1. Introduction
Hypochondriasis is one of the most frequent seen somatoform patterns, with a prevalence in general medical practice of between 4 and 9 percent. The disorder is characterized by multiple and stubbornly held complaints about possible physical illness even though no evidence of such illness can be found. Hypochondriacal complains are usually not restricted to any physiologically coherent symptom pattern; rather, they express a preoccupation with health matters and unrealistic fears of disease. Although hypochondriacal people repeatedly seek medical advice, their concerns are not in the least lessened by their doctors’ reassurances- in fact they are frequently disappointed when no physical problem is found.
In the past hypochondriasis was considered as mental illness but the later researches prove that it is rather an anxiety disorder. Because it is characterized by anxiety or fear that one has a serious disease. Therefore, the essential problem is anxiety, but its expression is different from that of the other anxiety disorders. In hypochondriasis, the individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease. Almost any physical sensation may become the basis for concern for individuals with hypochondrioasis. Some may focus on normal bodily functions such as a cough. Some individuals complain of very vague symptoms, such as aches or fatigue.
2. Clinical description
Like many terms in psychopathology, hypochondriasis has ancient roots. To the Greeks, the “hypochondria” was the region below the ribs, and the organs in this region affected mental state. For example, ulcers and abdominal disorders were once considered part of the hypochondriacal syndrome. As the actual causes of such disorders were discovered, physical complaints without a clear cause continued to be labeled hypochondreasis. In hypochondriasis, severe anxiety is focused on the possibility of having serious disease. The threat seems so real that no amount of reassurance, even from physicians, will help for long.
3. Major characteristics
Individuals with hypochondriasis may complain of uncomfortable and peculiar sensations in the general area of the stomach, chest, head, genitals, or anywhere else in the body. Complete physical examination and investigations do not show presence of any significant abnormality. They usually have trouble giving a precise description of their symptoms, however. They may begin by mentioning pain in the stomach, which on further questioning is not really a pain but a gnawing sensation, or perhaps a feeling of heat, or of pressure. The mental orientation of these individuals keeps them constantly on the alert for new symptoms.
Hypochondriarcal patients are likely to be avid readers of popular magazines on medical topics and are apt to feel certain that they are suffering from every new disease they read or hear about. Tuberculosis, cancer, exotic infections, and numerous other diseases are readily self-diagnosed by these individuals. Their morbid preoccupation with bodily processes, coupled with their often limited knowledge of medical pathology leads to some interesting diagnoses. Such individuals are sure they are seriously ill and cannot recover. Yet- and this is revealing – despite their exaggerated concerns over their health, they do not usually show the intense fear or anxiety that might be expected of those suffering from such horrible ills. In fact they are usually in good physical condition. Nevertheless, they are sincere in their conviction that the symptoms they detect represent real illness. Hypochondriacal persons often show a notable preoccupation with digestive and excretory functions. Some keep charts of their bowel movements, and most are able to give detailed information concerning diet, constipation and related matters. Many as suggested earlier, use a wide range of self-medications of the type frequently advertised on television. However, they do not show the losses or distortions of sensory, motor and visceral functioning that occur in conversion disorder; nor so their complaints have the bizarre delusional quality- such as “insides rotting away” or “lungs drying up”- that occurs in some psychotic disorders.
4. Statistics
We know very little about the prevalence of hypochondriasis in the general population. Early estimates indicate that anywhere between 1% and 14% of medical patients are diagnosed with hypochondriasis. Later estimates cite a range of 4% to 9% of patients in general medical practice. Although historically considered one of the “hysterical” disorders unique to women, the sex ratio is actually 50-50. It was thought for a long time that hypochondriasis was more prevalent in elderly populations, but this does not seem to be true. In fact, hypochondriasis is spread fairly evenly across various phases of adulthood. Naturally more elderly people go to see physicians, making the absolute number of patients in this age group somewhat higher than in the younger population. Hypocondriasis may emerge at any time of life, with the peak age periods found in adolescence, middle age (40s and 50s), and age 60.
5. Causes
Investigators with generally differing points of view agree or psychopathological processes ongoing in hypochondriasis faulty interpretation of physical signs and sensations as evidence of physical illness is central, so almost everyone agrees that hypochondriasis is basically a disorder of cognition or perception with strong emotional contributions.
