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Hypochondria
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Hypochondria

(Hypochondriasis)

En Español (Spanish Version)

Definition

Hypochondria is a psychological disorder. It is often chronic, and a person with hypochondria is often very anxious about his health. A hypochondriac fears that a real or imagined minor physical symptom is a sign of serious illness. Even when several doctors assure her otherwise, a hypochondriac is convinced that she has a serious disease. Psychiatric counseling and medications can relieve some, if not all, of the anxiety and suffering. But left untreated, hypochondria can be debilitating and affect daily function.

Causes

It is often difficult to identify a specific cause. Often a childhood or prior serious illness, or illness of a loved one can lead to hypochondria.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors for hypochondria include:

  • Family history of hypochondria
  • Psychiatric disorders such as depression, anxiety, or personality disorder
  • Physical, sexual, or emotional abuse in childhood
  • Witnessing violence in childhood
  • Stressful experience with your own or a loved one's illness
  • Alcoholism

Brain—Psychological Organ

Brain Man Face

Chemical imbalances and traumatic life experiences may contribute to the development of hypochondria.

© 2008 Nucleus Medical Art, Inc.

Symptoms

Symptoms include:

  • Chronic fear of serious illness
  • Chronic fear that minor symptoms are signs of a serious illness
  • Multiple physical complaints that often change over time
  • The disorder:
    • Lasts at least six months
    • Causes major distress
    • Interferes with social life or work
  • You may:
    • Make many doctor visits, sometimes in the same day
    • Seek repeated tests for the same symptoms
    • Repeatedly research information about specific illnesses and their symptoms

Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. If the exam shows no disease, your doctor may begin to suspect hypochondria. If further testing also fails to uncover a known medical condition, your doctor may diagnosis you with hypochondria if:

  • Your fear of illness lasts for at least six months
  • No other psychological disorder is causing your fear

Treatment

Physician Relationship and Monitoring

Effective treatment involves consistent, supportive care from one doctor, often in consultation with a mental health professional. Finding a healthcare provider who is willing to listen to your concerns, provide assurance, and avoid unnecessary testing is key to recovery.

You may feel overwhelmed by your symptoms. They may even seem to control your life. Schedule frequent visits, regardless of symptoms, with one doctor you can trust. Expect your doctor to:

  • Validate your distress
  • Be supportive
  • Direct your attention away from symptoms, and focus it on functioning in daily life
  • Discourage a sense of dependency and disability
  • Recommend psychiatric counseling

Psychological Counseling

Research has shown that cognitive behavior therapy, behavioral stress management, or explanatory therapy can be effective in treating hypochondria. This involves regular counseling with a psychotherapist to recognize false beliefs, understand anxiety, and stop anxious behaviors.

Medications

Anti-depressant medication, such as serotonin reuptake inhibitors (SSRIs) or tricyclics (TCAs) may relieve the symptoms of hypochondria. A recent randomized control trial in the Netherlands showed paroxetine (as well as cognitive behavioral therapy) to be of short-term help in relieving symptoms, and other studies have shown fluoxetine (Prozac) to be helpful.

Please Note: On March 22, 2004, the Food and Drug Administration (FDA) issued a Public Health Advisory that cautions physicians, patients, families, and caregivers of patients with depression to closely monitor both adults and children receiving certain antidepressant medications. The FDA is concerned about the possibility of worsening depression and/or the emergence of suicidal thoughts, especially among children and adolescents at the beginning of treatment, or when there’s an increase or decrease in the dose. The medications of concern, mostly SSRIs (Selective Serotonin Re-uptake Inhibitors), are: Prozac (fluoxetine), Zoloft (sertraline), Paxil (paroxetine), Luvox (fluvoxamine), Celexa (citalopram), Lexapro (escitalopram), Wellbutrin (bupropion), Effexor (venlafaxine), Serzone (nefazodone), and Remeron (mirtazapine). Of these, only Prozac (fluoxetine) is approved for use in children and adolescents for the treatment of major depressive disorder. Prozac (fluoxetine), Zoloft (sertraline), and Luvox (fluvoxamine) are approved for use in children and adolescents for the treatment of obsessive compulsive disorder. For more information, please visit http://www.fda.gov/cder/drug/antidepressants.

Prevention

There are no guidelines for prevention, because the cause is not known.

RESOURCES:

American Counseling Association
http://www.counseling.org/

American Psychiatric Association
http://www.psych.org/

CANADIAN RESOURCES:

Canadian Mental Health Association
http://www.ontario.cmha.ca/index.asp/

Canadian Psychiatric Association
http://www.cpa-apc.org/

Canadian Psychological Association
http://www.cpa.ca/

References:

American Psychiatric Association website. Available at: http://www.psych.org.

Canadian Psychological Association website. Available at: http://www.cpa.ca.

Greeven A, van Balkom AJ, Visser S, et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial (Netherlands). Am J Psychiatry. 2007 Jan;164(1):91-9. Available at: http://ajp.psychiatryonline.org/cgi/content/full/164/1/91.

Hypochondriasis. EBSCO Dynamed website. Available at: http://dynaweb.ebscohost.com/Detail.aspx?id=116036&sid=c70b52ce-3a28-4dd1-800a-2f09e003f973@sessionmgr3.

Mayo Clinic website. Hypochondria. Available at: http://www.mayoclinic.com/health/hypochondria/DS00841/DSECTION=1.

The Merck Manual of Medical Information. Simon and Schuster; 2006.

National Library of Medicine website. Available at: http://www.nlm.nih.gov/.

Psychotherapies for hypochondriasis. The Cochrane Collaboration website. Available at: http://www.cochrane.org/reviews/en/ab006520.html.



Last reviewed May 2008 by Theodor B. Rais, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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