Hypochondriasis
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Hypochondriasis is
characterized by a preoccupation with fear of having or developing a serious
physical illness
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The fear is often a
result of unrealistic interpretation of physical signs or sensations as
evidence of disease
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The disorder is often
chronic, with symptoms present for months or years
Epidemiology
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The prevalence in general
medical setting is known to be 49%
▪
Slightly predominant in men
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The peak age of onset is
20-30
Etiology
1. Psycho-Dynamic Theory :
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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
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The aggressive and
hostile wishes towards others are transformed into physical complaints through
repression or displacement
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The hypochondriacal
symptoms have also been viewed as an expression of wishes for caring,
attention, and sympathy
2. Socio cultural theory :
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It is visualized as a
learned social behavior
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The behavior was learned
because of its success in past in eliciting caretaking and in securing the
other secondary gains of the sick role
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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
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According to this theory,
hypochondriasis is the result of an underlying perceptual or cognitive
abnormality
Diagnostic guidelines (ICD-10)
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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:
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Somatization disorder
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Depressive disorders
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Delusional disorders
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Anxiety and panic
disorders
Clinical presentations:
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Full file of medical
records
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Consulted a number of
doctors
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Undergone a variety of
diagnostic procedures
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The patient believes that
he has serious disease
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They keep on scrutinizing
their body functioning
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Always preoccupied with
their body appearance
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Often complain abnormal
body sensations, disturbed body functions or anatomical deviations suggesting
disease
Management
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Basic principle of treatment can be outlined
as :
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Treatment by a single
physician, with whom the patient feels confident
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Supportive approach and
regularly scheduled visits
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Avoidance of
hospitalizations, diagnostic procedures and medications as possible
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Focusing on symptoms and
gradually concentrating on social or interpersonal problems
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Supportive psychotherapy
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Treatment of associated
or underlying depression and anxiety, if present
Treatment Modalities
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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
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