Hypochondrias

Unlike a conversion disorder where an individual perceives a functional disorder and simply use it to escape from uncomfortable situations, hypochondriacs have no real illness, but is overly obsessed over normal bodily functions. They read into the sensations of these normal bodily functions the presence of a feared disease. The main features of this disorders are:

Because of misinterpreting bodily symptoms, the patient becomes preoccupied with ideas or fears of having a serious illness.

Appropriate medical investigation and reassurance do not relieve these ideas.

These ideas are not delusional (as in Delusional Disorder) and are not restricted to concern about appearance (as in Body Dysmorphic Disorder).

They cause distress that is clinically important or impair work, social or personal functioning.

They have lasted 6 months or longer.

These ideas are do better explained by Generalized Anxiety Disorder, Major Depressive Episode, Obsessive-Compulsive Disorder, Panic Disorder, Separation Anxiety or a different Somatoform Disorder.

Associated Features:

Schizophrenia
Major Depression
Dysthymic Disorder
Organic Brain Syndrome

Differential Diagnosis:

Some disorders have similar or even the same symptoms. The clinician, therefore, in his/her diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Major Depression
Obsessive Compulsive Disorder
Generalized Anxiety Disorder
Panic Disorder (can often cause prominent somatic complaints with no organic basis)

Cause:

This is a chronic illness which usually develops in middle age or later. Patients become excessively worried about a physical symptom and cannot shake the idea that something is seriously wrong with them. They are not overtly delusional in this belief, but they continue to worry despite evidence to the contrary. They seek many tests and much reassurance from their doctor. The patients often seem highly invested in their own suffering. Males and females are equally affected, and such patients tend to have obsessive and/or paranoid personality traits.

Treatment:

A supportive relationship with a clinician is the main objective of treatment. The clinician should inform the person that no organic disease is present, but that continued medical follow-up will help control the symptoms. The person with hypochondrias feels real distress, so the symptoms should not be denied or challenged by others.

Counseling and Psychotherapy

The person should be encouraged to discuss other problems rather than reinforcing the symptoms. Family cooperation will be helpful. The person with hypochondrias and the family need to be helped to find ways to deal with stress other than developing new symptoms.