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The Condition of Worrying about Medical Conditions
Individuals with hypochondriasis hold a persistent belief that they have a serious disease even though they present with minor or no symptoms. These patients often misinterpret normal bodily sensations and refuse to accept reassurances from different physicians that no physical illness or abnormality is causing them. Hypochondriasis is similar to obsessive-compulsive disorder (OCD) with its obsessions and compulsions to relieve the anxiety that causes these obsessive thoughts. A majority of people with hypochondriasis, also experience depression, anxiety, or some other psychiatric disorder.
Hypochondriasis is a highly treatable condition. The first step in treatment tends to be a physical checkup with additional tests to rule out physical disease or illness. Your health care professional may ask you specific questions or use psychological tests to further rule out other related disorders, such as anxiety or OCD. You may next be referred to a mental health professional (a psychologist or psychiatrist) to diagnose and treat you.
Hypochondriasis treatments range from psychotherapy and stress management to complementary and alternative therapies. Medication is not specifically prescribed to manage hypochondriasis. Since anxiety and depression are associated with the condition, though, selective serotonin reuptake inhibitors (SSRIs) are sometimes used to improve symptoms. These medications are antidepressants. If other psychological or physical conditions are present, health care professionals may prescribe other medications.
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Treatments for Hypochondriasis
Psychotherapy is the primary treatment for hypochondriasis. In fact, cognitive-behavioral therapy (CBT), a form of psychotherapy, may be the most effective treatment. CBT works to decrease the behavioral, cognitive, physiological and affective changes that maintain anxiety and cause negative thoughts to spiral out of control. Behavior associated with hypochondriasis includes constantly checking your body for problems, seeking reassurance that you are not ill, and avoiding activities and situations that may worsen a feared disease. Cognitive factors include a preoccupation with health and illness, while physiological factors, such as labored breathing and palpitations, increase anxiety. Individuals with hypochondriasis also tend to experience depressive symptoms as a result of thinking they are seriously ill.
Engaging hypochondriacs in therapeutic intervention can be the most critical, and most difficult, part of treatment. Many with hypochondriasis are extremely reluctant to seek psychological therapy, fearing this treatment will further delay physical examinations. So, patients may come to therapy by order of relatives or physicians, who refuse to further treat patients without psychological assessment.
The therapist’s style is crucial in establishing trust with the patient. In the initial meeting, the therapist spends time acknowledging the patient's complaints. The patient, whose symptoms may have been dismissed in the past, will be watching for similar attitudes. The therapist, in discussing diagnosis and treatment, will reflect on cases of hypochondriasis he or she has treated to lessen the individual’s isolation with the condition.
The next part of the assessment is used to draw a complete psychological formulation of the patient’s concerns with specific examples. The patient is asked to hypothesize the cause of their concerns, and they may suggest an undiagnosed illness that requires additional treatment. As a competing hypothesis, the psychological formulation is presented. If the patient accepts this competing hypothesis, and many patients surprisingly do, a course of treatment using psychological techniques is completed. Reassurance that additional medical treatment can be sought if the patient still suspects illness is also offered.
In addition to engaging the patient in therapy, the other components of CBT include:
- Self-monitoring – asking patients to record health concerns, noting symptoms, anxiety levels, negative thoughts, and actions taken.
- Identifying and re-attributing negative thoughts – recognizing errors in cognition and thinking of rational causes of symptoms. Testing rational explanations when possible.
- Modifying abnormal behaviors related to illness - preventing the need for reassurance by explaining that the patient does not require constant assurance, that he or she is not sick and that such comments would deter effective treatment.
- Identifying and re-attributing dysfunctional beliefs – listing examples in which physical symptoms are not the result of physical illness to challenge false beliefs.
Other treatments can be effective at managing stress, which can improve symptoms of hypochondriasis. Acupuncture is believed by some to help balance the flow of energy in the body. This balancing effect may be especially therapeutic for individuals experiencing distorted perceptions of normal body sensations. Acupuncture may help reduce emotional stress and physical pain, relieve ongoing fear and apprehension, regulate sleep, and boost energy. Likewise, some health care professionals believe that regular massages, which include stress-relieving techniques, may help reduce symptoms of hypochondriasis. Regular visits to massage therapists, however, could cause some individuals to focus on their physical complaints, and increase their belief that they are seriously ill.
Since stress and anxiety may exacerbate the symptoms of hypochondriasis, individuals should regularly practice stress management on their own. Eating a balanced diet, getting exercise, meditating, and reducing or eliminating alcohol and caffeine intake can reduce stress. These practices, in combination with CBT, can make this chronic condition more manageable and hypochondriasis treatments more effective. Early psychological intervention, a good relationship with your primary health care professional, along with intense motivation to change, may increase the chances of getting better.
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University of Maryland Medical Center. www.umm.edu/altmed/articles/hypochondriasis-000089.htm
Warwick, Hilary M.C. “Cognitive therapy in the treatment of hypochondriasis." Advances in Psychiatric Treatment. Royal College of Psychiatrists, 1998.