Hypochondriasis (Hypochondriac)

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Outline

Overview

What is Hypochondriasis?
1. Excessive fear about having an illness
  1. Becoming obsessive
2. Persists for at least 6 months or more
  1. Despite negative medical diagnosis
  2. Disease being feared can change
3. DSM-5
  1. Now known as Illness Anxiety Disorder
  2. Somatoform/Somatic Symptom Disorder
    1. Mental disorder
    2. Manifests as physical symptoms of illness
    3. Can’t be explained
Symptoms
1. Physical symptoms of disease
  1. Often exaggerated
2. Other physical issues worsened by stress
  1. Weight changes
  2. Heart palpitations
  3. GI distress
  4. Fatigue
3. Disproportionate anxiety about health
4. Excessively checking for signs of sickness
5. Care avoidant
  1. Avoid doctors/hospitals
6. Care seeking
  1. Frequent hospital/doctor visits
7. Paranoia about disease
Risk factors
1. Major stress
2. Major loss
3. History of other mental disorders
  1. Anxiety
  2. Depression
  3. OCD
4. History of childhood trauma
  1. Abuse
  2. Neglect
  3. Illness
5. Family history
Treatment
1. Therapy
  1. Cognitive Behavioral Therapy (CBT)
    1. Focus on changing
      1. Behaviors
      2. Thoughts
      3. Emotions
    2. Develops healthy coping strategies
  2. Behavioral stress management
    1. Teaches relaxation techniques
  3. Complementary and Alternative Therapy
    1. Meditation
    2. Yoga
2. Medication
  1. Given to treat underlying mental health condition
  2. SSRIs
    1. Decrease anxiety and depression symptoms
    2. Prozac, Elavil

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Today we’re going to be talking about Hypochondriasis.

In this lesson we will cover symptoms of hypochondriasis, risk factors and treatment options available to patients diagnosed with hypochondriasis.

What is hypochondriasis? The name you are probably more familiar with is hypochondria. Hypochondriacs have an excessive, sometimes unrealistic fear of having a serious disease to the point that the fear becomes obsessive. In order to be diagnosed with hypochondriasis, the fear has to persist for at least 6 months or more. This is despite any negative medical diagnoses. Also know, while the fear has to persist, the disease the person is afraid of can change. If you’re not familiar with the DSM-5, it’s the American Psychiatric Association’s manual for mental disorders. Hypochondriasis has been renamed in the 5th revision as Illness Anxiety Disorder. It’s defined as a somatic symptom disorder, which manifests as physical symptoms of an illness without actually having that illness and can’t otherwise be explained.

Symptoms of hypochondriasis you may have seen before in family members or friends. We like to label people as hypochondriacs as soon as they begin revealing that they “might” have a certain disease. For instance, I have a family member we lovingly, but very seriously call doctor, because any time you say something doesn’t feel right, she tells you what you may have. Someone with hypochondriasis does this to themselves daily. They often experience exaggerated symptoms of the disease they think they have, likely with other symptoms caused by the stress they are feeling from worrying about it like weight changes, GI distress and fatigue. These are the people you want to stay away from Google because they already have a very disproportionate anxiety about the symptoms and I’m sure you’ve seen that can get worse if the internet validates their thoughts. There are two types of hypochondriacs as well: those who are always at the doctor office or hospital looking for help with their illness and those who avoid doctors at all costs because they’re afraid they are right. Hypochondriacs even go to the extent sometimes of asking others to check their symptoms to validate their fear, asking questions like “am I sweating?” or “feel my head, is it warm?”

What causes hypochondriasis isn’t really known, but there are some risk factors that have been identified to include poor coping from a major loss or stress, or a history of another mental disorder such as OCD, depression or anxiety, a history of childhood trauma or family history. Just FYI, the major loss could have been a loved one to the same disease the person thinks they may have. Take cancer for instance. Having a family history and losing those close to me to that disease can often be the starting point to my fear that I have it too. It doesn’t have to be the specific disease either. If a male family member had prostate cancer, knowing I don’t have a prostate, I could turn that fear into having any other type of cancer.

The treatments for hypochondriasis vary from therapy all the way up to medication, and can overlap as well. Depending on how severe the diagnosis, a person may be receiving different treatment modalities at the same time. Cognitive Behavioral Therapy focuses in on changing a person’s behaviors, thoughts and emotions and developing healthier coping strategies to maintain the changes. Behavioral stress management and Complementary and Alternative Therapy are additional treatments that teach healthy coping and relaxation techniques such as meditation and yoga. On the medication side of treatment, SSRIs are the go to option to treat an underlying mental health issue. As we said earlier, anxiety, depression and OCD can sometimes be risk factors, and potentially underlying issues. By prescribing medications like Prozac, we are treating those illnesses and minimizing the symptoms exhibited in hypochondriasis.

Some key points to think about. Don’t leave this lesson thinking googling your cold symptoms is a sign of hypochondriasis. Remember, this is a disorder where the fear of disease is an irrational fear. It’s obsessive, and the constant thoughts of the disease create the symptoms of it. Those symptoms are more often than not exaggerated and made worse by the constant stress of it all, so it could potentially look like the person is truly sick. Again, even though we don’t know what the true causes are, mental health history can be a key factor and can be making the situation much worse. We discussed other risk factors as well so check your patient’s history for possible links! Finally, treatments for hypochondriasis vary. While we can medicate to treat what’s behind the disorder, we often try managing coping strategies and outlooks first.

Hypochondriasis (Hypochondriac)

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