Hypochondriasis (or
hypochondria, often referred to as
health phobia) refers to an excessive preoccupation or worry about having 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, the concerns are far in excess of what is appropriate for the level of disease. Many people suffering from this disorder focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems,
palpitationA palpitation is an abnormal awareness of the beating of the heart, whether it is too slow, too fast, irregular, or at its normal frequency. It can be caused by ectopic beat, which is a more specific diagnosis....
s, or muscle fatigue.
The
DSMThe Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders...
-IV-TR defines this disorder, “Hypochondriasis,” as a
somatoform disorderSomatoform disorder is a mental disorder characterized by physical symptoms that mimic physical disease or injury for which there is no identifiable physical cause. Somatoform disorder is a condition in which the physical symptoms a person feels are due to mental factors. These symptoms can not be...
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'
diagnosisIn medicine, diagnosis is a label given for a medical condition or disease identified by its signs, symptoms, and from the results of various diagnostic procedures...
, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or un-lasting. 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 are completely avoidant of any reminder of illness, whereas others are frequent visitors of doctors’ offices. 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.
Etymology and colloquial use
The term
hypochondria comes from the Greek
hypo- (below) and
chondros (cartilage - of the breast bone), and is thought to have been originally coined by
HippocratesHippocrates of Cos or Hippokrates of Kos - Greek: ; Hippokrátēs was an ancient Greek physician of the Age of Pericles, and was considered one of the most outstanding figures in the history of medicine...
. It was thought by many Greek physicians of antiquity that many ailments were caused by the movement of the
spleenThe spleen is an organ found in virtually all vertebrate animals with important roles in regard to red blood cells and the immune system In humans, it is located in the left upper quadrant of the abdomen. It removes old red blood cells, holds a reserve in case of hemorrhagic shock, especially in...
, an organ located near the
hypochondriumThe hypochondrium is the upper part of the abdomen caudal to the lowest ribs of the thorax. The word derives from the Greek term ὑποχονδρος hupochondros, meaning abdomen, or literally under cartilage.The liver is found in the right hypochondrium....
(the upper region of the abdomen just below the ribs on either side of the
epigastriumThe epigastrium is the upper central region of the abdomen. It is located between the costal margins and the subcostal plane....
). Later use in the 19th Century employed the term to mean, “illness without a specific cause,” and it is thought that around that time period the term evolved to be the male counterpart to
female hysteriaFemale hysteria was a once-common medical diagnosis, made exclusively in women, which is today no longer recognized by modern medical authorities as a medical disorder. Its diagnosis and treatment were routine for many hundreds of years in Western Europe. Hysteria was widely discussed in the...
. In modern usage, the term
hypochondriac is often used as a pejorative label for individuals who hold the belief that they have a serious illness despite repeated reassurance from physicians that they are perfectly healthy. Hypochondria is sometimes also confused with
malingeringMalingering is a medical term that refers to fabricating or exaggerating the symptoms of mental or physical disorders for a variety of "secondary gain" motives, which may include financial compensation ; avoiding school, work or military service; obtaining drugs; getting lighter criminal sentences;...
, an intentional falsification of illness.
Manifestation and comorbidity
Hypochondriasis manifests in various ways. 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, considering the disease as a punishment for past misdeeds.
Hypochondriasis is often accompanied by other psychological disorders.
Clinical depressionMajor depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and loss of interest or pleasure in normally enjoyable activities...
,
obsessive-compulsive disorderObsessive–compulsive disorder is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts and behaviors...
(also known as OCD), phobias and
somatization disorderSomatization disorder is a psychiatric diagnosis applied to patients who chronically and persistently complain of varied physical symptoms that have no identifiable physical origin. One common general etiological explanation is that internal psychological conflicts are unconsciously expressed as...
are the most common accompanying conditions in people with hypochondriasis, as well as a generalized anxiety disorder diagnosis at some point in their life.
Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of
obsessive-compulsive disorderObsessive–compulsive disorder is a mental disorder characterized by intrusive thoughts that produce anxiety, by repetitive behaviors aimed at reducing anxiety, or by combinations of such thoughts and behaviors...
. 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.)
Factors contributing to hypochondria
CyberchondriaCyberchondria describes the behavior of hypochondriacs who use the Internet to gather information on health or healthcare...
is a
colloquialA colloquialism is an expression not used in formal speech, writing or paralinguistics. Colloquialisms are also sometimes referred to collectively as "colloquial language". Colloquialisms or colloquial language is considered to be characteristic of or only appropriate for casual, ordinary,...
term for hypochondria in individuals who have researched medical conditions on the
InternetThe Internet is a global system of interconnected computer networks that use the standardized 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
cancerCancer is a class of diseases in which a group of cells display uncontrolled growth , invasion , and sometimes metastasis...
and
multiple sclerosisMultiple sclerosis is an idiopathic disease of suspected autoimmune cause, in which the body's immune response attacks a person's central nervous system , leading to demyelination. Disease onset usually occurs in young adults, and it is more common in females...
(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
stressStress is a biological term for the consequences of the failure of a human or animal to respond appropriately to emotional or physical threats to the organism, whether actual or imagined....
.
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 disorderBody dysmorphic disorder...
).
Some anxieties and depressions are believed to be mediated by problems with brain chemicals such as
serotoninSerotonin is a monoamine neurotransmitter. It is found extensively in the gastrointestinal tract of animals, and about 80 to 90 percent of the human body's total serotonin is located in the enterochromaffin cells in the gut, where it is used to regulate intestinal movements...
and
norepinephrineNoradrenaline or norepinephrine is a catecholamine with dual roles 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 sick with a medical disease such as diabetes or
arthritisArthritis is a group of conditions involving damage to the joints of the body....
, there will often be psychological consequences, such as depression. Some even report being
suicidalSuicide is the intentional killing of one's self. Many dictionaries also note the metaphorical sense of "willful destruction of one's self-interest"...
. 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; 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.,
fluoxetineFluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. Fluoxetine is approved for the treatment of major depression , obsessive-compulsive disorder , bulimia nervosa, anorexia nervosa, panic disorder and premenstrual dysphoric disorder...
and
paroxetineParoxetine is a selective serotonin reuptake inhibitor 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 readjusting neurotransmitter levels and have been shown to be effective as treatments for anxiety and depression as well as for hypochondriasis.
In the United States, NIH-funded studies are now underway to compare different treatment approaches for hypochondriasis: a study in the New York City area and a study in the Boston area. In these studies, patients will be given one of four treatments: supportive therapy with fluoxetine, supportive therapy with placebo, cognitive behavior therapy, or cognitive behavior therapy with fluoxetine. For more information, visit the external links cited below.
See also
- Cyberchondria
Cyberchondria describes the behavior of hypochondriacs who use the Internet to gather information on health or healthcare...
- Munchausen syndrome
Münchausen syndrome is a term for psychiatric disorders known as Factitious disorders wherein those affected feign disease, illness, or psychological trauma in order to draw attention or sympathy to themselves...
- 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, 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...
External links