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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox">
'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.]]  
'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's&nbsp;Pathophysiology of Complex Patient Problems project.]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}} &nbsp;
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}  
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== Definition/Description ==
== Introduction ==


Hypochondriasis, or hypochondria, has recently been coined the new term Illness Anxiety Disorder (IAD).<ref name="(1)">Hypochondriasis | Center for Behavioral Health | Cleveland Clinic [Internet]. My.clevelandclinic.org. 2016 [cited 8 April 2016]. Available from: https://my.clevelandclinic.org/services/neurological_institute/center-for-behavioral-health/disease-conditions/hic-hypochondriasis</ref>&nbsp;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.<ref name="(2)">Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis</ref> IAD can also make people misinterpret normal body sensations as signs of a serious illness or generate worries in people who do have a physical illness that they are sicker than they truly are.<ref name="(1)" /> It is normally a long-term condition that can vary in severity. Severity typically increases in times of stress and with increasing age. Most common age of onset is early adulthood.<ref name="(3)">[Internet]. 2016 [cited 8 April 2016]. Available from: ) http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064</ref> The excessive anxiety, not whether there is a presence or absence of illness, tends to be the most disabling.
Illness anxiety disorder (IAD) (formerly known as hypochondriasis, a name that has been updated in the DSM-5<ref>Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8.</ref> due to the negative connotation) is a psychiatric disease characterised by excessive worry about having or developing a serious undiagnosed medical condition.<ref name=":0">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.</ref> 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.<ref name="(2)">Hypochondriasis [Internet]. University of Maryland Medical Center. 2016 [cited 8 April 2016]. Available from: http://umm.edu/health/medical/altmed/condition/hypochondriasis</ref> 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.<ref name=":1">Scarella TM, Boland RJ, Barsky AJ. Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment. Psychosom Med. 2019;81(5):398-407.</ref> 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.<ref name=":0" />


== <ref name="(4)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#a6</ref>Prevalence <br>  ==
== Prevalence    ==
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.<ref name=":0" /><ref>Bandelow B, Michaelis S. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015 Sep;17(3):327-35.</ref>


*Primary Hypochondriasis- 0.8-4.5% in primary care settings
== Aetiology  ==
*10-20% of healthy individuals demonstrate&nbsp;different levels&nbsp;of preoccupation with disease
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:
*45% of people without a diagnosis of a major psychiatric dissorder have intermittent unsubstantiated concerns about illness


== Characteristics/Clinical Presentation  ==
* 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.<ref name=":0" />
* If they had a serious disease as a child or if their parent(s) or siblings had a serious medical condition.<ref name=":1" /><ref name=":3">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.</ref>
* People with underlying anxiety disorders (e.g., generalised anxiety disorder).<ref name=":2" />
* 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.<ref name=":3" />


• Excessive worry or fear over having or getting a serious illness for at least six months<ref name="(1)" />[[Image:Laptop.jpg|right|300x250px]]
== Clinical Presentation  ==


• Persons concern of mild or non-symptoms are out of proportion<ref name="(1)" />
* 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


• Misinterpreting normal body symptoms<ref name="(2)" />
NOTE:


• Persistent fear of illness despite reassurance of health status by health care providers<ref name="(2)" />
* 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:


• Frequently scheduling doctor appointments for reassurance or avoiding medical care due to fear of being diagnosed<ref name="(3)" />
# A care-seeking type. These patients often use the healthcare system and change doctors. They may request several studies and therapies.
# 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.


• High Level of anxiety over personal health status<ref name="(1)" />  
<ref name=":0" /><ref>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.</ref><ref name=":2">French JH, Hameed S. Illness Anxiety Disorder. [Updated 2023 Jul 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023.</ref>
 
• Repeatedly checking body for signs of illness<ref name="(3)" />  
 
• Avoiding people, places or activities for fear of health risks<ref name="(3)" />  
 
• Overly excessive worry about a specific disease/illness because it runs in the family<ref name="(3)" />  
 
• Frequently searching the Internet for causes/symptoms of possible severe illness<ref name="(3)" />
 
• Difficulty maintaining a job, keeping relationships, and performing daily activities due to anxiety and distress<ref name="(2)" />


