Presentation
Signs and symptoms
Signs and symptoms include a general feeling of illness, anxiety and malaise. The patient may repeatedly complain of abdominal pain and epigastric discomfort, altered bowel habits, headaches, minor cough that the patient may perceive as serious, fever, urinary incontinence or dysuria, dizziness, loss of appetite, palpitations, chest pain, etc.
The symptoms may or may not be related with one another.
Systemic manifestations
There are no specific systemic manifestations. For example, a patient may complain of pain in the lower limb accompanied by stomach ache or he or she may present with a complain of itching all over the body and dizziness.
Entire Body System
- Pain
[…] chest pain, etc. [symptoma.com]
Pain Disorder When suffering from Pain Disorder, patients experience chronic pain in one or many areas of the body. In some cases, the pain can be so severe that it is debilitating. [treatment4addiction.com]
The fear of illness and pain dimension and the symptom effects dimension consistently shared stronger relations with the anxiety-related constructs compared to the other three IAS dimensions. [ncbi.nlm.nih.gov]
In some cases, the mind may genuinely create it - feeling pain where there wasn't pain because it expects pain to be there. In other cases, the symptom is there, but is caused by something harmless and is being misinterpreted by the brain. [calmclinic.com]
- Fatigue
[…] overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue [ncbi.nlm.nih.gov]
Main focus is on some particular symptoms like gastro-intestinal problems, palpitations, or muscle fatigue. [mindheal.org]
Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. [en.wikipedia.org]
Children with somatic symptom disorder worry excessively about physical symptoms that are fairly routine — headaches, stomachaches, nausea or fatigue — which they interpret as signs of serious illness. [childmind.org]
Symptoms may be specific (such as pain in the abdomen) or vague (such as fatigue). Any part of the body may be the focus of concern. [merckmanuals.com]
- Anorexia
Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder. [cambridge.org]
[…] of a person when present in public places or interacting with others (social phobia), fear or excessive worry not to get sick (obsessive compulsive disorder), fear of being separated from the loved ones (separation anxiety), fear of gaining weight (anorexia [thefreelibrary.com]
For example, Hollander et al posited an "obsessive-compulsive spectrum" to include hypochondriasis, obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), anorexia nervosa, and Tourette syndrome, all of which were believed to have similarities [emedicine.medscape.com]
- Malaise
Signs and symptoms Signs and symptoms include a general feeling of illness, anxiety and malaise. [symptoma.com]
Georgian age, in which individual self-care remained a duty, sufferers were exposed as never before to a Gothick horror literature of medical cautions, and the sick had unexampled access to an arsenal of drugs which certainly … would create real pain and malaise [academic.oup.com]
Gastrointestinal
- Loss of Appetite
The patient may repeatedly complain of abdominal pain and epigastric discomfort, altered bowel habits, headaches, minor cough that the patient may perceive as serious, fever, urinary incontinence or dysuria, dizziness, loss of appetite, palpitations, [symptoma.com]
To make matters even more complicated, the anxiety and stress caused by somataform disorders can produce their own physical symptoms, including: Chronic sweating Joint pain Nausea Dizziness Loss of appetite Weight changes Heart palpitations Tremors The [dualdiagnosis.org]
Hypochondria can cause one or more of the following effects: Anxiety attacks or panic attacks Depression Fear of impending doom Loss of appetite Decreased libido (sexual energy) Increased self-consciousness Decreased motivation in life. [psychologistanywhereanytime.com]
- Bulimia Nervosa
Affect and worry during a checking episode: A comparison of individuals with symptoms of obsessive-compulsive disorder, anorexia nervosa, bulimia nervosa, body dysmorphic disorder, illness anxiety disorder, and panic disorder. [cambridge.org]
Psychiatrical
- Fear
When we couldn't find the cause of certain symptoms, there was always the fear that we simply hadn't searched long enough or hard enough. [mayoclinic.org]
Neither group differed significantly from the other on the number and nature of feared physical symptoms. [ncbi.nlm.nih.gov]
Compare body image disturbances Preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms Preoccupation with the fear of having, or the idea that one has, a serious disease [icd9data.com]
- Anxiety Disorder
Comparison of SHAI scores across groups of patients with various anxiety disorders revealed elevated levels of health anxiety among patients with hypochondriasis and panic disorder relative to those with other anxiety disorders. [ncbi.nlm.nih.gov]
Like people with somatic symptom disorder, they are not easily reassured. Illness anxiety disorder can cause considerable distress and life disruption, even at moderate levels. [mayoclinic.org]
