Hypochondriasis

Hypochondriasis 

▪      Hypochondriasis is characterized by a preoccupation with fear of having or developing a serious physical illness

▪      The fear is often a result of unrealistic interpretation of physical signs or sensations as evidence of disease

▪      The disorder is often chronic, with symptoms present for months or years

Epidemiology

▪      The prevalence in general medical setting is known to be 49%

▪      Slightly predominant in men

▪      The peak age of onset is 20-30 

Etiology

1. Psycho-Dynamic Theory :

▪      It describes hypochondriasis as an alternative channel to deflect sexual, aggressive or oral drives or an ego- defense against guilt and low esteem or as sign of excessive self concern

▪      The aggressive and hostile wishes towards others are transformed into physical complaints through repression or displacement

▪      The hypochondriacal symptoms have also been viewed as an expression of wishes for caring, attention, and sympathy

2. Socio cultural theory :

▪      It is visualized as a learned social behavior

▪      The behavior was learned because of its success in past in eliciting caretaking and in securing the other secondary gains of the sick role

▪      They may have assumed the sick role initially as a result of an accident, injury or medical illness or by modeling themselves after someone, who successfully used the sick role

3. Neuropsychological theory

▪      According to this theory, hypochondriasis is the result of an underlying perceptual or cognitive abnormality

Diagnostic guidelines (ICD-10)

▪      For a definite diagnosis, both of the following should be present:

a. Persistent belief in the presence of at least one serious physical illness underlying the presenting symptom or symptoms, even though repeated investigations and examinations have identified no adequate physical explanation, or a persistent preoccupation with a presumed deformity

b. Persistent refusal to accept the advice and reassurance of several different doctors that there is no physical illness or abnormality underlying the symptoms

Differential diagnosis:

▪      Somatization disorder

▪      Depressive disorders

▪      Delusional disorders

▪      Anxiety and panic disorders

Clinical presentations:

▪      Full file of medical records

▪      Consulted a number of doctors

▪      Undergone a variety of diagnostic procedures

▪      The patient believes that he has serious disease

▪      They keep on scrutinizing their body functioning

▪      Always preoccupied with their body appearance

▪      Often complain abnormal body sensations, disturbed body functions or anatomical deviations suggesting disease

Management

▪       Basic principle of treatment can be outlined as :

▪      Treatment by a single physician, with whom the patient feels confident

▪      Supportive approach and regularly scheduled visits

▪      Avoidance of hospitalizations, diagnostic procedures and medications as possible

▪      Focusing on symptoms and gradually concentrating on social or interpersonal problems

▪      Supportive psychotherapy

▪      Treatment of associated or underlying depression and anxiety, if present

Treatment Modalities

▪      Drug therapy

ü  Antidepressants

ü  Benzodiazepines

▪      Psychological treatment

ü  Supportive psychotherapy

ü  Relaxation therapy

Undifferentiated somatoform disorder

▪      When physical symptoms are multiple, varying and persistent, but the complete and typical picture of somatization disorder is not fulfilled, this category is to be considered