Hypochondriasis: Wikis

  
  

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Hypochondriasis
Classification and external resources
ICD-10 F45.2
ICD-9 300.7
MeSH D006998

Hypochondriasis (or hypochondria, often referred to as health phobia) refers to an excessive preoccupation or worry about having a serious illness.[1] 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, the concerns are far in excess of what is appropriate for the level of disease. Many people suffering from this disorder focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue.

The DSM-IV-TR defines this disorder, "Hypochondriasis," as a somatoform disorder[2] and one study has shown it to affect about 3% of the visitors to primary care settings.[3]

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. 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 are completely avoidant of any reminder of illness, whereas others are frequent visitors of 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.

Contents

Etymology and colloquial use

The term hypochondria comes from the Greek hypo- (below) and chondros (cartilage - of the breast bone), and is thought to have been originally coined by Hippocrates. It was thought by many Greek physicians of antiquity that many ailments were caused by the movement of the spleen, an organ located near the hypochondrium (the upper region of the abdomen just below the ribs on either side of the epigastrium). Later use in the 19th Century employed the term to mean, “illness without a specific cause,” and it is thought that around that time period the term evolved to be the male counterpart to female hysteria. In modern usage, the term hypochondriac is often used as a pejorative label for individuals who hold the belief that they have a serious illness despite repeated reassurance from physicians that they are perfectly healthy. Hypochondria is sometimes confused with malingering, an intentional falsification of illness for external gains such as avoiding work or school, or factitious disorder, an intentional falsification of illness to assume the sick role.

Manifestation and comorbidity

Hypochondriasis manifests in various ways. 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, considering the disease as a punishment for past misdeeds. [4]

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. [5]

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. [4] 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.)[citation needed]

Factors contributing to hypochondria

Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the Internet. The media and the Internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis (some of the diseases hypochondriacs commonly think they have) often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.

Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease. A simple suggestion of mental illness can often trigger one with hypochondria to obsess over the possibility.

It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.


A majority of people who experience physical pains or anxieties over non-existent ailments are not actually "faking it", but rather, experience the natural results of other emotional issues, such as very high amounts of stress.

Grief that finds no vent in tears makes other organs weep.

—Dr. Henry Maudsley, British psychiatrist

Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. [4] Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder).[6]

Some anxieties and depressions are believed to be mediated by problems with brain chemicals such as serotonin and norepinephrine. The physical symptoms that people with anxiety or depression feel are indeed real bodily symptoms, and are believed to be triggered by neurochemical changes. For example, too much norepinephrine will result in severe panic attacks with symptoms of increased heart rate and sweating, shortness of breath, and fear. Too little serotonin can result in severe depression, accompanied by a sleep disturbance, severe fatigue, and typically is treatable with medical intervention.[citation needed]

Treatment

If a person is sick 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; 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.[7][8][9][10][11] 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.

In the United States, NIH-funded studies are now underway to compare different treatment approaches for hypochondriasis: a study in the New York City area[12] and a study in the Boston area.[13] In these studies, patients will be given one of four treatments: supportive therapy with fluoxetine, supportive therapy with placebo, cognitive behavior therapy, or cognitive behavior therapy with fluoxetine. For more information, visit the external links cited below.

