Friday, May 6, 2011

Hypocondriasis

From Wikipedia,

Hypochondriasis or hypochondria (sometimes referred to as health phobia or health anxiety) refers to excessive preoccupation or worry about having a serious illness.  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, palpitations, or muscle fatigue. The duration of these symptoms and preoccupation is 6 months or longer.

The DSM-IV-TR defines this disorder, "Hypochondriasis," as a somatoform disorder  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, 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’ 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.

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), scheduled for publication in May 2013, would combine hypochondriasis with somatization disorder, pain disorder, and undifferentiated somatoform disorder under a single classification known as complex somatic symptom disorder.

 Manifestation and effects

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 disorders 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, obsessive-compulsive disorder (also known as OCD), phobias and somatization disorder 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/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. 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.).

If a person is ill with a medical disease such as diabetes or arthritis, there will often be psychological consequences, such as depression. Some even report being suicidal. 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 and paroxetine) 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.
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