• Preoccupation with fears of having, or idea that one has, serious disease based on misinterpretation of bodily symptoms
• One in a group of disorders (including somatization, somatoform and pain disorders) characterized by patient complaints of physical symptoms without apparent cause
• Distinguishing features of hypochondriasis include
— Preoccupation with fear of a particular disease
— Interpretation of minor physical complaints as a sign of severe or catastrophic illness
— Fear persists despite evaluation and reassurance by one or more health-care providers.
— Patients may frequently change health-care providers.
• 300.7 Hypochondriasis
• No organic illness related to symptomatology (by definition)
Prevalence and risk factors
• Estimated prevalence in the general public (United States and Europe) varies from <1% to 6%, depending on the specific population studied and the exact criteria used.
• No difference in incidence by gender or age (although older female patients in general are more likely to be affected by somatization disorders)
• May be associated with history of significant illness in the patient or patient’s family during childhood
• May be associated with a history of traumatic personal experience
• Worsening of symptom(s) often associated with patient anxiety/fear
• Obsessive compulsive disorder
• Panic disorder
• Patient complaints are usually
— Described as physical sensations having ambiguous characteristics
— Focused on specific bodily functions or benign physical abnormalities
• Medical/social history often significant for
— Patient self-description as being “conscientious” or “a worrier”
— Extensive searching of Internet for health information
— Self-medication with multiple herbal remedies
— “Body hypervigilance” (checking the body/bodily functions)
— Transient, limited reduction in anxiety with provider reassurance, and frequent “doctor shopping”
Making the diagnosis
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV) criteria
— Preoccupation with fears of having, or idea that one has, serious disease based on misinterpretation of bodily symptoms
— Preoccupation persists despite appropriate medical evaluation and reassurance.
— Exclude diagnosis if belief of delusional intensity or restricted to circumscribed concern about appearance.
— Distress or impaired functioning
— Duration longer than six months
• Some psychiatric literature suggests diagnosis can be made based on such factors as “illness worry,” functional impairment, and excessive use of health-care resources.
• Consider alternative psychiatric diagnoses, including
— Depression/anxiety disorders
— Personality, delusional, malingering, or factitious disorders
— Somatization or psychogenic pain disorder
• Exclude true, organic illness (e.g., actual MI with complaint of chest pain).
• Disease is typically chronic and characterized by periodic remissions and exacerbations (usually associated with an identifiable stressor).
• Worse outcomes are generally associated with a history of more severe symptoms, longer duration of illness, and other concurrent psychiatric illnesses.
• Thorough medical evaluation and management by (ideally) a single primary-care clinician
• Type of interaction with health-care provider is important and should stress
— Reassurance (although may not necessarily be helpful)
— Warm empathetic manner
— Subtle encouragement to express feelings
— Education about physiologic and psychophysiologic processes
— Using less stigmatizing terms for hypochondriasis, such as illness anxiety or health anxiety disorder
• Some evidence for efficacy of serotonin-specific reuptake inhibitors (especially fluoxetine [Prozac]), but evidence regarding pharmacotherapy is generally limited.
• Medical and psychiatric literature contains extensive evidence demonstrating efficacy of psychotherapy for improvement in symptoms of hypochondriasis. For example:
— Recent Cochrane review (2007) found various forms of cognitive and behavioral therapy to be associated with significant alleviation of symptoms.
— Cognitive behavioral therapy (CBT)
- 2004 study found that six weeks of CBT resulted in significant improvement in social functioning and ability to carry out activities of daily living.
- 2007 study suggested that 16 weeks of CBT may be superior to both paroxetine (Paxil) and placebo.
- 2008 study found short course of CBT resulted in significant reduction in “health anxiety,” generalized anxiety, and depression.
— Older (1998) study found that cognitive therapy may reduce “health anxiety” better than behavioral stress management or no therapy.
— 2002 study found that group cognitive-educational approach seemed to be effective for 21 patients with hypochondriasis.
• Explanatory therapy (education, reassurance, and facilitation of patients’ learning to perceive somatic symptoms free of anxiety) reported to reduce health-care utilization (2000 study).
For complete references, see www.ebscohost.com/dynamed/.