- Compulsive Disorder
Obsessive compulsive disorder, like depression, can give a feeling of being overwhelmed, absorbed, and trapped. Selective serotonin reuptake inhibitors do seem to work well with obsessive compulsive disorder, but I don’t really know why. [bmj.com]
Disorder-specific neuroanatomical correlates of attentional bias in obsessive-compulsive disorder, panic disorder, and hypochondriasis. [scielo.br]
Some authors have likened HC to obsessive-compulsive disorder (OCD) on the basis of similarities between obsessions and illness preoccupation and the ritualistic checking behavior observed in each condition. [ncbi.nlm.nih.gov]
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. [behavenet.com]
- Anger
The main differences between the patterns can be found in the features and the outcome of the premorbid (pre-hypochondriacal) narcissistic functioning, presence of the accompanying emotional disturbances (anxiety, dysphoria, anger), and the 'purposive [ncbi.nlm.nih.gov]
The hypochondriacal patient responds to medical reassurance with fear and anger. Their symptoms and complaints are intensified. “What if you missed something? You would take this more seriously if it were happening to you! [drlizhale.com]
Importantly, the psychiatry team can also provide support and education for the patient's family and the medical staff caring for the patient, all of whom may be coping with their own feelings of disbelief, anger, guilt, or other emotions. [clinicaladvisor.com]
In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed [feelinggood.com]
Be aware of emotional reactions toward the patient (ie, anger, hopelessness, helplessness) and seek frequent informal consultation when possible. [emedicine.medscape.com]
- Obsessive Thoughts
I used to go to psychotherapy sessions with multiple different psychotherapists and more often than not the solutions they offered were along the line of “keep as busy as possible not to give in to the thoughts” or “imagine the obsessive thoughts as a [feelinggood.com]
Urogenital
- Sexual Dysfunction
dysfunction, not due to a substance or known physiological condition ( F52.- ) thumb-sucking ( F98.8 ) tic disorders (in childhood and adolescence) ( F95.- ) Tourette's syndrome ( F95.2 ) trichotillomania ( F63.3 ) Somatoform disorders F45.2 ICD-10-CM [icd10data.com]
Sexual dysfunction is listed as a rare side effect for SSRIs, and I’ve always wondered if its manifestation was the result of something physical or if the mere suggestion in the fine print that erections might be less frequent and less impressive was [adequateman.deadspin.com]
- Urinary Incontinence
The patient may repeatedly complain of abdominal pain and epigastric discomfort, altered bowel habits, headaches, minor cough that the patient may perceive as serious, fever, urinary incontinence or dysuria, dizziness, loss of appetite, palpitations, [symptoma.com]
Neurologic
- Headache
“I have a headache, I must have a brain tumor.”) [biobehavioralinstitute.com]
When Charlie has a headache, he becomes convinced that he has a brain tumor. This is a good example of how a normal physical issue, like a headache, could spur fear of a serious disease, like cancer. [study.com]
A headache will be perceived as a tumor; a sneeze is pneumonia; etc. Add flashcard Cite Random Word of the Day Get the word of the day delivered to your inbox [alleydog.com]
According to one study, 85 to 90 percent of the most common symptoms, like headaches or pain, can’t be explained by a doctor. What makes it hypochondriasis is simply behavior. One person will say, “I have a headache; I don’t know why. [drlizhale.com]
- Irritability
At 78 years of age, he consulted a neurologist with complaints of facial numbness and irritability. Neurological examination revealed no overt abnormality, and he scored 21 points on the Mini-Mental State Examination. [ncbi.nlm.nih.gov]
Family and friends can become alienated and irritated by persistent discussions of health and medical details, and people can find their jobs strained when they constantly request time off to visit doctors. [web.archive.org]
He is anxious at baseline and increasingly irritable when you propose less invasive evaluation. He ends the encounter by stating that he will “find another doctor who sees my point and will get me what I need.” [emedicine.medscape.com]
Hence his imagination is perpetually placing these morbid feelings in different parts of the body to the account of some serious organic disease. 47 Treatment now consisted of diverting the mind and removing potential sources of nervous irritation. [academic.oup.com]
- Memory Impairment
Criminal defendents who malinger commonly simulate mental rather than physical illness, presenting with claims of psychosis or memory impairment. Individuals who malinger are also more likely to have antisocial personality disorder. [clinicaladvisor.com]
Workup
Work up includes a detailed history and physical examination along with the appropriate tests.
