The hypochondriac’s epitaph: “NOW will you believe me?” – Unknown

Hypochondria, or as it is medically known, Hypochondriasis (sometimes referred to as ‘health phobia’ or ‘health anxiety’) is a condition in which a person believes that he or she is, or is likely to become, ill when no actual signs of illness can be identified.  It often involves symptoms when illness is neither present nor likely, and continues despite reassurance and medical evidence to the contrary.  If there is a medical illness their concerns are far beyond what is appropriate for the level of disease.  People suffering from hypochondriasis (hypochondriacs) often present themselves to their doctors over a long period of time as suffering from a series of different symptoms and diseases.  It is important to realize that people with this disorder do not intentionally create these symptoms.  They are not faking or lying about their symptoms; they truly believe they are sick and are simply unable to control them.

Hypochondriacs tend to misinterpret normal body sensations as being signs of serious illness.  It has an obsessive as well as a delusional component and is somewhat similar to obsessive-compulsive disorder, because of the obsession with illness and the compulsion to do something to lessen their anxiety.  An estimated 75 – 85% of people who suffer from this disorder also have anxiety, depression, or another mental disorder.  The onset of hypochondriasis most often occurs in men in their 30’s and in women in their 40’s. It occurs equally amongst men and women, and depression and alcoholism have been clearly demonstrated to worsen the condition.

Hypochondriacs will often examine their own body, and even though they may recognize that their fear of having a serious disease is unreasonable or unfounded, such knowledge does little to alleviate their worries and concerns.  The symptoms they describe can range from general complaints, such as pain or fatigue, to concerns about normal body functions, such as breathing or stomach noises.  Some of the signs and symptoms of a person suffering from hypochondriasis include:

• The person has a history of going to many doctors.  They may “doctor shop” for a doctor who will agree that he or she has a serious illness.
• Preoccupation with a serious illness for at least 6 months.
• A doctor’s reassurance does not calm the person’s fears.  In fact, they are often convinced the doctor is wrong or made a mistake.
• The person’s obsession about illness interferes with their job, keeping relationships, and performing normal daily activities.
• Misinterpreting normal body symptoms.
• The person is overly worried about a specific organ or system of the body, such as the heart, lungs or the digestive system.
• The person’s symptoms or focus of concern may shift or change over time.
• They may have recently experienced a significant loss or stressful event.
• The individual may have a history of anxiety and/or depression.

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 (OCD).  In fact, brain scan research suggests that hypochondriasis involves an increase of metabolic activity in the same areas of the brain that are affected in 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. Although some people might have both, these are very separate conditions.

Experts in the diagnosis and treatment of hypochondriasis describe severe health anxiety as a devastating condition that, if left untreated, can ruin lives.  The crucial difference between a casual worrier and a hypochondriac is that a hypochondriac’s imagination of disaster is unbending in the face of facts disproving their fear.  They describe hypochondriasis as a disorder of extreme internal vigilance in that individuals afflicted with this actually believe they are facing something that will kill them.  Health phobia is thought to be caused by both genetic and environmental factors. It is common for people with the disorder to have had difficult childhoods, but also have the natural

inclination to worry and obsess.

Treatment of hypochondriasis most often includes a combination of the following options:

• Supportive care — In most cases the best course of action is for the person to stay in regular contact with a trusted health care provider.  Within this doctor-patient relationship the doctor can monitor the symptoms and stay attentive to any changes that might signal a real medical illness. The doctor’s main approach is likely to focus on reassuring and supporting the person, and preventing unnecessary tests and treatments.  The individual should have only one primary care provider to avoid having too many tests and procedures.  This health care specialist should be honest about the fact that the person does not have a disease, but also that continued medical follow-up will help control the symptoms they are experiencing.
• Psychotherapy — Cognitive-behavioral therapy (CBT) and stress management are the cornerstones of treatment for hypochondriasis.  It can be helpful in changing the thinking and behavior that contribute to the symptoms. Therapy also can help:
  • Develop more effective methods of coping with their symptoms.
  • Recognize what it is that makes the symptoms worse.
  • Improve social and work functioning.

Unfortunately, most people with hypochondriasis deny there are any mental or emotional problems, making them fairly resistant to psychotherapy.

• Medicines — Medications are oftentimes used if a person also has a mood or anxiety disorder.  Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help reduce the worry and physical symptoms of this disorder.

• Acupuncture – Several studies have demonstrated that acupuncture may be of benefit in treating this disorder. Acupuncturists believe the procedure balances the flow of energy in the body. This balancing effect may be particularly helpful for people who have distorted perceptions of normal body sensations.

Hypochondriasis tends to be a long-term (chronic) condition that can last for years, and in many cases the symptoms can reappear. Only a small percentage of patients recover completely. For that reason, the focus of treatment is on learning to manage and control symptoms, and on minimizing functional difficulties associated with this disorder.

There are a number of highly qualified and capable Cognitive-Behavioral therapists within the Tri-Counties with extensive experience in treating hypochondriasis.  They can be found by entering “Cognitive Behavioral Therapists in (insert your local area)” on your favorite search engine.