hypochondriasis /hy·po·chon·dri·a·sis/ (-kon-dri´ah-sis) a somatoform disorder characterized by a preoccupation with bodily functions and the interpretation of normal sensations or minor abnormalities as indications of serious problems needing medical attention.hypochon´driachypochondri´acal

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hy·po·chon·dri·a·sis (hp-kn-dr-ss)

n. pl. hy·po·chon·dri·a·ses (-sz)

See hypochondria.

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hypochondriasis

[hī′pōkəndrī′əsis]

Etymology: Gk, hypo + chondros, cartilage, osis, condition

a chronic abnormal concern about the health of the body. It is characterized by extreme anxiety, depression, and an unrealistic interpretation of real or imagined physical symptoms as indications of a serious illness or disease despite rational medical evidence that no disorder is present. The condition is caused by some unresolved intrapsychic conflict and may involve a specific organ, such as the heart, lungs, or eyes, or several body systems at various times or simultaneously. In severe cases the distorted body-mind relationship is so strong that actual symptoms and disease may develop. Treatment usually consists of psychotherapy to uncover the underlying emotional conflict. Also called hypochondria.

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hypochondriasis (hī´pōkondrī´-sis),

n See hypochondria.

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hypochondriasis

Hypochondria Psychiatry An exaggerated concern of diseases or medical disorders that can result in psychosomatic Sx; excessive concern for perceived bodily Sx despite assurance that such concern is unfounded. See Medical school syndrome.