== Associated Co-morbidities  ==
== Associated Co-morbidities  ==


Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.<ref name="(2)" /><br>  
* Hypochondriasis is often accompanied by other psychological conditions such as obsessive compulsive disorder and anxiety.<ref name="(2)" />
 
* Substance abuse and dependence is also common among this population.<ref name="(5)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall</ref>
Substance abuse and dependence is also common among this population.<ref name="(5)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-overview#showall</ref>  
* 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.<ref name="(5)" />
 
A study at a general medicine outpatient clinic demonstrated that 88% of patients with hypochondriasis also had one or more other psychiatric disorders.&nbsp; These included general anxiety disorder (71%), Dysthymic disorder (45.2%), major depression (42.9%), Somatization disorder (21.4%) and panic disorder (16.7%).&nbsp; This study also stated that patients are 3 times more likely to have a personality disorder than the general population.<ref name="(5)" />  
 
== Medications  ==
 
Doctors typically don’t like to use drugs to treat hypochondriasis but may prescribe medication for the anxiety aspect of the disease.
 
• Antidepressants – such as Selective Serotonin Reuptake Inhibitors (Sertraline, Fluoxetine, Fluvoxamine, or Paroxetine)<ref name="(3)" /><ref name="(2)" />
 
== Diagnostic&nbsp;Criteria  ==
 
Diagnosis of Hypochondriasis is dependent upon presentation of symptoms and the patients behavior. These symptoms can be observed by a healthcare provider or it can be reported by people who are close to the patient such as family and friends.&nbsp; The patient can report these symptoms as well.&nbsp; It is important to note the frequency,duration, and severity of the symptoms.<ref name="(1)" /> Other signs to be aware of are frequent doctor's visits without significant findings, seeing multiple physicians or specialists for the same condition without significant findings, objective findings that do not match the patient's complaints, and previous losses of function that resolved spontaneously.<ref name="(6)">Thomson A, Page L. Psychotherapies for hypochondriasis. Protocols [Internet]. 2007 [cited 8 April 2016];. Available from: http://emedicine.medscape.com/article/290955-clinical</ref>
 
Characteristics of Hypochondriasis, now referred to as Illness Anxiety Disorder, as described by the DSM 5 are as follows:
 
*A preoccupation of having or getting a serious medical condition.<ref name="(7)">Illness anxiety disorder Tests and diagnosis - Mayo Clinic [Internet]. Mayoclinic.org. 2016 [cited 8 April 2016]. Available from: http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/tests-diagnosis/con-20124064</ref>
*The preoccupation of illness lasts up to or&nbsp;more than six months.&nbsp; The medical condition in question may change durring this time.<ref name="(7)" />
*Becoming easily worried about your health.<ref name="(7)" />
*Lack of physical symptoms. If physical symptoms are present they are mild.<ref name="(7)" />
*Excessive health related behaviors such as repeated checking for symptoms of a disease, or avoidance of medical examination due to a fear of being diagnosed with a serious condition.<ref name="(6)" /><ref name="(7)" />
*Excessive preoccupation of a current medical condition, or of a family history of a condition to the point of significant distress or impairment.<ref name="(6)" /><ref name="(7)" />
*The excessive preocupation can not be better explained by other mental disorders.<ref name="(7)" />
 
== Etiology/Causes  ==
 
True cause is unknown, but several factors may increase the risk of developing disease including:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
 
• Major life stress event<ref name="(1)" />&nbsp;
 
[[Image:Stress.jpg|left]]
 
• History of abuse or neglect as a child<ref name="(1)" />
 
• History of childhood illness<ref name="(1)" />
 
• Family history of hypochondriasis or anxiety issues<ref name="(3)" />
 
• Disturbance in perception that magnifies normal sensations<ref name="(3)" />
 
• Having another mental disorder (e.g. major depression, obsessive compulsive disorder, psychotic disorders)<ref name="(3)" />
 
<br>
 
<br>
 
<br>
 
== Systemic Involvement  ==
 
Though hypochondriasis is a physchological condition patients will percieve that they have a serious medical condition affecting them.&nbsp;Any normal bodily function or minor medical condition can be percieved as a serious medical condition by someone who presents with hypochondriasis.<ref name="(3)" /> This fear of illness can manifest in all regions and systems of the body whether symptoms of&nbsp;illness or dysfunction&nbsp;are present or not.<ref name="(1)" />&nbsp; Typically patients complain of pain in the trunk, head, and neck.<ref name="(2)" />
 
== Medical Management (current best evidence)&nbsp;&nbsp;  ==
 
It is recommended and ideal that the patient’s primary care provider (PCP) continues to be a vital role in the patient’s medical care. The individual should continue to see the PCP on a normal, regular basis (every three to six months) to address any ongoing concerns.<ref name="(1)" /> It is recommended that the patient should find one doctor that they are comfortable with and stick with them and not go back and forth between multiple doctors.
 