See also

References

  1. ^ "Hypochondriasis". University of Maryland Medical Center. http://www.umm.edu/altmed/articles/hypochondriasis-000089.htm. 
  2. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised, Washington, DC, APA, 2000.
  3. ^ Escobar JI, Gara M, Waitzkin H, Silver RC, Holman A, Compton W (1998). "DSM-IV hypochondriasis in primary care". Gen Hosp Psychiatry 20 (3): 155–9. doi:10.1016/S0163-8343(98)00018-8. PMID 9650033. http://linkinghub.elsevier.com/retrieve/pii/S0163-8343(98)00018-8. 
  4. ^ a b c Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616.
  5. ^ Barsky AJ: Hypochondriasis and obsessive-compulsive disorder. Psychiatr Clin North Am 1992; 15:791-801.
  6. ^ Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BAM, Grados, MA, Nestadt G: The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry 2000, 48:287-293.
  7. ^ Barsky AJ, Ahern DK: Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004; 291:1464-1470.
  8. ^ Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell M, Ludgate J, Ahmand S, Richards HC, Gelder M: Two psychological treatments for hypochondriasis, a randomized controlled trial. Br J Psychiatry 1998; 173:218-225.
  9. ^ Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz D, Liebowitz MR: The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 1996; 32:607-611.
  10. ^ Fallon BA, Qureshi AI, Schneiner FR, Sanchez-Lacay A, Vermes D, Feinstein R, Connelly J, Liebowitz MR: An open trial of fluvoxamine for hypochondriasis. Psychosomatics 2003; 44:298-303.
  11. ^ Greeven A, Van Balkom AJ, Visser S, Merkelbach JW, Van Rood YR, Van Dyck R, Van der Does AJ, Zitman FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007; 164:91-99.
  12. ^ "cumc.columbia.edu". http://www.illnessworry.cumc.columbia.edu. Retrieved 2007-12-20. 
  13. ^ "The Health Study - Home". http://www.thehealthstudy.com/index.html. Retrieved 2007-12-20. 

External links

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1911 encyclopedia

Up to date as of January 14, 2010

From LoveToKnow 1911

Medical warning!
This article is from the 1911 Encyclopaedia Britannica. Medical science has made many leaps forward since it has been written. This is not a site for medical advice, when you need information on a medical condition, consult a professional instead.

HYPOCHONDRIASIS (synonyms - "the spleen," "the vapours"), a medical term (from T6 inroxbvbpcov, Ta inroxbvbpca, the soft part of the body immediately under the Xovbpos or cartilage of the breast-bone)given by the ancients,and indeed by physicians down to the time of William Cullen, to diseases or derangements of one or more of the abdominal viscera. Cullen (Clinical Lectures, 1777) classified it amongst nervous diseases, and Jean Pierre Falret (1794-1870) more fully described it as a morbid condition of the nervous system characterized by depression of feeling and false beliefs as to an impaired state of the health. The subjects of hypochondriasis are for the most part members of families in which hereditary predisposition to degradation of the nervous system is strong, or those who have suffered from morbid influences affecting this system during the earlier years of life. It may be dependent on depressing disease affecting the general system, but under such circumstances it is generally so complicated with the symptoms of hysteria as to render differentiation difficult (see HYSTERIA). Hypochondriasis is often handed down from one generation to another in its individual form, but it is also not unfrequently to be met with in an individual as the sole manifestation in him of a family tendency to insanity. In its most common form it is manifested by simple false belief as to the state of the health, the intellect being otherwise unaffected. We may instance the "vapourish" woman or the "splenetic" as terms society has applied to its milder manifestations. Such persons are constantly asserting a weak state of health although no palpable cause can be discovered. In its more definite phases pain or uneasy sensations are referred by the patient to some particular region, generally the abdomen, the heart or the head. That these are subjective is apparent from the fact that the general health is good: all the functions of the various systems are duly performed; the patient eats and sleeps well; and, when any circumstance temporarily overrides the false belief, he is happy and comfortable. No appeal to the reason is of any avail, and the hypochondriac idea so dominates his existence as to render him unable to perform the ordinary duties of life. In its most aggravated form hypochondriasis amounts to actual insanity, delusions arising as to the existence of living creatures in the intestines or brain, or to the effect that the body is materially changed; e.g. into glass, wood, &c. The symptoms of this condition may be remittent; they may even disappear for years, and only return on the advent of some exciting cause. Suicide is occasionally committed in order to escape from the constant misery. Recovery can only be looked for by placing the patient under such morally hygienic conditions as may help to turn his mind to other matters. (See also NEUROPATHOLOGY.)


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