Hypochondria

Answer 1

Definition

Hypochondria is a belief that real or imagined physical symptoms are signs of a serious illness, despite medical reassurance and other evidence to the contrary.

Alternative Names

Hypochondriasis

Causes, incidence, and risk factors

People with hypochondria are preoccupied with their physical health. They have an unrealistic fear of serious disease that is out of proportion to the actual risk. There is no specific cause of hypochondria, and it occurs equally in men and women.

Symptoms

• Disturbance lasts for at least 6 months (24 weeks)
• Misinterpret symptoms
• No apparent physical disorder that can account for symptoms
• Persistent fear of having a serious illness with no medical reason
• Preoccupied with fear of illness
• Symptoms may shift and change
• Symptoms may be vague or specific (see somatoform pain disorder)

Those who are affected may recognize that their fear of having a serious disease is excessive, unreasonable, or unfounded.

Signs and tests

• Physical examination to rule out illness
• Psychological evaluation to rule out other related disorders

Treatment

It is important to have a supportive relationship with a health care provider. There should be one primary provider to avoid unnecessary tests and procedures.

The health care provider should tell the person that he or she does not have a disease, but that continued medical follow-up will help control the symptoms. People with hypochondria feel real distress, so their symptoms should not be denied or challenged.

Expectations (prognosis)

The disorder is usally long-term (chronic), unless the psychological factors or mood disorder is treated.

Complications

• A real disease may be overlooked because previous complaints were untrue
• Complications from invasive testing to look for the cause of symptoms
• Dependence on pain relievers or sedatives
• Lost time from work due to frequent appointments with health care providers

Calling your health care provider

Call your health care provider if you or your child has symptoms of hypochondria.

References

Moore DP, Jefferson JW. Hypochondriasis. In: Moore DP, Jefferson JW, eds. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa: Mosby Elsevier; 2004:chap 92.

deGruy FV. The somatic patient. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 61.

Purcell TB. Somatoform disorders. In: Marx J, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2006:chap 111.

Answer 2

Definition

Hypochondria is a belief that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness.

Alternative Names

Hypochondriasis

Causes, incidence, and risk factors

People with hypochondria are overly focused on their physical health. They have an unrealistic fear of having a serious disease. This disorder occurs equally in men and women.

The way people with hypochondria think about their physical symptoms can make them more likely to have this condition. As they focus on and worry about physical sensations, a cycle of symptoms and worry begins, which can be difficult to stop.

It is important to realize that people with hypochondria do not purposely create these symptoms (malingering). They are unable to control the symptoms.

People who have a history of physical or sexual abuse are more likely to have this disorder. However, this does not mean that every person with a hypochondria disorder has a history of abuse.

Symptoms

People with hypochondria are unable to control their fears and worries. They often believe any symptom or sensation is a sign of a serious illness.

They seek out reassurance from family, friends, or health care providers on a regular basis. They feel better for a short time at most, and then begin to worry about the same symptoms, or about new symptoms.

Symptoms may shift and change, and are often vague. People with hypochondria often examine their own body.

Those who are affected may recognize that their fear of having a serious disease is unreasonable or unfounded.

Signs and tests

• Physical examination to rule out illness
• Psychiatric evaluation to rule out other related disorders

Treatment

It is important to have a supportive relationship with a health care provider. You should have only one primary care provider to avoid having too many tests and procedures.

The health care provider should tell you that you do not have a disease, but that continued medical follow-up will help control the symptoms. People with hypochondria feel real distress, so their symptoms should not be denied or challenged.

Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help reduce the worry and physical symptoms of this disorder.

Finding a mental health provider who has experience treating this disorder with talk therapy (psychotherapy) can be helpful. Cognitive behavioral therapy (CBT), a kind of talk therapy, can help you deal with your pain. During therapy, you will learn:

• To recognize what seems to make the symptoms worse
• To develop methods of coping with the symptoms
• To keep yourself more active, even if you still have symptoms

Expectations (prognosis)

The disorder is usually long-term (chronic), unless psychological factors or mood and anxiety disorders are treated.

Complications

• Complications from invasive testing to look for the cause of symptoms
• Dependence on pain relievers or sedatives
• Depression and anxiety or panic disorder
• Lost time from work due to frequent appointments with health care providers

Calling your health care provider

Call your health care provider if you or your child has symptoms of hypochondria.

References

Greenberg DB, Braun IM, Cassem NH. Functional somatic symptoms and somatoform disorders. In: Stern TA, Rosenbaum JF, Fava M, Biederman J, Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier;2008: chap 24.

WitthA¶ft M, Hiller W. Psychological approaches to origins and treatments of somatoform disorders. Annu Rev Clin Psychol. 2010;6:257-283.

deGruy FV. The somatic patient. In: Rakel RE, ed. Textbook of Family Medicine. 7th ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 61.

Reviewed By

Review Date: 08/09/2010

Linda Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Michelle Benger Merrill, MD, Instructor in Clinical Psychiatry, Department of Psychiatry, Columbia University Medical Center, New York, NY. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.