What Is It?
Hypochondriasis is a persistent fear of having a serious medical illness. A person with this disorder tends to interpret normal sensations, bodily functions and mild symptoms as a sign of an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be a sign of a serious disease.
A person with hypochondriasis may be especially concerned about a particular organ system, such as the cardiac or digestive systems. A doctor's reassurance and even a complete medical evaluation often will not calm the person's fears. Or, if it does calm them, other worries may emerge days later.
Generally, people with this disorder do not develop "somatic delusions" (ideas about health that are completely divorced from reality). One common perspective on this disorder is that health anxiety is so great that reassurance is only temporarily helpful at best. Patients may admit the possibility that their fears are exaggerated. However, they may not accept being told that there is "nothing wrong."
The research about the prevalence of hypochondriasis is less thorough than the research on other mental disorders. The best estimate is that up to 4% or 5% of patients in general medical practices may have hypochondriasis. Another 10% may have some hypochondriacal symptoms without having the full disorder.
In severe forms, there is a tendency to go from doctor to doctor, looking for one that will confirm the presumed illness. The patient and the doctors may become frustrated or angry. The intensive search for illnesses that cannot be found sometimes interferes with the person getting proper care if he or she develops a medical illness for which there is an effective treatment.
Hypochondriasis is in some ways similar to obsessive-compulsive disorder. In fact, some researchers see it as a related disorder. The person is obsessively preoccupied with thoughts of illness and feels compelled to do things (feel lumps, browse for medical information, visit the doctor) to quell the anxiety they feel.
Some people with this disorder have had a serious illness in the past, commonly during childhood. Often hypochondriasis starts in young adulthood and can last many years. But it can occur at any age and in both men and women. Symptoms may become more intense after a stressful event, for example, the death of a loved one.
Although medical illnesses are uncomfortable, they can bring benefits, such as relief from responsibilities along with the attention and care of family members, friends and doctors. Sometimes, hypochondriasis is motivated by these advantages, although the individual is often not aware of that motivation.
Less often, a person may feign illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. In cases where someone is consciously seeking such advantages, the condition is called malingering. But hypochondriasis is not malingering. In hypochondriasis, the patient isn't pretending. He or she believes the illness is real and truly feels ill.
Symptoms of hypochondriasis include:
Preoccupation with having serious illness
Misinterpretation of body symptoms
Persistent fear despite medical reassurance
Absence of delusions or psychosis
Clinical distress or functional impairment
The diagnosis usually is suspected by a primary care physician and confirmed by a psychiatrist or other mental health professional, although the patient often refuses to see a mental health clinician. The diagnosis is based on a person's medical complaints and history, and a doctor's physical examination and laboratory tests. The disorder may be accompanied by severe anxiety symptoms or obsessive-compulsive symptoms. The evaluator needs to consider the possibility that a person is suffering from another mental disorder where fear or exaggerated concerns about medical illness can appear, such as the various forms of depression, schizophrenia or somatization disorder.
Hypochondriasis is a chronic (long-lasting) condition that can begin at any time of life, although it is most common between ages 20 and 40. The disorder tends to last longer in cases where the symptoms are severe and if the person has other psychiatric difficulties or vulnerabilities. If symptoms have a more sudden onset and are associated with other medical -- but not psychiatric -- symptoms, the duration tends to be shorter.
There is no known way to prevent this disorder.
Since people with hypochondriasis may also have depression, anxiety or psychosis, these conditions should be evaluated and treated.
The symptoms of hypochondriasis may be relieved by an antidepressant even when no other psychiatric illness is present. Experts who have noticed this disorder's similarity to obsessive-compulsive disorder (OCD) have found that it can help to prescribe OCD treatments, such as serotonin specific reuptake inhibitors (SSRIs) like fluoxetine or serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine.
There is evidence that a number of therapies can help people with hypochondriasis: cognitive therapy, behavior therapy, cognitive behavior therapy and stress management. Therapists help patients focus less on their symptoms and talk instead about how stress, anxiety and depression increase their psychological discomfort. Therapists explain that the actions patients take to relieve anxiety usually make things worse (feeling for lumps, reading about illness). They also teach distraction and relaxation techniques.
Reassurance is also helpful when it is done correctly by the patient's primary care doctor. Hypochondriasis is so common that many primary care physicians understand this disorder well and know how to provide reassurance in a kindly way that doesn't undermine the relationship. The medical complaints may never go away, so a regular schedule of short appointments, during which physical complaints are taken seriously, may help to contain the patient's anxiety. If a doctor attempts to limit contact with the patient by being dismissive, the patient's anxiety may get worse.
Many people with the disorder are not eager to see a mental health professional, so -- where possible -- it may help to integrate mental health services with the medical practice.
Doctors and therapists should take the physical symptoms seriously because the symptoms are real. But taking symptoms seriously does not mean doing unnecessary tests or procedures. While maintaining a serious and respectful attitude toward the medical complaints, doctors try to intervene as they would with any patient -- when it is needed, avoiding doing overly intrusive tests, and not suggesting approaches that could be inappropriately risky. The clinical team will also try to provide support for coping with chronic illness.
When to Call a Professional
People with hypochondriasis tend to contact health care professionals readily. However, they usually do not want to see mental health professionals because they fear that people view their medical symptoms as "all in your head." Nonetheless, early treatment by a mental health professional can be helpful.
Some patients respond well to medication, psychotherapy or both. If the person has anxiety or depression that responds to treatment with medication, the prognosis can be quite good. In mild cases, the symptoms can be short-lived. If the symptoms are severe and the person has other mental health disorders, the person may be susceptible to chronic distress and problems functioning.
American Psychiatric Association
1000 Wilson Blvd.
Arlington, VA 22209-3901
Web site: http://www.psych.org/
Public information site: http://www.healthyminds.org/
American Psychological Association
750 First St., NE
Washington, DC 20002-4242
National Alliance for the Mentally Ill
Colonial Place Three
2107 Wilson Blvd.
Arlington, VA 22201-3042
Mental Health America
2000 N. Beauregard St., 6th Floor
Alexandria, VA 22311