Treating a hypochondriac

People who have gone through nursing or medical school have experienced the feeling that they have contracted each ailment as it is studied. And many have friends or relatives who, for want of attention, seem to be always “coming down” with something serious. It is easy to label such people as hypochondriacs, but in truth hypochondria is a real and serious ailment.

Basically, hypochondria is the belief that sundry symptoms are the result of a dire illness, when there is no evidence to support the claim. Out of this belief, the person can develop symptoms which are very real to the person, called psychosomatic (originating in the mind) symptoms. The person becomes even more ill with worry. This cycle is out of the control of the person suffering, and can affect both men and women in equal proportions. After seeking help from friends, family or health professionals, the symptoms may subside. Yet eventually the symptoms, or a new set of symptoms, re-emerge. The person is constantly examining his or her own body, and even if he or she is aware that the fear may be unfounded, the hypochondria is too powerful to resist.

Hypochondriacs (those suffering from hypochondria) find it hard to accept a negative diagnosis, and tend to misread ordinary bodily functions. For example, a normal person would interpret a headache as a sign of tension and take some aspirin, whereas a hypochondriac will run to a hospital in the false belief that he or she is suffering from a brain tumor. Such unfounded fear can interfere with the person having a normal life. He might miss a lot of work, or she might neglect her children. This condition usually begins in early adulthood. This belief is not to be confused with people who fake or lie about their perceived symptoms; they genuinely think that they are suffering, and in fact they are. They will take the symptoms they perceive to the Internet or medical books and try to find out which disease applies to them.

Often on the Internet or in cheap newspapers, people will relate stories of being misdiagnosed with a mild disorder when they in fact had a serious but treatable situation. This only fuels a hypochondriac’s fears.

It is important for the patient and his or her friends and relatives to recognize the severity of the hypochondria. The person may not believe that he is dying, but he will believe that he is suffering from something serious. Symptoms of the disorder include:

• Thinking he has a disease after he reads about it

• Doing an inordinate amount of health research

• Regularly switching doctors when a doctor tells her there is nothing wrong, or seeking second opinions in this case

• Having a long-term intense fear that he has a serious disease or health condition

• Frequently checking vital signs (pulse, blood pressure, etc.)

• Talking with family and friends constantly about the symptoms

• Worrying that minor symptoms or simple bodily functions may indicate a serious problem

• Going to doctors frequently and submitting oneself to expensive and complex testing; this may even include exploratory surgery

• The symptoms or area of concern may change

• The person’s concern interferes with work, family or social life

• The person suffers from anxiety, depression or nervousness

The anxiety, and how a person handles it, can lead to further complications. Tests and procedures may create their own troubles, Friends, family and doctors may think that the patient is “crying wolf” and therefore miss real problems which can still occur. Invasive testing always carries with it a risk. She may become dependent on pain relievers or sedatives, or develop depression, anxiety or panic disorder. Loss of time at work due to excessive medical appointments may even cost the patient her job.

There are many suspected causes of hypochondria but nothing firm. Almost all alcoholics started with beer, but that doesn’t mean that a beer drinker will become an alcoholic. Patients with hypochondria often have a history of physical or sexual abuse. Other factors include having had a serious illness as a child, a poor ability to express emotions, the death of a loved one, being neglected as a child, knowing someone close who is suffering from a serious disease, or learning the behavior from a parent or close relative. It can’t be prevented because the symptoms have to arise before there is a suspicion of hypochondria.

Treatment for hypochondria can come from one of three fronts, and should eventually involve all three. First and foremost, if the patient himself or herself notices the similarity between the symptoms listed above and his or her own behavior, there is a good prognosis of healing the psyche. The second front is one’s family and friends. If they suspect a problem, they should approach the person and suggest seeking help. The third front is the doctor in care of the person. If the doctor just randomly or submissively calls for tests which are invasive or expensive, or if the doctor dismisses the patient as having nothing wrong, this will only aggravate the situation.

The person who suspects he or she is suffering from anxiety about illnesses that are not real can do a lot to help himself. Friends and family may make suggestions to which the person gives credence. He can avoid situations that trigger the anxiety such as self-examinations, reading disease-of-the-week stories, doctor-shopping, and avoiding drugs and alcohol. By getting active in sports, jogging, swimming or other exercise, the person can divert thinking away from himself. Or a doctor may suggest the situation. Above all, he needs to seek the proper doctor, one who will trust the patient’s suspicion and who will work with mental health professionals to help alleviate the hypochondria while keeping an eye out for real illnesses. There are also support groups he can join.

