Hypochondriasis

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 checkups, 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.