Individuals with hypochondriasis experience physical sensations that are common to all of us, but they quickly focus their attention to these sensations. Remember that the very act of focusing on yourself increases arousal and makes the physical sensations seem more intensive than they actually are. If you also tend t misinterpret these as symptoms of illness, your anxiety well increase further. Increased anxiety produces additional physical symptoms, in a vicious cycle. Using procedures from cognitive science such as the Stoop test, Hithcock and Mathews confirmed that subjects with hypochondriasis show enhanced perceptual sensitivity to illness cues. They also tent to interpret ambiguous stimuli as threatening. Thus, they quickly become aware of any sign of possible illness or disease. A minor headache, for example, might be interpreted as a sure sign of a brain tumor. Once again, this cycle is similar to what happens in panic disorder.
What causes individuals to develop this pattern of somatic sensitivity and distorted believes? Although we are not sure, we can safely say the solution is unlikely to be found in isolated biological or psychological factors. There is every reason to believe that the fundamental causes of hypochondriasis runs in families a possible genetic contribution may be nonspecific, such as a tendency to over respond to stress, and thus may be indistinguishable from the nonspecific genetic contribution to anxiety disorders. Hypperresponsivity might combine with a tendency to view negative life events as unpredictable and uncontrollable and therefore, to be guarded against at all times.
We know that children with hypochondriacal concerns often report the same kinds of symptoms that other family members may have reported at one time. It is therefore quite possible, as in panic disorder, that individuals who develop hypochondriasis have learned from family members to focus their anxiety on specific physical conditions and illness.
Three other factors may contribute to this etiological process. First, hypochondriasis seems to develop in the context of a stressful life event, as do many disorders, including anxiety disorders. Such events often involve death or illness. Second, people who develop hypochondriasis tend to have had a disproportionate incidence of disease in their family when they were children. Thus, even if they did not develop hypondriasis until adulthood, they carry strong memories of illness that could easily become the focus of anxiety. Third, an important social and interpersonal influence may be operating. Some people who come from families where illness is a major issue seem to have learned that an ill person is often paid increased attention. The “benefits” of being sick might contribute to the development of the disorder. A sick person who thus receives more attention and less responsibility is described as adopting a sick role. These issues may be even more significant in somatization disorder.
6. Treatment
Unfortunately, we know very little about treating hypochondriasis. Scientifically controlled studies have appeared only recently. Warwick, Clark, Cobb and Salkovskis randomly assigned 32 patients to either cognitive behavioral therapy or a no-treatment wait-list control group. Treatment focused on identifying and challenging illness related misinterpretation of physical sensations and on showing patients how to create “symptoms” by focusing attention on certain body areas. Bringing on their own symptoms persuaded many patients that such events were under their control. Patients were also coached to seek less reassurance regarding their concerns. Patients in the treatment group improved an average of 76% and those in the wait-list group only 5%; benefits were maintained for 3 months.
Although it is common clinical practice to uncover unconscious conflicts through psychodynamic psychotherapy, results on the effectiveness of this kind of treatment have seldom been reported. Surprisingly, clinical reports indicate that reassurance seems to be effective in some cases, because patients with hypochondriasis are not supposed to benefit from reassurance about their health. However, reassurance is usually given only very briefly by family doctors have little tome to provide the ongoing support and reassurance that might be necessary. Mental health professionals may well be able to offer reassurance in a more effective and sensitive manner, devote sufficient time to all the concerns the patient may have, and attend to the meaning of the symptoms. Participation in support groups may also give these people the reassurance they need. It is very likely we will see more research on the treatment of hypochondriasis in the future.
Conclusion
Most of us as children learn well the lesson that, when we are sick, special comforts and attention are provided and, furthermore, that we are excused from a number of responsibilities or at least are not expected to perform certain chores up to par. This lesson has been learned all too well by the hypochondriarchal adult. Such an adult is in effect saying I deserve more of your attention and concern and you may not legitimately expect me to perform as a well person would. Typically these messages are conveyed with more than a touch of angry rebuke, inconsolable demand.
Hypochondriasis may be viewed as a certain type of needful interpersonal communication as well as a disorder involving abnormal preoccupation with disease. Treatment of the latter in the absence of an appreciation of the former frequently produces clinical frustration, if not exasperation. In fact, it may be that the impatience with which many physicians react to these patients has the unintended effect of maintaining or increasing their fears of abandonment and an early demise from some terrible condition that remains undetected by an insufficiently caring physician.
