Hypochondriasis

Introduction[edit | edit source]

Illness anxiety disorder (IAD) (formerly known as hypochondriasis, a name that has been updated in the DSM-5[1] due to the negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition.[2] IAD is an overwhelming fear that you have a serious disease or life-threatening illness even though health care providers confirm to you that you have only mild symptoms or no symptoms at all.[3] IAD is characterised by ongoing worry or fear of getting a significant medical condition that would negatively impact one's daily activities. Despite normal physical examination findings and laboratory test results, the fear persists.[4] People with IAD overreact to normal physical sensations (such as digestion or sweating) and misunderstand these sensations as symptoms of serious disease. IAD is often a long-term condition.[2]

Prevalence[edit | edit source]

The prevalence of IAD is mainly unclear because this diagnosis is new. However, in the general population, the estimated prevalence of IAD is 0.1%, whereas in the medical outpatient setting, it is approximately 0.75 percent. Adolescents without a gender majority are prone to IAD, which usually gets worse with age. Less educated and unemployed people are more likely to suffer from IAD.[2][5]

Aetiology[edit | edit source]

The specific cause of sickness anxiety disorder is still unknown. Multiple risk factors, however, have been linked to the development of this condition. Some of which are:

  • If a person spends an inordinate amount of time on the internet researching health-related topics, he or she may be at an elevated risk of acquiring IAD.[2]
  • If they had a serious disease as a child or if their parent(s) or siblings had a serious medical condition.[4][6]
  • People with underlying anxiety disorders (e.g., generalised anxiety disorder).[7]
  • If a person was raised in a family where health concerns were regularly mentioned, or if their parents were overly concerned about health-related matters.[6]

Clinical Presentation[edit | edit source]

  • Patients continue to have a significant crippling concern and anxiety about an underlying dangerous medical illness, despite a normal physical examination, laboratory testing, and repeated reassurance
  • Even if another medical condition is present, the worry with their health is plainly excessive and disproportionate to the severity of the problem
  • Patient is dissatisfied with negative assessments and consult many physicians for the same medical concern
  • Patients may also indicate that they inspect their bodies frequently for skin blemishes, hair loss, or physical abnormalities
  • They may also obsess with death and disability
  • They may have concerns about their health, including the possibility that their social and occupational functioning will be considerably hampered

NOTE:

  • People suffering from illness anxiety disorder frequently seek initial assistance from their primary care provider rather than a mental health care professional.
  • Most patients with IAD are in these two groups:
  1. A care-seeking type. These patients often use the healthcare system and change doctors. They may request several studies and therapies.
  2. A care-avoidant type. These patients avoid seeking medical attention. They are terrified that the primary doctor or laboratory testing would disclose a life-threatening illness.

[2][8][7]

Associated Co-morbidities[edit | edit source]

  • Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.[3]
  • Substance abuse and dependence is also common among this population.[9]
  • A study at a general medicine outpatient clinic demonstrated that 88% of patients with hypochondriasis also had one or more other psychiatric disorders. These included general anxiety disorder (71%), Dysthymic disorder (45.2%), major depression (42.9%), Somatization disorder (21.4%) and panic disorder (16.7%). This study also stated that patients are 3 times more likely to have a personality disorder than the general population.[9]

Treatment/Management[edit | edit source]

Doctor patient.png

It is essential to note that psychotherapy is the first-line treatment of IAD, while pharmacological drugs are second-line.[2][4]However, The majority of patients require both psychotherapy and pharmacological treatment.[7]

  • Cognitive-behavioral therapy (CBT) is a type of psychotherapy that involves behavioural modification strategies to cure the patient's dysfunctional maladaptive cognitive beliefs. It may address the patient's habit of excessively monitoring his or her body for indicators of sickness. CBT also includes instruction on common bodily feelings and their variations.[2]
  • Acceptance and commitment therapy, group therapy, and mindfulness-based cognitive therapy may also be used.[7]
  • Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be beneficial in this condition.[4]

Some other things to note:

  1. Primary care providers should strive to build rapport and a therapeutic relationship with their patients so that they feel at ease addressing their health concerns.
  2. Patients' concerns and fears must be acknowledged.
  3. If necessary, the patient may be referred to other healthcare specialists.

