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Hypochondria by Rick Alan Deanna M. Neff, MPH

Definition

Hypochondria is a health anxiety disorder. It is often chronic. A person with hypochondria is often very anxious about his or her health. A hypochondriac fears that a real or imagined minor physical symptom is a sign of serious illness. Even when several doctors assure her otherwise, a hypochondriac is convinced that she has a serious disease. Psychiatric counseling and medications can relieve some, if not all, of the anxiety and suffering. But left untreated, hypochondria can be debilitating and affect daily function.

Causes

It is often difficult to identify a specific cause for hypochondria.

Risk Factors

Factors that may increase your risk for getting hypochondria include:

Family history of hypochondria
Having a serious childhood illness
Psychiatric disorders such as depression , anxiety, or personality disorder
Physical, sexual, or emotional abuse in childhood
Observing violence in childhood
Stressful experience with your own or a loved one's illness

Brain—Psychological Organ

Symptoms

Symptoms include:

Chronic fear of serious illness
Chronic fear that minor symptoms are signs of a serious illness
Many physical complaints that often change over time
The disorder:
- Lasts at least six months
- Causes major distress
- Interferes with social life or work
You may:
- Make many doctor visits, sometimes in the same day
- Seek repeated tests for the same symptoms
- Repeatedly research information about specific illnesses and their symptoms

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. If the exam shows no disease, your doctor may begin to suspect hypochondria. If further testing also fails to uncover a known medical condition, your doctor may diagnosis you with hypochondria if:

Your fear of illness lasts for at least six months
No other psychological disorder is causing your fear

Treatment

Physician Relationship and Monitoring

Effective treatment involves consistent, supportive care from one doctor, often along with a mental health professional. Finding a healthcare provider who is willing to listen to your concerns, provide support, and avoid needless testing is key to recovery.

You may feel overwhelmed by your symptoms. They may even seem to control your life. Schedule frequent visits, regardless of symptoms, with one doctor you can trust. Expect your doctor to:

Validate your distress
Be supportive
Direct your attention away from symptoms and focus it on functioning in daily life
Discourage a sense of dependency and disability
Recommend psychiatric counseling

Psychological Counseling

Psychotherapy such as cognitive behavior therapy and behavioral stress management can be effective in treating hypochondria. This involves regular counseling with a psychotherapist to recognize false beliefs, understand anxiety, and stop anxious behaviors.

Medications

Antidepressant medicines (eg, serotonin reuptake inhibitors [SSRIs], tricyclics antidepressants) may help relieve the symptoms of hypochondria.

Prevention

There are no guidelines to prevent hypochondria because the cause is not known.

RESOURCES:

American Counseling Association http://www.counseling.org/
American Psychiatric Association http://www.psych.org/

CANADIAN RESOURCES:

Canadian Mental Health Association http://www.ontario.cmha.ca/index.asp/
Canadian Psychological Association http://www.cpa.ca/

References:

Abramowitz JS, Schwartz SA, Whiteside SP. A contemporary conceptual model of hypochondriasis. Mayo Clin Proc . 2002;77(12):1323-1330.
Antidepressant use in children, adolescents, and adults. US Food and Drug Administration website. Available at: http://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/UCM096273 . Published May 2, 2007. Accessed December 31, 2012.
Greeven A, van Balkom AJ, Visser S, et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial (Netherlands). Am J Psychiatry . 2007;164:91-99.
Hypochondriasis. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/disorders/Hypochondriasis/hic_Hypochondriasis.aspx . Updated July 25, 2011. Accessed December 31, 2012.
Hypochondriasis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated June 1, 2011. Accessed December 31, 2012.
Psychotherapies for hypochondriasis. The Cochrane Collaboration website. Available at: http://www.cochrane.org/reviews/en/ab006520.html . Published July 8, 2009. Accessed December 31, 2012.

Last reviewed November 2012 by Brian Randall, MD

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This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

Hypochondria by Rick AlanDeanna M. Neff, MPH