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Conservative use of drug therapy
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A psychological approach that emphasizes the present and future of the patient, rather than the past.
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Emphasis on nutrition and physical exercise
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Family participation, if appropriate
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Psychoeducation for patients and relatives
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WHAT IS HYPOCHONDRIASIS?
Hypochondriasis is a somatoform disorder characterized by the preoccupation with the idea that one has a serious disease or the fear of having a serious disease. The preoccupation is based on the misinterpretation of one or more bodily signs or symptoms (e.g. "I have a headache, I must have a brain tumor.")
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CRITERIA |
The current psychiatric diagnostic manual (DSM-IV), indicates the following diagnostic criteria:
- Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
- The preoccupation persists despite appropriate medical evaluation and reassurance.
- The belief criterion A is not of delusional intensity (as in Delusional Disorder, somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).
- The preoccupation causes clinically significant distress or impairment in social, occupational, 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 another Somatoform Disorder.
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Hypochondriasis is viewed as an "Obsessive-compulsive spectrum disorder" since it seems to share many common features with Obsessive Compulsive Disorder (OCD). For example, hypochondriacal individuals are preoccupied or "obsessed" with an imagined illness, which creates high levels of anxiety. Reassurance seeking behavior seems to act similar to a compulsion in OCD as it temporarily reduces anxiety but increases it over the long-term.
WHAT ARE THE SYMPTOMS OF HYPOCHONDRIASIS?
- Preoccupation with bodily functions (heartbeat, sweating)
- Preoccupation with minor physical complaints (small sore, occasional cough)
- Preoccupation with vague and ambiguous physical sensations (tired heart, aching veins)
- Numerous complaints about pain (headaches, stomach aches, back pains)
- Hypersensitive to any small physical changes in their body
- Concern with having a deadly disease such as AIDS or cancer
- Seeking repeated physical examinations, diagnostic tests, and reassurance from physicians
- Physician reassurance and medical tests do not decrease the concern
- Being alarmed if friends or family are diagnosed with a disease
- Seeking reassurance from friends and family about their physical symptoms
- Doing extensive research on the disease, such as reading medical journals
- "Doctor-shopping"—Visiting numerous doctors who will "correctly" identify and treat them.
- Complaints that doctors and specialists were not good or were unable to find the problem.
- Repeatedly checking own body for signs of disease, such as monitoring blood pressure, pulse, doing breast exams etc.
- Avoiding certain foods or activities thought to cause the disease.
WHO SUFFERS FROM HYPOCHONDRIASIS?
The prevalence of hypochondriasis is estimated to be between 4 to 9 percent in those seeking treatment in outpatient settings. It tends to begin in early adulthood and is usually chronic. It is equally common in males and females. It is important to understand that hypochondriasis is not a way of seeking attention from others by pretending to be sick. Individuals honestly believe that they are suffering from a medical condition and feel misunderstood. Most individuals are not concerned with the pain but rather with what the physical symptoms imply.
WHAT TREATMENTS ARE AVAILABLE FOR HYPOCHONDRIASIS?
Current research conducted at our Institute as well as other facilities, indicates that techniques used to treat obsessive compulsive disorder (OCD) are also effective for hypochondriasis. Cognitive therapy and exposure and response prevention (ERP) are the current psychological treatments of choice. Both individual and group treatments have proven successful. In addition, there are certain medications which might be helpful.
WHAT IS EXPOSURE AND RESPONSE PREVENTION?
ERP is the specific behavioral technique implemented at our facility for hypochondriasis and numerous similar disorders. ERP involves exposing patients to situations frequently avoided or feared while preventing the person from engaging in compulsive behaviors that temporarily reduce the anxiety. Patients are exposed to anxiety provoking situations at their own pace, and ERP sessions are conducted at a rate that patients can tolerate.
The following is a case example of behavioral treatment:
"Lisa" had a fear that she had a brain tumor. She couldn't stop thinking about them. She wondered how she would know if she had one and pondered ways she could prevent from getting one. When she had a headache, she was convinced she had a tumor. The fear grew until she was also concerned about tumors, swelling of the brain, migraines, embolisms, and strokes. She began to pay close attention to her blood pressure and pulse, measuring them many times a day. She refrained from physical activities and certain foods that she believed might cause cancer. She would read ingredients on packages while shopping for food to make sure they did not contain ingredients thought to cause cancer. She consulted with 13 physicians, had four MRI's and two PET scans over a period of two years.
Behavioral treatment for Lisa consisted of gradually exposing her to stimuli that caused her fear and anxiety. For example, she was asked to perform physical exercises that deliberately increased her heart rate and eat foods that she believed were "cancer-causing." She was asked to refrain from speaking to doctors, friends, and family about the diseases. She also refrained from checking her vital signs. She was asked to imagine that her headaches were indeed a sign of a tumor. Over time, Lisa learned that her fears did not make sense and learned not to become anxious or concerned with minor physical symptoms.
WHAT IS COGNITIVE THERAPY?
Cognitive therapy involves challenging and altering faulty thinking patterns. It is believed that faulty beliefs lead to negative emotions and behaviors. In cognitive therapy, patients learn to first identify faulty thinking patterns, challenge these thoughts and finally derive more constructive beliefs. It is believed that constructive thoughts lead to more positive emotions and behaviors
Patients with hypochondriasis are helped to accept alternate and more rational explanations for their physical complaints by challenging the belief that unusual or uncomfortable physical symptoms must indicate a serious illness. After the patient is able to generate alternate explanations for symptoms, therapy focuses on challenging the need for guarantees. Patients are taught to acknowledge that there is a degree of risk in everyday life and one must accept these risks rather than try to control them.
The following is an example of a cognitive therapy session with Lisa in which the therapist helps her generate alternate explanations for her frequent headaches:
Therapist: You said you feel as though you have a headache, and you believe that this feeling indicates that you have a brain tumor. Is this correct?
Lisa: Yes, I read that frequent headaches are one of the symptoms of a tumor.
Therapist: Do you have any other evidence that you have a tumor?
Lisa: Not really. I have seen two specialists who assured me that I am fine. I also had an MRI done recently.
Therapist: Is it possible that there could be something else responsible for the way you are feeling?
Lisa: I suppose there could be.
Therapist: Try to generate some other possible explanations.
Lisa: Well, I do get headaches from staring at a computer screen all day at work.
Therapist: Okay that's one explanation. What else?
Lisa: It could be stress.
Therapist: When do you tend to feel stressed out?
Lisa: I guess when I think about getting headaches.
Therapist: What happens when you think about getting headaches?
Lisa: I usually end up getting one.
Therapist: Are you saying that simply focusing on your head may be responsible for producing the headache?
Lisa: I guess thinking about it does make it worse.
Therapist: It seems then that a tumor is not the only possible explanation for your symptom.
WHAT MEDICATIONS ARE HELPFUL FOR HYPOCHONDRIASIS?
Current research indicates that anti-depressant medications when used in conjunction with psychological treatment may be quite helpful for hypochondriasis.
Some commonly used anti-depressant medications for hypchondriasis:
- Sinequan
- Tofranil
- Elavil
- Anafranil
- Prozac
Anti-psychotic medications have also been indicated.
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