Hypochondriasis

Hypochondriasis is an overwhelming fear that one has a serious disease, even though healthcare providers can find no evidence of illness. It is based on misinterpreting normal body sensations. Mild, occasional preoccupation with disease is quite common. This is not the same as hypochondriasis, which is severe and persistent and interferes with work as well as relationships. An estimated 75% to 85% of those who have hypochondriasis also have anxiety, depression, or another mental disorder.

Signs and Symptoms

• Preoccupation with a serious illness for at least six months
• Persistent fear of illness despite reassurance to the contrary from healthcare providers
• Difficulty maintaining a job, keeping relationships, and performing normal daily activities

What Causes It?

There are several theories about what causes hypochondriasis, including the following:

• The belief that an illness may atone for past real or imagined wrongdoing
• Having learned apparent benefits of being sick, such as receiving attention; may occur in one who had a childhood illness or had a sibling with a childhood illness
• Hypochodriasis is sometimes considered a variant of another psychiatric disorder such as anxiety or obsessive-compulsive disorder (OCD); in other words, hypochondriasis may develop from or be a sign of one of these other disorders.

Who's Most At Risk?

• These factors increase the risk of developing hypochondriasis: witnessing or experiencing a prolonged childhood illness (learning the apparent benefits of being sick)
• Family history of hypochondriasis
• Recent stressful event (for example, the death of a close friend or relative)

What to Expect at Your Provider's Office

A healthcare provider will perform a physical exam along with other tests to determine whether a physical disease may account for the reported symptoms. He or she will also ask specific questions and administer psychological tests to rule out the possibility of other related disorders such as anxiety or obsessive-compulsive disorder. A trained specialist, such as a psychologist or a psychiatrist, may be consulted to aid in the diagnosis and treatment.

Treatment Options

Treatment Plan

In addition to regular visits with a healthcare provider, people with hypochondriasis may also benefit from psychotherapy. Group therapy, behavior modification, and cognitive therapy have been reported to work particularly well (see section entitled Surgical and Other Procedures for more details). Because people with hypochondriasis tend to have other mental health conditions, such as anxiety and depression, treatment of these associated conditions is an important step in resolving the symptoms of hypochondriasis.

Drug Therapies

Drugs are generally not used to treat hypochondriasis specifically, but medication for associated mental health conditions may improve symptoms of hypochondriasis. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, fluvoxamine, or paroxetine, are a class of medications that your doctor may consider.

Surgical and Other Procedures

Several types of psychotherapy may help:

• Cognitive-behavioral therapy is intended to identify psychological factors that contribute to fears about illness and to correct misinterpretations of body sensations. This model focuses on helping patients recognize that their problem is health anxiety (worrying about illness) rather than having an actual illness.
• Behavioral-stress management therapy teaches stress management and relaxation techniques to help patients avoid becoming focused on illness during stressful situations. Comparatively, however, cognitive-behavioral therapy may be longer lasting.

Complementary and Alternative Therapies

Cognitive-behavioral therapy and stress management are the cornerstones of treatment for hypochondriasis. Good results have also been documented with the use of acupuncture and music therapy. Little other formal research exists regarding the use of complementary and alternative therapies for hypochondriasis. Regular appointments with a supportive CAM provider, though, may help to relieve health related fears because of the consistency of visits, the reassurance from a professional, and the focus on wellness as well as healthy behaviors.

Nutrition
To date, no scientific studies have investigated the role of nutrition in hypochondriasis. However, people with hypochondriasis who also have anxiety or depression might benefit from using less alcohol and caffeine. In general, it makes good sense for a person with hypochondriasis to follow healthy nutritional guidelines and to make only one dietary change at a time. A registered dietitian may also be helpful in creating a healthy eating plan. He or she may encourage the following:

• Maintain a whole-foods diet that includes plenty of fresh fruits, vegetables, and whole grains.
• Limit sugar, dairy, and refined, processed foods.
• Drink at least eight glasses of water each day to reduce constipation and other gastrointestinal complaints.
• Eat small, frequent meals throughout the day. This helps stabilize blood sugar (which can improve mood) and normalize digestion (which may reduce awareness of normal body sensations as food passes through the intestines).

