Hypochondria
Encyclopedia
Hypochondriasis or hypochondria (sometimes referred to as health phobia or health anxiety) refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition. An individual suffering from hypochondriasis is known as a hypochondriac. Hypochondriacs become unduly alarmed about any physical symptoms they detect, no matter how minor the symptom may be. They are convinced that they have or are about to have a serious illness. Often, hypochondria persists even after a physician has evaluated a person and reassured them that their concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far in excess of what is appropriate for the level of disease. Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitation
Palpitation
A palpitation is an abnormality of heartbeat that causes a conscious awareness of its beating, whether it is too slow, too fast, irregular, or at its normal frequency. The word may also refer to this sensation itself...

s, or muscle fatigue
Muscle fatigue
Muscle fatigue is the decline in ability of a muscle to generate force. It can be a result of vigorous exercise but abnormal fatigue may be caused by barriers to or interference with the different stages of muscle contraction...

. The duration of these symptoms and preoccupation is 6 months or longer.

The DSM
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

-IV-TR defines this disorder, "Hypochondriasis," as a somatoform disorder
Somatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

 and one study has shown it to affect about 3% of the visitors to primary care settings.

Hypochondria is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis
Medical diagnosis
Medical diagnosis refers both to the process of attempting to determine or identify a possible disease or disorder , and to the opinion reached by this process...

, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or un-lasting. Additionally, many hypochondriacs experience elevated blood pressure, stress, and anxiety in the presence of doctors or while occupying a medical facility, a condition known as "white coat syndrome." Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends. Some hypochondriacal individuals completely avoid any reminder of illness, whereas others frequently visit doctors’ surgeries. Other hypochondriacs will never speak about their terror, convinced that their fear of having a serious illness will not be taken seriously by those in whom they confide.

Characteristics

Hypochondriac Syndrome is categorized as a somatic amplification disorder— a disorder of "perception and cognition" that involves a hyper-vigilance of the bodys situation and a tendency to react to the initial perceptions in a negative manner that is further debilitating. Hypochondriasis manifests in many ways. Puri B. K, Laking P.J, Treasaden I.H, (2000) states that hypochondrisis can manifest at any age, but usually between the ages of 20 and 30 years, occurring marginally more in males in contrast to other somatoform disorder
Somatoform disorder
In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

s which are more common in women. Some people have numerous intrusive thoughts and physical sensations that push them to check with family, friends and physicians. Other people are so afraid of any reminder of illness that they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Again, some people are afraid of getting a disease because they have a disease. Yet, some others live in despair and depression, certain that they have a life-threatening disease and no physician can help them. Some consider the disease as a punishment for past misdeeds.

Hypochondriasis is often accompanied by other psychological disorders. Clinical depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...

, obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

 (also known as OCD), phobias and somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...

 are the most common accompanying conditions in people with hypochondriasis, as well as a generalized anxiety disorder diagnosis at some point in their life.
Autism
Autism
Autism is a disorder of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all begin before a child is three years old. Autism affects information processing in the brain by altering how nerve cells and their...

/Aspergers can be another sign of this.

Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of obsessive-compulsive disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

. However, while people with hypochondriasis are afraid of having an illness, patients with OCD worry about getting an illness or of transmitting an illness to others. Although some people might have both, these are distinct conditions.

Patients with hypochondriasis often are not aware that depression and anxiety produce their own physical symptoms that might be mistaken for signs of a serious medical disease. For example, people with depression often experience changes in appetite and weight fluctuation, fatigue, decreased interest in sex and motivation in life overall. Intense anxiety is associated with rapid heart beat, palpitations, sweating, muscle tension, stomach discomfort, and numbness or tingling in certain parts of the body (hands, forehead, etc.).

Diagnosis

The ICD-10
ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

 defines hypochondriasis as follows:
A. Either one of the following:
  • A persistent belief, of at least six months duration, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient).
  • A persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder
    Body dysmorphic disorder
    Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...

    ).

B. Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigations (or equivalent help from local healers).

C. Persistent refusal to accept medical advice that there is no adequate physical cause for the symptoms or physical abnormality, except for short periods of up to a few weeks at a time immediately after or during medical investigations.

D. Most commonly used exclusion criteria: not occurring only during any of the schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

 and related disorders (F20-F29, particularly F22) or any of the mood disorders (F30-F39).