Friends and family should get involved. If the person is exhibiting symptoms of hypochondria, people close to her should sit her down for a heart-to-heart discussion, explaining why they suspect the disorder. Once the patient has acknowledged the problem, those friends and family can encourage her to seek help, and assist her in finding the right kind of help. They should also be ‘kept in the loop’ as the patient learns about the disorder and experiences progress.

The medical profession has recognized hypochondria as a real illness, and has made great inroads on the treatment of this condition. Symptom criteria are spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It usually takes both medical and mental health professionals to diagnose and treat it. The patient would probably seek a doctor first, assuming he or she is suffering from an actual illness, but sometimes this fear is confessed to a mental health professional first. The medical doctor should take the tests necessary to look for illness, and the patient should have a psychiatric evaluation. The patient needs to work with both professionals, and stay with them rather than shop for others, to avoid duplicating testing and effort.

The patient should have a regular physical exam, determining height, weight and vitals, with examination of heart, lungs and abdomen. The medical doctor will probably prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs) (fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil)), or tricyclic antidepressants such as clomipramine (Anafranil) and imipramine (Tofranil), to reduce worry and even physical symptoms. This would be needed if the patient was suffering from a mood or anxiety disorder. Rather than just hand out placebos or general sedatives, the doctor should prescribe directly for the disorder itself. Meanwhile, the doctor can regularly see the patient in order to determine any possible changes in the medication, and to keep a watch out for real problems which would occur with anyone. This supportive behavior eases anxiety in itself, and will help avoid unnecessary testing while handling real illness when it occurs. If there is a severe pain involved, pain inhibitors may be prescribed. A complete blood count (CBC) will be taken to screen for alcohol and drugs while checking on the condition of the thyroid. The intention of the opening treatment is to make the patient physically comfortable as possible and rule out other conditions which might bring on the symptoms. At the same time, any complications of the hypochondria can be isolated. The doctor will also have a series of questions to determine whether the patient does in fact have hypochondria. During this discussion period, the doctor will recommend mental health help, and find out what the patient has tried to do so far. The doctor can apprise the patient on regular questions such as how long treatment would be, what the patient can do on his own, and what treatment is involved. If available, the doctor will supply reading material for the patient to bring home.

Although the patient may feel that this is a medical problem, as noted above, the causes are psychological, and therefore it is imperative that the patient also get mental health support from a psychiatrist or psychologist. The mental health professional should have a thorough discussion with the medical doctor, then perform a psychiatric evaluation on the patient. This will include questions about thoughts, feelings and behaviors, when symptoms started, how severe they are, and how this or similar episodes have affected the patient’s daily life. Using talk therapy (psychology or Cognitive Behavior Therapy), the professional will help the patient recognize those things which seem to make the symptoms worse, and get more active, even with symptoms. Observation of the patient may include getting back to the medical doctor with suggestions about any changes in medication. Mostly, the mental health professional will help the patient learn how to cope with hypochondria, since this is usually a chronic disorder and rarely fully “cured”. A personality assessment is another tool that the professional may use to diagnose the disorder, after ruling out physical causes for the symptoms. While the main goal is to help patients learn to live and function as normally as possible, this is often difficult because the patient needs to be convinced that the symptoms are of an emotional or mental origin. Once this hurdle is passed, the patient can learn to deal in different ways with stress and improve functioning on a work or social level. If a thorough physical exam has not been done, the mental health professional will recommend it. The patient will be educated to recognize symptoms of hypochondria itself, such as obsessive research and self-examination. Sometimes counseling includes exposure therapy, wherein the patient confronts his or her health fears in a safe environment, learning how to cope with those uncomfortable sensations. Psychological counseling is the primary treatment for the disorder, so it is necessary that the patient stick to this and other treatments as a unit.

The disorder of hypochondria may never go away completely, so the person suffering from it needs to learn how to cope, how to trust support groups, medical, psychological and social, and how to recognize the difference between an hypochondriac episode and a real illness. This is quite difficult to achieve, so the person must be determined to achieve control over the disorder as he or she would with a medical illness. The person must stick to the treatment plan, taking advantage of professional and social observation, and never make a medication change on his or her own. Symptoms may recur. The person must be ready to manage and control associated symptoms and minimize functional problems.

Those people suffering from hypochondria can satisfy their desire to research by going to http://thehypochondriac.com/ where they can find information on the disorder, diagnosis and treatment.