Although no scientific studies have examined the effect of supplements on hypochondriasis, the following may support general health and well-being:

• Multivitamin taken daily
• Mineral supplements (including calcium and magnesium) (Note: taking too much calcium may lead to constipation and too much magnesium to gas, bloating, and diarrhea)
• Vitamin B complex, including pantothenic acid (B5) and pyridoxine (B6); (Note: taking too much niacin (vitamin B3), may cause flushing of the skin and perspiration)
• Lactobacillus acidophilus helps to decrease bowel symptoms.

Herbs
Certain herbs that are used to energize people during times of stress may also help a person with hypochondriasis become less preoccupied with disease (which tends to worsen during stressful times). Other herbs may help lessen symptoms of hypochondriasis. An herbalist may recommend a combination of two to four of the following dried herbs for the stated purposes:

• Echinacea (Echinacea angustifolia, E. purpurea, E. pallida) to reduce frequency and duration of colds
• Kava kava (Piper methysticum) for anxiety with restlessness. This herb should not be used along with any prescription psychotropic medications (used to treat anxiety and certain mental illnesses).
• Lemon balm (Melissa officinalis) for calming stress reactions, particularly with associated gastrointestinal symptoms (such as constipation, gas, bloating, nausea) or insomnia
• Oat straw (Avena sativa) to assist recovery from cold or other illnesses and strengthen a weakened constitution
• Passionflower (Passiflora incarnata) for restlessness, nervous stress, anxiety, rapid heartbeat related to anxiety, and sleep disorders
• St. John's wort (Hypericum perforatum) for symptoms of depression, anxiety and nervous unrest. This herbal medicine should not be used with other medications for depression or with a class of medications called protease inhibitors such as indinavir. In addition, women who use St. John's wort while on oral contraceptives may experience spotting between periods. This herb may also make your skin more sensitive to the sun.
• Skullcap (Scutellaria lateriflora) for nervous tension.

Homeopathy
There have been few studies examining the effectiveness of specific homeopathic remedies. Some healthcare professionals, however, believe that homeopathy promotes a sense of well-being and may relieve feelings of anxiety and depression often associated with hypochondriasis. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum — for a sense of panic and fear; this remedy is most appropriate for individuals who believe that they are so sick they are going to die
• Arsenicum album — for anxiety and fear of dying; this remedy is most appropriate for individuals who call the doctor often and are difficult to reassure; children may be worried about everything and tend to act more sick than they actually are
• Lycopodium — for general fear and anxiety about health; this remedy is most appropriate for stressed individuals who complain often of stomach problems
• Phosphorus — for general anxiety about health; this remedy is most appropriate for individuals who have a fear that something bad will happen (sense of impending doom) and may latch onto the fears of others, but tend to be easily reassured

Acupuncture
Several studies indicate that acupuncture may be a promising treatment for hypochondriasis. Acupuncture is believed to balance the flow of energy (qi) in the body and this balancing effect may be particularly helpful for people with distorted perceptions of body sensations. The studies suggest that acupuncture may be useful for:

• Relieving ongoing fear and apprehension
• Reducing symptoms of emotional stress
• Diminishing perceptions of stress and pain
• Regulating sleep patterns
• Improving work capacity

Massage
Some healthcare practitioners believe that regular visits to a massage therapist (which include techniques to relieve stress) may help reduce symptoms of hypochondriasis. It is possible, however, that massage could draw attention to physical complaints, thereby increasing symptoms. For these reasons, more research is needed before definitive conclusions can be drawn about the value of massage for hypochondriasis.

Prognosis/Possible Complications

Stress and anxiety may worsen the symptoms of hypochondriasis. Many patients will also struggle with costly medical evaluations and develop addictions to certain medications. Although hypochondriasis is a chronic illness, early psychiatric treatment combined with a strong motivation to change may increase the chances of a healthy prognosis. Some reports suggest that one-third to one-half of patients improve over time, and one-tenth recover completely from the illness.

Following Up

Try to maintain a healthy relationship with your primary healthcare provider. He or she will want to schedule regular appointments to monitor your symptoms.

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