Hypochondria

Defining Hypochondriasis

Hypochondriasis is defined as an excessive fear of having a serious disease even when a medical examination finds no evidence of a disease. People with with this disorder are often able to acknowledge that their fears are unrealistic, but intellectual realization alone is not enough to reduce their anxiety. In order to qualify for this diagnosis of the patient must have a  preoccupation with fear of disease that causes a great deal of distress, to the point that it  interferes with a person's ability to perform important activities, such as work, school activities, or family and social responsibilities. Hypochondriasis is included in the category of somatoform disorders, though some experts feel it shares many of the same features as obsessive-compulsive and panic disorders, and might be more appropriately classified with the anxiety disorders. Somatoform disorders, like hypochondriasis and body dysmorphic disorder, center on the perception that something is wrong with the patients body, even though from an external objective view, there are no abnormalities present.

Diagnostic Criteria

For a clinical diagnosis, the following six symptoms must occur:

  • A preoccupation with the idea that one has a serious disease, based on the person's misinterpretation of bodily symptoms.
  • This preoccupation continues, even after medical evaluations come back with the doctor's assurance that the results are negative.
  • The mistaken belief doesn't focus on appearance and is not delusional in intensity. In other words, the person recognizes that the belief is irrational.
  • The duration has been at least 6 months.
  • The preoccupation can't be better explained by another diagnosis, such as Generalized Anxiety Disorder, Panic Disorder, Separation Anxiety, or another of the Somatoform Disorders.

The belief may be intensified when the person is reading about, or hearing described, symptoms that someone else has experienced. This is actually very common in the internet age, as patients seek out information about an illness, and find a well-spring of information available. They then rush to the doctor, insisting they have this illness. What differentiates the person who has symptoms that are real, but may be misinterpreted and the person with hypochondriasis is that the former can be shown the results and will see they were wrong. The later can not do that. Even in the face of clinical evidence, they will insist.

Another symptom the medical staff can watch for are vague or inappropriately applied terms, for instance "painful veins" or a "tired heart". These indicate that the patient has some knowledge of the symptom, but doesn't understand how they would really present. The "painful veins" for instance, would not be possible: there are no nerves in the blood vessel that would cause pain.


Causes

There are two general theories about the development of hypochondriasis:

The first theory suggests that people with hypochondriasis are simply very sensitive to physical sensations. They are more likely than most people to pay close attention to sensations within their bodies, which intensifies their experience of these feelings. While many people fail to notice minor discomfort as they go about their regular activities, the individual with hypochondriasis pays constant attention to inner sensations and becomes alarmed when these sensations vary in any way. This heightened scrutiny may actually increase the intensity of the sensations, and the intensity of the experience fuels fears that the sensations signal an underlying illness. Once the fears are aroused, preoccupation with the symptom increases, further enhancing the intensity of sensations. The tendency to amplify may be either temporary or chronic; it may also be influenced by situational factors, which helps to explain why hypochondriacal fears are made worse by stress or by events that appear to justify concerns about illness. Some researchers have observed that heightened sensitivity to internal sensations is also a feature of panic disorder, and have suggested that there may be an overlap between the two disorders.For this reason, clinicians may treat the patient for both the hypochondriasis as well as anxiety disorders.

The second theory points to the centrality of dysfunctional thinking in hypochondriasis. According to this theory, the internal physical sensations of the person with hypochondriasis are not necessarily more intense than those of most people. Instead, people with hypochondriasis are prone to make catastrophic misinterpretations of their physical symptoms. They are pessimistic about the state of their physical health, and overestimate their chances of falling ill. Hypochondriasis thus represents a cognitive bias; whereas most people assume they are healthy unless there is clear evidence of disease, the person with hypochondriasis assumes he or she is sick unless given a clean bill of health. Interestingly, research suggests that people with hypochondriasis make more realistic estimations of their risk of disease than most people, and in fact underestimate their risk of illness. Most people simply underestimate their risk even more. Some studies indicate that people with hypochondriasis are more likely to have suffered frequent or serious illnesses as children, which may explain the development of a negative cognitive bias in interpreting physical sensations or symptoms.

There doesn't appear to be any physiological basis for the disorder. It isn't  linked to any brain abnormalities and there is no indication of genetic influence. The disorder, looked at on it's own, appears to be one that is strictly cognitive in nature.


Treatment

Hypochondriasis occurs in about 4-8% of the general population, with men and women being equally affected by it. It used to be that only adults would be diagnosed with it, but several years ago it was recognized that children and teens were also presenting with symptoms, so there is no longer an age requirement.

Treatment can be straightforward, but takes time. Because there is no physical issue to treat, the most effective treatment has been found to be cognitive behavioral therapy. Cognitive behavioral therapy focuses on changing the thought habits of the patient, through group and one on one therapy sessions. The sessions often examine recent life changes or events that occurred prior to symptoms developing. From there the person can use journalling techniques to help identify triggers and chart progress. Sessions can also include recognizing how the body feels, and identifying possible reasons other that medical problems that might be causing those feelings.

In some cases, medication may be used. Because up to 88% of patients with hypochondriasis are diagnosed with another psychiatric issue, like depression or anxiety, the use of medications to treat those issues has shown to decrease the symptoms of both.

No matter which method you use, it is important to stay with it throughout treatment. It typically takes time for the habits of the mind to change permanently so following through on the treatment regimen is vital to successfully overcoming this problem.

Comments 2 comments

deepa 5 years ago

Thanks for the awesome post. I liked it a lot. Great work, keep it up.


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MrsBkay 4 years ago from Southern California Desert

I actually own the DSM! Hypochondria can be difficult to diagnose because the person may be experiencing other symptoms due to stress and other factors. When lay people read the DSM they read, say okay, you have ... this. But remember, it is only a guideline and made for professionals who are extensively taught to use it, so be careful what you do with this information. And it's only a book. Homosexuality was a mental illness in this same manual until 1973 or 1986, depending on your view.

Great article with lots of resources!

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