Hypochondriasis
Hypochondriasis, alternately known as hypochondria or hypochondriacal neurosis, is a psychological disease in which the afflicted believes that real or imagined physical symptoms and sensations are signs of a serious illness, contrary to medical advice. It is characterized by a high anxiety over the possibility of having a disease, and is frequently made worse by hearing stories of illness from the media or persons close to the afflicted. The disease was first described using a term Hippocrates had used in the 4th century BC, hypochondrium, meaning the anatomical area below the ribs. It was said that humors or fluids emanating from this area caused ill effects upon the psyche through the various diseases they caused.
By current guidelines in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, hypochondriasis is defined as a preoccupation with fears of having, or the belief that one has a serious disease based on misinterpretation of bodily symptoms. Criteria outlined by the DSM-IV include:
� The preoccupation persists despite appropriate medical evaluation and reassurance.
� The belief is not of delusional intensity and is not restricted to a circumscribed concern about appearance.
� The preoccupation causes clinically significant distress or impairment in social, occupation, or other important areas of functioning.
� The duration of the disturbance is at least 6 months.
� The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or other Somatoform Disorder.
Common symptoms include a preoccupation with and fear of illness, misinterpretation of symptoms, shifting and changing symptoms, vague and non-specific symptoms, no apparent physical problems that can account for symptoms and recognition of unfounded, excessive fear by the affected. Typically, the sufferer will insist that that he or she does have a serious illness and request immediate treatment. There is no single cause for hypochondriasis, though it is frequently found in the relatives of those who have already been diagnosed with hypochondriasis. It is assumed that psychological factors are then responsible for this disease. Some theories include psychodynamics, in which an unconscious intrapsychic conflict or need is converted into physical symptoms that express the wish but protect the individual from a conscious awareness of it; childhood abuse; the learning theory, in which a child learns the benefits of being �sick� and is reluctant to recover; difficulty expressing emotion; loneliness; or maintenance of an inner family homeostasis.
In an example case, Ms. X complains to her doctor of chest pains. She explains that she heard on a talk show that chest pains are signs of a heart attack and she is deathly worried about having a heart attack. He sends her for testing and finds nothing medically wrong with her to explain why she should have chest pains. Ms. X then tells her doctor that she just knows she is going to have a heart attack and that he is not looking hard enough. He is skeptical of her having pains at all; last month, she had complained that some mouth sores were a result of a cancer when in fact, they were caused by the serrated edges of the cereals and nuts she was eating every morning. She admits that she might be worrying too much and nervously laughs off her worries, but she is still very persistent. He discovers that in addition to a hypochondriacal and paranoid cousin, she also watches health shows that exaggerate health risks for viewers. He concludes that these influences are nurturing a hypochondriacal state, but she will not accept his advice and insists on more of his time and more tests.
Hypochondriacs span a wide spectrum, from a mild worry, to an incapacitating dread. The more severe patients have a high degree of impairment in functioning and are not responsive to the normal physiological medical treatments they are seeking. Symptoms are usually normal physical sensations or benign ailments that have little to do with any serious condition. Misinterpretation of these symptoms causes a recurrent syndrome known as �illness as a way of life�. It is important to note that hypochondriacs are not making up their symptoms. Hypochondriacs usually have an extensive medical history, characterized by a growing unsatisfaction with their doctors. They feel emotionally let down by their caregivers, and the high cost of health care can also take its toll on their mental health. In response to their mental stresses, they frequently add �new� symptoms to the gamut of symptoms already presented. This only offers frustration to the physician; they are constantly dismissed and ignored and as a result, they feel that the patients are exceptionally difficult to treat. Their advice is not accepted unless it confirms what the hypochondriac wants to hear. Patients are usually unwilling to accept the psychosocial factors that could be causing their symptoms.
In the case mentioned above, Ms. X experiences benign symptoms that she misinterprets as a serious disease. She is easily led to believe that she could have one by a similarly suffering relative and the media, and is unwilling to accept that she might not have any disease, no matter how much she fears having the disease. She has changed symptoms within a month and the nature of her complaint has become another disease altogether. She acknowledges her unreasonable worry, but cannot accept that there can be nothing wrong with her. She then dismisses the doctor�s work and becomes angry at the appropriate reassurances she is offered. From all of these points, a diagnosis of hyponchondriasis in Ms. X can be suggested.
Around 5% of medical outpatients suffer from hypochondriasis, without reference to socioeconomic status, education, race, age or sex. 66% of hypochondriacs also suffer from other psychological disorders, including major depression (found in approximately 40 percent of cases), panic disorder (in 15 percent), obsessive-compulsive disorder (in 10 percent), and generalized anxiety disorder.
A couple of therapies exist to deal with hypochondriasis. With cognitive-behavioral therapy, the patient is educated about their illness and taught to dispel their dysfunctional beliefs and assumptions through written materials for personal or group use. Patients are led to discuss common misunderstandings and are asked to notate their feelings and what would be a more adaptive response to their symptoms. This kind of therapy led to general improvements in anxiety, concern and social functioning. Drug therapies are successful when using drugs aimed at dealing with coexisting psychological disorders, such as selective serotonin reuptake inhibitors (SSRIs), Prozac, Paxil, Zoloft, Serzone, Anafranil, Xanax, and Cardene. However, the patient can also become attached to the drugs and might become over-reliant on higher and higher doses of a medicine. Other ways of dealing with hypochondria are sometimes not acceptable to the patient: stress management programs emphasize that they are just feeling stressed, psychiatric help tend to suggest to the patients that they are �crazy�, and psychosurgery has unclear side effects. Exercise and electro-convulsive therapy is sometimes used. Successful treatment using any therapy should be focused on symptoms, rather than the disease, because the effect of the symptoms do not minimize when they are found not to have the disease. The doctor and patient should have a long-term, caring relationship and visits must be on a regular basis, rather than on an �as-needed� basis.
It may be easy for some to categorize the hypochondriac, but one must also be wary of the possible existence of an actual condition, such as lupus or MS. Hypochondriasis is still a serious illness that must be treated with care, both physically and psychologically.