| Hypochondriasis is a type of mental health disorder called a somatoform disorder in which the individual believes that real or imagined physical symptoms are signs of a serious illness despite medical reassurance that they are not. The individual's concerns about having a serious illness are generally based on a preoccupation with bodily functions and the interpretation of normal sensations (such as heartbeats, sweating, peristaltic action, and bowel movements) or minor abnormalities (e.g., a runny nose, minor aches and pains, or slightly swollen nodes) as indications of highly disturbing problems needing medical attention. An individual with hypochondriasis might think, "I have a headache; therefore, I must have a brain tumor." Hypochondriasis is sometimes episodic, suggesting that it may be related to stressful life events.
Negative results of diagnostic evaluations and reassurance by physicians only increase the individual's anxious concern about his or her health. The individual feels distressed because of the negative findings and seeks further medical attention. The ability of many hypochondriacs to function in social, occupational, and interpersonal roles may be impaired.
Frequent appointments with health care providers are typical, and time off from work is often taken for doctors' appointments, treatments, laboratory tests, and so on. In one general medical outpatient clinic, 88% of patients with this condition also had a concurrent disorder such as general anxiety disorder, depression, or panic disorder (Hilty).Risk: The cause of hypochondriasis is not known. There are no known risk factors. Incidence and Prevalence: Hypochondriasis can occur at any age but peaks in adolescence and during middle age (Maleki). Men and women appear to be affected equally (Phillips 603). The disorder's prevalence in the US is estimated to be between 3% and 5%, although one study found that 10% to 20% of healthy people and 45% of people without a major psychiatric disorder have intermittent unfounded worries about their health; international rates are similar to US rates (Hilty). |
Source: Medical Disability Advisor
| History: Individuals with hypochondriasis believe they have a serious illness. They are preoccupied with minor symptoms and with persistent fear of illness for at least 6 months, despite the absence of an apparent physical disorder or of abnormal medical findings. The individual's belief that he or she has a serious illness is usually based on a misinterpretation of shifting symptoms that may be specific or vague. Physical exam: The physical exam is usually normal. Tests: Invasive diagnostic tests should be minimized, but appropriate psychological and psychiatric evaluation should be performed to rule out related disorders. |
Source: Medical Disability Advisor
| Treatment may be difficult. Sometimes reassurance helps. If continued reassurance does not ease the individual's concerns, improvement may sometimes result from a trusting relationship with a caring physician. Group rather than individual therapy is most helpful. Coexisting mental health conditions should be treated.
Techniques used to treat obsessive-compulsive disorder (OCD) may also be effective for hypochondriasis. Two such techniques, cognitive therapy and exposure and response prevention (ERP), are showing favorable research results. Use of antidepressant and anti-anxiety medications may be effective when hypochondriasis coexists with a depressive or anxiety disorder. |
Source: Medical Disability Advisor
| Perhaps 5% at most of affected individuals recover permanently, but 33% of individuals with this disorder eventually show significant improvement (Hilty). Hypochondriasis has been shown to fluctuate in intensity, with periods of relative remission and exacerbation that may wreak havoc in the individual's life. A good prognosis seems to be linked to higher socioeconomic status and the absence of a medical condition or other mental health disorder. The prognosis is poorer if a psychoanalytic treatment approach is used or if depression coexists. |
Source: Medical Disability Advisor
| A coexisting anxiety or mood disorder, especially major depression, complicates the course and prognosis of hypochondriasis. The individual's refusal of psychological treatment and any life stresses (e.g., financial, marital) may exacerbate the disorder. A bona fide disease may be overlooked and go untreated because of the individual's previously unfounded complaints. |
Source: Medical Disability Advisor
| Work restrictions or accommodations are generally only necessary for the most serious cases. In these instances, time-limited restrictions and work accommodations should be individually determined, based on the characteristics of the individual's response to the disorder, the functional requirements of the job and work environment, and the flexibility of the job and work site. The restrictions/accommodations should help the worker remain at the workplace without a work disruption and promote timely and safe transition back to full work productivity. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Have existing medical conditions been ruled out through medical history and physical exam by a physician?
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Has a psychological evaluation been performed?
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What is individual's health care history?
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Has individual previously been under medical supervision for this same problem?
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Was medical condition previously established or ruled out?
Regarding treatment:
- Were physical exam and diagnostic testing performed to identify or rule out an organic basis for complaints?
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Were existing complaints treated symptomatically as appropriate?
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Is individual scheduled for or receiving regular follow-up visits?
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Because it is very difficult for individual to accept that the health problem is not a serious organic illness, is individual and/or family receiving psychotherapy to help deal with this situation?
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Is individual involved in group therapy that provides needed support and social interaction? Is therapy sufficient to reduce fear and anxiety?
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Is antidepressant or anti-anxiety medication warranted?
Regarding prognosis:
- Is individual making an effort to avoid going to different doctors and getting repeat medical tests?
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Is individual involved in an effective group therapy?
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Is individual able to focus on other aspects of life and move on?
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Would additional psychotherapy help?
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Source: Medical Disability Advisor
| Hilty, Donald M., and Shayna L. Marks. "Hypochondriasis." eMedicine. Eds. Sarah C. Aronson, et al. 6 Oct. 2004. Medscape. 11 Oct. 2004 <http://emedicine.com/med/topic3122.htm>.Maleki, Meysa. "Hypochondriasis." Counseling and Learning Skills Service. 9 Jun. 2003. University of Toronto. 11 Oct. 2004 <http://www.calss.utoronto.ca/pamphlets/hypochondriasis.htm>. Phillips, Katharine A. "Hypochondriasis." The Merck Manual of Home Health Care. Ed. Mark H. Beers. 2nd ed. Whitehouse Station, NJ: Merck Research Laboratories, 2003. 603-604. |
Source: Medical Disability Advisor