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; [[Image:Doctor_patient.png|125x100px]]
 
Psychotherapy, in particular Cognitive Behavioral Therapy (CTB) can be helpful for those with illness anxiety disorder when dealing with health anxiety. CTB is a common type of talk therapy that helps those patients cope with the fear and anxiety that is common with IAD. It can also be an effective way to learn strategies to live a more productive lifestyle and to function independently on a day-to-day basis.<ref name="(3)" />
 
Behavior stress management therapy is another resource that has been shown to be helpful in regards to learning relaxation techniques and how to handle stress and anxiety. Doctors may suggest using this in combination with Cognitive Based Therapy.<ref name="(2)" />
 
It is also suggested that individuals should be physically active and have a set routine for exercise as well as to stay involved in work, social and family activities. Other possible resources that may have some benefits when trying to manage symptoms include proper nutrition, acupuncture, and massage.<ref name="(2)" />
 
It is recommended that individuals avoid alcohol and any recreational drugs, as well as limiting reading any medical books and websites.<ref name="(3)" />
 
== Physical Therapy Management (current best evidence)  ==
 
Current evidence on Physical Therapy Management of hypochondriasis is limited.&nbsp; Due to the psychological nature of the disease there are often no physical symptoms that would benefit from physical therapy.&nbsp; If a patient is not improving with traditional therapeutic intervention, objective findings do not match the patient's complaints, and the patient fits the diagnostic criteria for hypochondriasis a referral to their primary care physician would be appropriate.&nbsp;
 
== <ref name="(3)" /><ref name="(8)">[Internet]. 2016 [cited 11 April 2016]. Available from: http://www.brown.edu/Courses/BI_278/Other/Clerkship/Didactics/Readings/Hypochondriasis.pdf</ref>Differential Diagnosis  ==
 
IAD can be difficult to diagnosis. To be diagnosed, the patient needs to be able to accurately describe the symptoms that they perceive as well as help from family members or individuals close to the patient who pick up on any symptoms that the individual may not be aware of.
 
The following diagnoses need to be screened for when discussing hypochondriasis:
<div class="column" style="color: rgb(69, 69, 69); font-family: UICTFontTextStyleBody; font-size: 17px;"></div>
*Briquet’s Syndrome
*Conversion Disorder
*Body Dysmorphic Disorder
*Malingering and Factitious Illness
*Depression
*Histrionic personality disorder
*Schizophrenia
 
There is always the possibility that the minor symptoms perceived do in fact indicate a serious disease. Each possible disease related to reported symptoms would need to be screened for.
 
== Case Reports/ Case Studies  ==
 
add links to case studies here (case studies should be added on new pages using the [[Template:Case Study|case study template]])<br>
 
1) Anandkumar S. Effect of Pain Neuroscience Education and dry needling on chronic elbow pain as a result of cyberchondria: a case report. Physiotherapy Theory &amp; Practice [serial on the Internet]. (2015, Mar), [cited April 7, 2016]; 31(3): 207-213. Available from: Academic Search Complete.<br>
 
http://eds.b.ebscohost.com/ehost/command/detail?vid=17&amp;sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&amp;hid=127&amp;bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=102076641&amp;db=a9h
 
<br>
 
2) Hadjistavropoulos H, Hadjistavropoulos T, Quine A. Health anxiety moderates the effects of distraction versus attention to pain. Behaviour Research And Therapy [serial on the Internet]. (2000, May), [cited April 7, 2016]; 38(5): 425-438. Available from: MEDLINE


http://eds.b.ebscohost.com/ehost/command/detail?vid=19&amp;sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&amp;hid=127&amp;bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#AN=10816903&amp;db=cmedm
== Treatment/Management  ==
[[Image:Doctor patient.png|right|175x125px]]It is essential to note that psychotherapy is the first-line treatment of IAD, while pharmacological drugs are second-line.<ref name=":0" /><ref name=":1" />However, The majority of patients require both psychotherapy and pharmacological treatment.<ref name=":2" />