Laboratory testing
There are no diagnostic tests of this condition and a diagnosis is made based on clinical findings and more importantly, the patients history. Screening tests are available and they include:
Whitely Index of Hypochondriasis: it is used for detection, for rating severity and for measuring change per interventions [6].
Health Anxiety Inventory: it reliably distinguishes patients with hypochondriasis from patients with anxiety disorders and healthy controls [7].
Imaging
Imaging studies are generally not required, however, they may be conducted to check for any underlying abnormalities depending upon the patients symptoms. For example, if a patient complains of chest pain, a chest X-ray, CT scan, and an ECG may be conducted to rule out heart or lung disease.
Test results
To qualify for the diagnosis of hypochondriasis, the symptoms must have been experienced for at least 6 months [8]. When a thorough medical examination does not reveal any sign of disease and yet the patient complains of persistent symptoms despite assurance that he or she is in perfect physical health, he or she may be diagnosed as a hypochondriac.
Treatment
The high prevalence of personality disorders, particularly OCPD, among patients with hypochondriasis suggests that consideration of personality features is important in assessment and therapeutic interventions for hypochondriasis [9].
Medications
Antidepressants and antipsychotics are the mainstay of medicinal treatment of this condition. Commonly used antidepressants include serotonin reuptake inhibitors like Sertralin, Flouxetine, Paroxetine, Clomipramine, etc.
Psychotherapy
This is the primary treatment of hypochondriasis. Patients need to be counselled about hypochondriasis and its manifestations so that they may understand their condition.
Randomised control trials now suggest that cognitive behaviour therapy (CBT) is efficacious in the treatment of hypochondriasis [10]. With regular sessions and physical and mental exercises, the patients may show improvement.
Prognosis
Hypochondriasis does not have a good prognosis as the the condition is prone to worsen over time. Death by the condition itself, however, is rare but it may occur as a consequence of comorbidities such as heart disease, severe schizophrenia, etc. With appropriate treatment such as antidepressant medications and psychotherapy, the prognosis may be improved.
Complications:
Complications of hypochondriasis are twofold. They may be medical; such as development of hypertension, ischemic heart disease, stroke, etc as well as behavioural; such as lifestyle changes, depression, OCD, etc. The patient may sometimes hallucinate and even become suicidal. Indeed, many hypochondriacs have been known to become so depressed that they have attempted suicide which results in a significant mortality rate.
Etiology
Hypochondriasis does not have a specific etiology. It is considered a psychosomatic disorder, as in a mental illness with physical symptoms [2] and it is a result of a combination of factors. These predisposing factors include a higher than normal awareness of bodily sensations, a high level of interest in signs linked to diseases, an influence of Internet or television regarding diseases, predisposition to anxiety, etc.
Epidemiology
Incidence
Hypochondriasis does not have an exact recorded incidence because many cases go misdiagnosed or unreported. However, some studies show a prevalence rate of 0.8-4.5% cases in primary care settings of primary hypochondriasis [3].
