Speaking of Health – Hypochondriasis

By Gilda Morales, ANP, DC

Today’s column is about a condition that is more common than one would think—hypochondriasis, or hypochondria, making up 25 to 50% of primary care visits.  It is defined as at least six months of the following symptoms:

•Greater than one physical symptoms which produce a belief that these symptoms are signs that there is a serious, underlying physical illness.

•Fear and anxiety that there is a serious medical problem present and unless treated, there could be significant harm, disability or death.

•Even after a thorough medical exam and workup showing no medical problem, the patient is not convinced that he/she does not have a serious medical condition.

•There is an obsessive quality to the behavior.

•The patient constantly seeks a physical diagnosis that would explain his/her symptoms.

The condition affects men equally as women, but women seem to seek treatment more than men.  The age that this condition usually hits is in the 30s or 40s.

The cause of hypochondriasis is not completely known, but there are some theories that have been explored.  There is some evidence that some patients have a much lower pain or discomfort threshold, or that some experienced numerous or serious actual medical illnesses during childhood, leading to hypochondriasis at an older age.  Another theory is that the patient may have experienced or witnessed a serious disease and fears a relapse.  Some research has shown that the patient may have an overwhelming need for attention, and playing the sick role is one way to receive that attention.  However, much of the patient’s time is taken up going to medical professionals looking for validation or reassurance of their symptoms.

Patients with anxiety or depression may experience physical symptoms as a manifestation of their anxiety or depression, and in some cultures, physical problems are acceptable, where mental conditions are not.

As with other conditions, there are some risk factors that may contribute to hypochondriasis including exposure to life-threatening conditions in themselves or others, or being raised by overprotective parents who obsess about their children’s health.

The diagnosis is made primarily by a thorough history with the patient reporting concern with perfectly normal symptoms such as heartbeats, sweating, hiccups, or gas.  The patient may also have an irrational concern about minor physical findings such as a small rash or common cough, or may report vague physical sensations. The actual physical examination usually  does not find any cause for the symptoms or their severity.

Treatment may include therapy, and regular medical appointments even if no new symptoms are present.  Although there is no specific medication for hypochondriasis, antidepressants and antianxiety medications are quite successful in patients who also suffer from depression and anxiety.


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