The DSM-IV defines hypochondriasis according to the following criteria:

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical evaluation and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder
Delusional disorder
Delusional disorder is an uncommon psychiatric condition in which patients present with circumscribed symptoms of non-bizarre delusions, but with the absence of prominent hallucinations and no thought disorder, mood disorder, or significant flattening of affect...

, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder
Body dysmorphic disorder
Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...

).

D. The preoccupation causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months.

F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder
Obsessive-compulsive disorder
Obsessive–compulsive disorder is an anxiety disorder characterized by intrusive thoughts that produce uneasiness, apprehension, fear, or worry, by repetitive behaviors aimed at reducing the associated anxiety, or by a combination of such obsessions and compulsions...

, Panic Disorder
Panic disorder
Panic disorder is an anxiety disorder characterized by recurring severe panic attacks. It may also include significant behavioral change lasting at least a month and of ongoing worry about the implications or concern about having other attacks. The latter are called anticipatory attacks...

, a Major Depressive Episode
Major depressive episode
A major depressive episode is the cluster of symptoms of major depressive disorder. The description has been formalised in psychiatric diagnostic criteria such as the DSM-IV and ICD-10, and is characterized by severe, highly persistent depression, and a loss of interest or pleasure in everyday...

, Separation Anxiety
Separation anxiety
Separation anxiety may refer to:*Separation anxiety disorder or Separation anxiety test*Spider-Man & Venom: Separation Anxiety, a 1995 SNES video game*Separation Anxieties, a 2000 album by 12 Rods...

, or another Somatoform Disorder.


It may be further specified as "with poor insight if, for most of the time during the current episode,
the person does not recognize that the concern about having a serious
illness is excessive or unreasonable."

A proposed change in the next revision of the DSM (DSM-5
DSM-5
The next edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders , commonly called DSM-5 , is currently in consultation, planning and preparation...

), scheduled for publication in May 2013, would combine hypochondriasis with somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...

, pain disorder
Pain disorder
Pain disorder is when a patient experiences chronic pain in one or more areas, and is thought to be caused by psychological stress. The pain is often so severe that it disables the patient from proper functioning. Duration may be as short as a few days or as long as many years. The disorder may...

, and undifferentiated somatoform disorder under a single classification known as complex somatic symptom disorder.

Cause

Cyberchondria
Cyberchondria
Cyberchondria refers to the unfounded escalation of concerns about common symptomology based on review of search results and literature online. Articles in popular media position cyberchondria anywhere from temporary neurotic excess to adjunct hypochondria...

 is a colloquial
Colloquialism
A colloquialism is a word or phrase that is common in everyday, unconstrained conversation rather than in formal speech, academic writing, or paralinguistics. Dictionaries often display colloquial words and phrases with the abbreviation colloq. as an identifier...

 term for hypochondria in individuals who have researched medical conditions on the Internet
Internet
The Internet is a global system of interconnected computer networks that use the standard Internet protocol suite to serve billions of users worldwide...

. The media and the Internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

 and multiple sclerosis
Multiple sclerosis
Multiple sclerosis is an inflammatory disease in which the fatty myelin sheaths around the axons of the brain and spinal cord are damaged, leading to demyelination and scarring as well as a broad spectrum of signs and symptoms...

 (some of the diseases hypochondriacs commonly think they have) often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.

Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease. A simple suggestion of mental illness can often trigger one with hypochondria to obsess over the possibility.

It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.

A majority of people who experience physical pains or anxieties over non-existent ailments are not actually "faking it", but rather, experience the natural results of other emotional issues, such as very high amounts of stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...

.
Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder
Body dysmorphic disorder
Body Dysmorphic Disorder is a type of mental illness, a somatoform disorder, wherein the affected person is exclusively concerned with body image, manifested as excessive concern about and preoccupation with a perceived defect of his or her physical features...

).

Some anxieties and depressions are believed to be mediated by problems with brain chemicals such as serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...

 and norepinephrine
Norepinephrine
Norepinephrine is the US name for noradrenaline , a catecholamine with multiple roles including as a hormone and a neurotransmitter...

. The physical symptoms that people with anxiety or depression feel are indeed real bodily symptoms, and are believed to be triggered by neurochemical changes. For example, too much norepinephrine will result in severe panic attacks with symptoms of increased heart rate and sweating, shortness of breath, and fear. Too little serotonin can result in severe depression, accompanied by a sleep disturbance, severe fatigue, and typically is treatable with medical intervention.