<br>  
* 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.<ref name=":0" />
* Acceptance and commitment therapy, group therapy, and mindfulness-based cognitive therapy may also be used.<ref name=":2" />


3) Weck F, Neng J, Richtberg S, Jakob M, Stangier U. Cognitive therapy versus exposure therapy for hypochondriasis (health anxiety): A randomized controlled trial. Journal Of Consulting And Clinical Psychology [serial on the Internet]. (2015, Aug), [cited April 7, 2016]; 83(4): 665-676. Available from: PsycARTICLES.<br>  
* Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be beneficial in this condition.<ref name=":1" />


http://eds.b.ebscohost.com/ehost/detail/detail?vid=28&amp;sid=09c6d464-6683-4107-a2bb-80a3dd9e49e8%40sessionmgr102&amp;hid=127&amp;bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmUmc2NvcGU9c2l0ZQ%3d%3d#db=pdh&amp;AN=2014-55446-001
Some other things to note:


== Resources <br>  ==
# 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.
# Patients' concerns and fears must be acknowledged.
# If necessary, the patient may be referred to other healthcare specialists.


[http://umm.edu/health/medical/altmed/condition/hypochondriasis University of Maryland Medical Center]
<ref name=":0" /><ref name=":2" />


[http://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/basics/definition/con-20124064 Mayo Clinic]
== Physiotherapy Management  ==


[https://my.clevelandclinic.org/services/neurological_institute/center-for-behavioral-health/disease-conditions/hic-hypochondriasis Cleveland Clinic]
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.<ref>KOVAČ AM, UMEK DP, KRESAL DF. The role of physiotherapy in the treatment of anxiety disorders.</ref> Some of these are:


== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
* Movement therapy, particularly aerobic exercise and strength training, appears promise because it has been shown to have anxiolytic benefits.<ref>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).</ref>
* 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.<ref>Gyllensten AL, Skoglund K, Wulf I. Basic body awareness therapy: Embodied identity. Stockholm: Vulkan; 2018.</ref><ref>Gyllensten AL, Skoglund K, Wulf I. Basic body awareness therapy: Embodied identity. Stockholm: Vulkan; 2018.</ref>
* Passive treatments, on the other hand, such as manual therapy, have only been proved to be useful in the short term.<ref>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.</ref><ref>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.</ref>


see tutorial on [[Adding PubMed Feed|Adding PubMed Feed]]
== Differential Diagnosis  ==
<div class="researchbox">
<rss>http://www.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=16cUU5Jcud0BSZQpEj188GnbAbGfJoSCO1aRQbH6PiXHYcXUoj|charset=UTF-8|short|max=10</rss><br>


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


* Obsessive-compulsive disorder (OCD)<ref>Goodman WK, Grice DE, Lapidus KA, Coffey BJ. Obsessive-compulsive disorder. Psychiatr Clin North Am. 2014 Sep;37(3):257-67.</ref>
* Somatic symptom disorder (SSD)<ref>Kurlansik SL, Maffei MS. Somatic Symptom Disorder. Am Fam Physician. 2016 Jan 01;93(1):49-54.</ref>
* Generalized anxiety disorder (GAD)<ref>Maron E, Nutt D. Biological markers of generalized anxiety disorder. Dialogues Clin Neurosci. 2017 Jun;19(2):147-158.</ref>
* Body dysmorphic disorder (BDD)<ref>Fang A, Matheny NL, Wilhelm S. Body dysmorphic disorder. Psychiatr Clin North Am. 2014 Sep;37(3):287-300.</ref><div class="researchbox">
== References  ==
== References  ==
<references /></div>
<references responsive="0" /></div>

Latest revision as of 13:07, 1 February 2024

Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.

Top Contributors - Michael Fauser, Patrick Bailey, David Olukayode, WikiSysop, Simisola Ajeyalemi, Rujuta Naik and Elaine Lonnemann

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.
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