PSYCHOLOGY CORNER

PSYCHOSOMATIC DISORDERS:

HYPOCHONDRIA

By

AMY L. CHAVES

Sept. 24, 1999

CONTEXT:

What is hypochondria?

A person with hypochondria is preoccupied with physical health and body. The diagnosis is used when a person during at least 6 months believes, fears or is convinced that he has a serious disease despite medical reassurance. This fear of disease or preoccupation with symptoms is unpleasant, interferes with the patient's daily life in a negative way and leads to medical examinations and/or treatment. The patient can only temporarily accept assurance that there is no physical explanation to his symptoms.

Is hypochondria a medical diagnosis?

In common language hypochondriac indicates a person who thinks he is ill or merely imagines that he has symptoms. However, hypochondria, or excessive health anxiety, is as serious as any other medical diagnosis. It has always been a part of the official medical diagnostic systems, and still is. Hypochondria must be "positively diagnosed", i.e. it is not enough to exclude physical disease, and the exaggerated health anxiety must also be found. Hypochondria is as common in men as in women, and can be found in all age groups and social classes.

What are typical symptoms in hypochondria?

The physical symptoms are always real, but might be "normal" physical signs (like headache, belly pain, dizziness, fatigue etc). which are misinterpreted as more dangerous than they really are. The physical symptoms may change or can be stable over time, and they can be vague or quite specific.

EXPERIENCE:  

          I used to think that my mother was a hypochondriac.  She used to have many illnesses even when she was younger.  A loose bowel movement is for her, a serious problem.  She wanted me to run to the nearest pharmacy and buy her medicine.  If she has a headache, it is major news.  Or if I am the one who would get sick, she will imagine a more serous illness than the symptoms.  So I disliked her for that because she caused undue anxiety and stress in me.

          When she was finally diagnosed to have cancer I did not tell her about it because she was always magnifying her illnesses.  This one she could not anymore magnify.  This time, she need not know because I know how it would affect her.  But I was wrong.  Even if I did not tell her, somehow she knew that she was dying.  This time, she was no longer a hypochondriac.  She was a realist—not adding to, nor subtracting from her illness.

          So I am glad to know that my mother was not a hypochondriac after all. She was just very much concerned about her health and body because there were just the two of us.  If she gets very sick, and I was still younger then and single, she might have been thinking of how I could possibly cope living alone without her.  Her concern about her health and body was her way of loving me—she did not want to go at that time.

          I have not really met a real hypochondriac person, thank God.  It must be difficult to be around that person.  He/She must always be talking about his/her health and the imagined illnesses or diseases that are not really there.

          However, imagining or believing that one has a serious disease like cancer may produce the cancer-like symptoms.  This is the case of psychosomatic disorder.  What the mind thinks affects the body and vice-versa.

REFLECTION:

          I believe that what is in the mind affects every single cell of the body.  Just thinking that one has brain tumor even if it is only a case of migraine, can cause brain tumor symptom.  On the other hand, if the mind can cause symptomatic disease, the mind is also capable of healing a real disease (like what happened to Rio Diaz).  I believe so much in the power of the mind. It can be the source of some diseases or the healer of some real and even serious diseases.

Can hypochondria be treated?  Yes. However, it might take time and the tendency to have exaggerated health anxiety might not completely vanish (after all it is normal to fear cancer). However, the patient with hypochondria can realize that he has anxiety, and not a serious physical disease, and gradually reduce his anxiety. The patient is not healed when he realizes that he has health anxiety (just as a person can still be afraid of flying even though he knows it), but it is an important first step. When hypochondria begins in conjunction with a major life event (for instance, your are 40 years old and somebody close to you dies) treatment takes shorter time than if you have always been cautions, anxious and afraid of physical disease.

ACTION:

Sometimes, the person manifesting a hypochondriac behavior may just be needing attention and love, just like my mother.   The first step is to listen, try to understand, and show care and concern.  However, the person must still be examined to reduce the anxiety level.

How is hypochondria treated? At Deaconess Home Hospital Haraldsplass in Bergen, psychologists use cognitive-behavioural treatment, sometimes combined with medication. In the first consultation the patient explains his symptoms, and the psychologists make an evaluation whether he has been examined good enough. Of course doctors never discuss whether the patient has his symptoms or not. Symptoms (like pain, nausea, numbness etc.) are always subjective, and hence "accepted". However, doctors do discuss how to interpret the symptoms. What do they mean? Most patients believe that something serious must be present. They cannot imagine that symptoms like they have can be caused by anxiety.

During the treatment the patient register the thoughts that go through his mind when he notices his physical symptoms. Hypochondriacs choose the most serious, but often least probable, explanation. Headache is not migraine or stress but brain tumor; chest pain is not caused by tense muscles but is serious heart attack and so on. These thoughts are then discussed and alternative explanations are tested out. Often patients with hypochondria have beliefs like: It is normal to feel completely well all the time.  A physical symptom is a sign that something serious is wrong in my body. You can be 100% sure that you are completely well.  Doctors often misdiagnose cancer. The program includes homework assignments which might be behavioral (less checking of the body, activation etc.) or cognitive work (registration of situations, thoughts, feelings and behavior).

Current research:

Research fellow Jørn Bødtker is planning an epidemiological study of hypochondriasis. He is also examining if patients with hypochondria have visceral hypersensitivity (in the stomach). Some people have a sensitive body, i.e. they notice things that other people do not notice or ignore. If the patients do not have this visceral hypersensitivity their main problem might be the misinterpretation of completely normal bodily symptoms - or there might be a combination of different factors. We are also doing a 1 year prospective randomized clinical trial comparing cognitive-behavioral therapy with paroxetin (a serotonin reuptake inhibitor).

BIBLIOGRAPHY:

            Halgin, Richard & Susan Krauss Whitbourne. ABNORMAL PSYCHOLOGY: THE EXPERIENCE OF PSYCHOLOGICAL DISORDERS.  Updated With DSM IV. Madison: Brown & Benchmark. 1993.

            DSM-IV. 4^th Ed.  American Psychiatric Association.  1994.

            Http://mentalhelp.net. 7/28/1999.

************

http://amychaves.bizland.com/articles/hypochondria.htm