Treatment

If a person is ill with a medical disease such as diabetes or arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....

, there will often be psychological consequences, such as depression. Some even report being suicidal
Suicide
Suicide is the act of intentionally causing one's own death. Suicide is often committed out of despair or attributed to some underlying mental disorder, such as depression, bipolar disorder, schizophrenia, alcoholism, or drug abuse...

. In the same way, someone with psychological issues such as depression or anxiety will sometimes experience physical manifestations of these affective fluctuations, often in the form of medically unexplained symptoms. Common symptoms include headaches; abdominal, back, joint, rectal, or urinary pain; nausea; fever and/or night sweats; itching; diarrhea; dizziness; or balance problems. Many people with hypochondriasis accompanied by medically unexplained symptoms feel they are not understood by their physicians, and are frustrated by their doctors’ repeated failure to provide symptom relief. Common to the different approaches to the treatment of hypochondriasis is the effort to help each patient find a better way to overcome the way his/her medically unexplained symptoms and illness concerns rule her/his life. Current research makes clear that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy.

Recent scientific studies have shown that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs; e.g., fluoxetine
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...

 and paroxetine
Paroxetine
Paroxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...

) are effective treatment options for hypochondriasis as demonstrated in clinical trials. CBT, a psycho-educational “talk” therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is found helpful in reducing the intensity and frequency of troubling bodily symptoms. SSRIs can reduce obsessive worry through adjusting neurotransmitter levels and have been shown to be effective as treatments for anxiety and depression as well as for hypochondriasis.

Another treatment that has proved effective in the treatment of hypochondriasis is exposure therapy. In one study, this was shown to be equally as effective as cognitive therapy and the improvements in condition were maintained after the study.

See also

  • Cyberchondria
    Cyberchondria
    Cyberchondria refers to the unfounded escalation of concerns about common symptomology based on review of search results and literature online. Articles in popular media position cyberchondria anywhere from temporary neurotic excess to adjunct hypochondria...

  • Mithridatism
    Mithridatism
    Mithridatism is the practice of protecting oneself against a poison by gradually self-administering non-lethal amounts. The word derives from Mithridates VI, the King of Pontus, who so feared being poisoned that he regularly ingested small doses, aiming to develop immunity...

  • Münchausen syndrome
    Munchausen syndrome
    Münchausen syndrome is a psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention or sympathy to themselves. It is also sometimes known as hospital addiction syndrome or hospital hopper syndrome...

  • Nocebo
    Nocebo
    In medicine, a nocebo reaction or response refers to harmful, unpleasant, or undesirable effects a subject manifests after receiving an inert dummy drug or placebo...

  • Psychosomatic medicine
  • Sickness behavior
    Sickness behavior
    thumb|350px|right|[[Michael Peter Ancher|Ancher, Michael]], "The Sick Girl", 1882, [[Statens Museum for Kunst]]Sickness behavior is a coordinated set of adaptive behavioral changes that develop in ill individuals during the course of an infection....

  • Somatoform disorder
    Somatoform disorder
    In psychology, a somatoform disorder is a mental disorder characterized by physical symptoms that suggest physical illness or injury - symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder . The symptoms that...

  • Somatopsychic
    Somatopsychic
    Somatopsychic is a medical term for the effects of the body on the mind. Somatopsychic is used to describe a body-mind relationship, as does psychosomatic. Psychosomatic, however, refers to the mind's effect on the body.-External links:**...

  • Somatosensory amplification
    Somatosensory amplification
    Somatosensory amplification is a tendency to perceive normal somatic and visceral sensations as being relatively intense, disturbing and noxious. It is a common feature of hypochondriasis and is commonly found with fibromyalgia, major depressive disorder, some anxiety disorders, Asperger syndrome,...

  • Medical students' disease
    Medical students' disease
    Medical students' disease, also known as hypochondriasis of medical students or medical student syndrome or medical student disorder, is a condition frequently reported in medical students, who perceive themselves or others to be experiencing the symptoms of the disease they are studying.The...

  • Man flu
    Man flu
    Man flu is a pejorative term that refers to the idea many men, when they have a cold, exaggerate and claim they have the flu — the implication being that women do not do so...


External links

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