Age
It may occur at any age but studies reveal that it has the highest incidence in patients that are young adults.
Sex
Hypochondriasis is known to occur equally in both sexes.
Race
Hypochondriasis has no known predilection to any race or demographic.
Pathophysiology
Hypochondriasis manifests itself slowly. It is characterised as a somatic amplification disorder- a disorder of perception and cognition [4]. It may begin as a general feeling of ill health and then progress to a firm, albeit wrong, belief that the patient is suffering from a serious disease.
Cognitive theories of hypochondriasis suggest that catastrophic misinterpretations of benign bodily sensations are a core feature for the maintenance of this disorder [5]. The end result of this condition is depression, anxiety, delusion and complications due to other comorbidities.
Prevention
As hypochondriasis is a psychological condition which may develop at any time, it has no known prevention. However, it is safe to say that a healthy, happy and positive life style may prevent this condition from occurring.
Summary
Hypochondriasis is a psychological condition in which a patient perceives that he is ill despite medical evidence to the contrary. Misinterpretation of one or more bodily functions leads patients with hypochondriasis to persistently believe that they have or will contract a serious disease, despite appropriate medical reassurance [1].
Patient Information
- Definition: Hypochondriasis, or health anxiety, is a psychological condition in which a person thinks he is ill even though all physical examinations reveal no underlying condition. Such a person, known as a hypochondriac, mistakes normal body sensations as abnormal and becomes convinced that he is suffering from a disease, when in reality, he is physically healthy.
- Cause: Hypochondriasis may be caused due to other psychological conditions or it may be a result of a highly stressful and a discontent life.
- Symptoms: As it is a psychological disorder in which hypochondriacs delude themselves that they are ill, symptoms can vary widely. Some common presenting symptoms include complains of fever, headaches, abdominal pain, altered bowel habits, malaise, cough, joint pain, fainting spells, etc. Despite complaints of such patients, all laboratory test results and physical examination come negative.
- Treatment: Hypochondriasis is treated by a combination of psychotherapy and antidepressant medications. Other drugs may be prescribed to avoid complications such as heart diseases and other psychological conditions like OCD, schizophrenia, etc.
- Prevention: A healthy, happy life style and a positive outlook may prevent this condition from occurring.
References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. American Psychiatric Association, Washington DC. 2000.
- Ford, Allison. "Hypochondria: Can you worry yourself sick?" Divine Caroline. Divine Caroline. Retrieved Oct 27, 2014.
- Magarinos M, Zafar U, Nissenson K, Blanco C. Epidemiology and Treatment of Hypochondriasis. CNS Drugs 2002;16(1):9-22 [Medline]
- Avia MD, M.A. Ruiz. Recommendations for the Treatment of Hypochondriac Patients. Journal of Contemporary Psychotherapy. 35.3(2005):301-313.
- Schreiber F, Neng JM, Heimlich C, Whitthoft M, Weck F. Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure. J Anxiety Disord. 2014 Oct 28;(7):671-8. Doi 10.1016/j.janxdis.2014.07.004 EPub. PMID 25124504.
- Speckens AE, Spinhoven P, Sloekers PP, Bolt JH, van Hemert AM. A validation study of the Whitely Index, the Illness Attitude Scales and the Somatosensory Amplification Scales in general medical and general practice patients. J Psychosol Res. Jan 1996;40(1):95-104 [Medline].
- Salkovskis PM, Rines KA, Warwick HM, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. July 2002;32(5):843-53.
- Goldberg RJ, MD. Practical Guide to the Care of the Psychiatric Patient. 3rd ed. 2007. Pa: Moseby-Elsevier: USA.
- Sakai R, Nestoruic Y, Nolido NY, Barsky AJ. The prevalence of personality disorders in hypochondriasis. J Clin Psychiatry. 2010 jan;71(1):41-7. Doi: 10.4088/JCP.08m04838blu. PMID 20129004 PubMed.
- Visser S, Bouman TK. The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behav Res Ther. Apr 2001;39(4):423-42.