[2][7]

Physiotherapy Management[edit | edit source]

Current evidence on Physical Therapy Management of hypochondriasis is limited. However, there has been a growing amount of research in the field of exercise-based and somatic therapies for the treatment of anxiety disorders in recent years.[10] Some of these are:

  • Movement therapy, particularly aerobic exercise and strength training, appears promise because it has been shown to have anxiolytic benefits.[11]
  • Scandinavian physiotherapists have developed approaches for treating mental health illnesses such as Basic Body Awareness Therapy (BBAT) and Norwegian Psychomotor Therapy (NPMT). Both approaches aim to enhance the body-mind connection and help patients acquire physical and psychological flexibility and strength.[12][13]
  • Passive treatments, on the other hand, such as manual therapy, have only been proved to be useful in the short term.[14][15]

Differential Diagnosis[edit | edit source]

The following diagnoses need to be screened for when initially assessing IAD:

  • Obsessive-compulsive disorder (OCD)[16]
  • Somatic symptom disorder (SSD)[17]
  • Generalized anxiety disorder (GAD)[18]
  • Body dysmorphic disorder (BDD)[19]

References[edit | edit source]

  1. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8.
  2. 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 Newby JM, Hobbs MJ, Mahoney AEJ, Wong SK, Andrews G. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res. 2017;101(5):31-37.
  3. 3.0 3.1 Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis
  4. 4.0 4.1 4.2 4.3 Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407.
  5. Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015 Sep;17(3):327-35.
  6. 6.0 6.1 Alberts NM, Hadjistavropoulos HD, Sherry SB, Stewart SH. Linking Illness in Parents to Health Anxiety in Offspring: Do Beliefs about Health Play a Role? Behav Cogn Psychother. 2016 Jan;44(1):18-29.
  7. 7.0 7.1 7.2 7.3 7.4 French JH, Hameed S. Illness Anxiety Disorder. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.
  8. Almalki M, Al-Tawayjri I, Al-Anazi A, Mahmoud S, Al-Mohrej A. A Recommendation for the Management of Illness Anxiety Disorder Patients Abusing the Health Care System. Case Rep Psychiatry. 2016;2016:6073598.
  9. 9.0 9.1 Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall
  10. KOVAČ AM, UMEK DP, KRESAL DF. The role of physiotherapy in the treatment of anxiety disorders.
  11. Kandola A, Vancampfort D, Herring M, Rebar A, Hallgren M, Firth J, Stubbs B. Moving to beat anxiety: epidemiology and therapeutic issues with physical activity for anxiety. Curr Psychiatry Rep. 2018;20(63).
  12. Gyllensten AL, Skoglund K, Wulf I. Basic body awareness therapy: Embodied identity. Stockholm: Vulkan; 2018.
  13. Gyllensten AL, Skoglund K, Wulf I. Basic body awareness therapy: Embodied identity. Stockholm: Vulkan; 2018.
  14. Kukimoto Y, Ooe N, Ideguchi N. The effects of massage therapy on pain and anxiety after surgery: A systematic review and meta-analysis. Pain Manag Nurs. 2017;18(6):378-390.
  15. Grafton-Clarke C, Grace L, Roberts N, Harky A. Can postoperative massage therapy reduce pain and anxiety in cardiac surgery patients? Interact Cardiovasc Thorac Surg. 2018;28(5):716-721.
  16. Goodman WK, Grice DE, Lapidus KA, Coffey BJ. Obsessive-compulsive disorder. Psychiatr Clin North Am. 2014 Sep;37(3):257-67.
  17. Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Fam Physician. 2016 Jan 01;93(1):49-54.
  18. Maron E, Nutt D. Biological markers of generalized anxiety disorder. Dialogues Clin Neurosci. 2017 Jun;19(2):147-158.
  19. Fang A, Matheny NL, Wilhelm S. Body dysmorphic disorder. Psychiatr Clin North Am. 2014 Sep;37(3):287-300.