hypochondria

Hypochondria: description

The term hypochondria covers a whole range of diseases. It ranges from pronounced health awareness and health-oriented behavior to hypochondriacal delusion – the full picture of hypochondria. The most important characteristic of hypochondria is the fear of illness or illness, which is exacerbated by the misinterpretation of one’s own physical perceptions (such as the heartbeat).

Due to this morbid anxiety, which usually severely limits the quality of life of those affected, hypochondria often resembles a panic or anxiety disorder. In fact, however, it is counted among the so-called somatoform disorders. This group includes diseases in which emotional discomfort and stress are reflected in physical symptoms. However, this is not the main criterion of hypochondria, which is why their association with somatoform disorders is controversial.

Hypochondria: frequency

A number of well-known people are or were said to suffer from hypochondria. These include Charlie Chaplin, Frederick the Great, Woody Allen or Thomas Mann. Overall, probably around one percent of Germans are affected by hypochondria. The full picture of the disease, the hypochondriacal delusion, can be found in about 0.05 percent of Germans – that is, five out of every 10,000 people. Mild health-related fears show six percent of the population. At university, psychotherapeutic ambulances, hypochondriacs make up a quarter of the patients. Worldwide, between two and seven percent of GPs are affected. Men and women are equally affected.

The unreported number of hypochondriacs is probably much higher, as there are also those who are not noticeable in the health system. This may be due to the fact that these hypochondriacs show a pronounced avoidance behavior or use alternative medicine. In general, hypochondriacs use the healthcare system unusually frequently and thus cause high costs.

So far, there is no reliable data regarding the age at which hypochondria break out. One third of patients claim to have had excessive anxiety about childhood illnesses as early as childhood. In principle, hypochondria can affect all age groups as well as men and women alike. Statistically, people of lower education are especially affected. A genetic predisposition plays in hypochondria from today’s perspective, only a minor role.

Some people sometimes develop hypochondriacal seizures after actual serious illnesses or experiences. But even after acquiring new information about health and illness, it can lead to hypochondriacal phases – such as with medical students.

Secondary hypochondria

Especially in the context of schizophrenic disorders and anxiety disorders, hypochondriacal symptoms can also occur as a non-independent clinical picture. In this case, the doctor speaks of a secondary hypochondria, which is primarily (first) triggered by another disease.

Hypochondria: symptoms

People with hypochondria are very afraid of disease. This fear of being sick can severely curtail life. It includes the concern of pain, disability, suffering and death. The fear is usually not unconscious, but stiffening on certain diseases. Hypochondriors also do extensive research and gather information about the dreaded diseases. Conversations and activities of everyday life are dominated by the fear of illness and disturb the social interaction.

In addition, in hypochondria there is the difficulty of enduring insecurity and the urgent need to clarify symptoms. And symptoms of any kind are perceived in an increased way: hypochondriacs pay attention to signals of the body very deliberately and exaggerated, so that they are already perceived in low intensity. Hypochondriacs are absolutely convinced that they have or will soon contract a disease. Catastrophic thoughts about one’s own state of health circle uninterruptedly in the head of the hypochondriac. This leads to insecurity and anxiety to severe panic attacks. The sufferers are more and more taken by the suffering.

Permanent guest in the waiting room or escape from doctors

To fight their excessive fear, hypochondriacs are increasingly looking for reinsurance – over and over again and more often. Many sufferers often examine themselves, run from one doctor to another and ask friends and family again and again for their opinion on the supposed disease symptoms. The purpose of this communication is to confirm that the suspected illness actually exists. Since this is usually denied, hypochondriac usually causes frustration and dissatisfaction.

On the other hand, there are also hypochondriacs who consciously avoid the health system in order to prevent a confrontation. For example, these people bypass hospitals and cemeteries.

The increased search for confirmation of one’s own health or illness is a central feature of hypochondria. Symptoms and fears can be alleviated successfully only in the short term, so that the cycle soon starts again at the faulty disease views.

Conscientious health care

In addition, hypochondriacs are increasingly trying to protect themselves from a disease: they conscientiously change their diet, do a lot of sports and develop a lifestyle that is as healthy as possible.

Focus on specific organs and diseases

For the most part, the anxiety associated with hypochondria affects the gastrointestinal tract, muscles and skeleton, as well as the nervous system. Often, the focus is on diseases such as skin or breast cancer. Those affected very often examine the skin or the breast for signs of cancer. Oftentimes, hypochondriacs are very well informed about the disease and see all the descriptions met with them. It is important that hypochondriacs actually have the described symptoms, they do not simulate.

Depressed and narcissistic features

In addition, hypochondriacs are often depressive-melancholic and may show narcissistic behavior. Narcissism is conspicuous in this context, above all because of overestimation and desire for attention. Some specialists in hypochondria assume an association with a neurotic personality. This is characterized by a disturbed mental development.

Therapy can help or hurt

If a hypochondriac is offered help in the form of a therapy for his supposed illness, it often has a contradictory effect. Instead of improving the condition, there are often more complications, side effects and an intensification of existing symptoms. In addition, the hypochondriac can discover symptoms of a new kind in itself.

Diverse clinical picture

Overall, the clinical picture of hypochondria is very heterogeneous, so that different subtypes are characterized according to the dominance of individual symptoms. As the disease progresses, health concerns can affect all areas of life, resulting in a significant reduction in quality of life. This can lead to conflicts, especially at work and in relationships.

Hypochondria: causes and risk factors

There are several theories for the development of hypochondria, but so far the cause has not been conclusively resolved. In addition, it is often unclear whether hypochondria is a completely independent disease or, more importantly, a symptom of another disease, such as depression.

The usually exaggerated disease views, which are mainly due to the overestimation of the probability and severity of a disease, are considered to be an important basis for the development of hypochondria. The over- and misinterpretation of body signals is a crucial step on the way to severe hypochondriacal phases.

Often, hypochondriacs have lower self-esteem than other people, with a sense of vulnerability. You feel that you have an increased risk of illness.

Hypochondria is also characterized by the desire for attention and help. Often sufferers have the experience that as a sick person can draw a high attention to themselves.

In particular, the deep-psychological explanation assumes an experience in childhood as a trigger of hypochondria. The diseases a hypochondriac is particularly afraid of are often related to previous experiences. For example, in cases of increased skin cancer anxiety, it may be the case that a close relative or the person affected earlier had a skin cancer. Even an earlier confrontation with death can shape the patterns of thinking and behavior so that hypochondria develop later.

Overall, hypochondria can be interpreted as a coping and self-healing strategy for other problems.

Hypochondria: examinations and diagnosis

Get first aid hypochondriac with your family doctor. This usually has the best overview of real illness concerns and the health of the patient. So he is usually best able to distinguish between exaggerated fears and actual health risks.

After a detailed conversation, the family doctor can refer the patient to a psychiatrist or psychologist. The patient must agree, because his willingness is a fundamental condition for the initiation of a therapy of hypochondria.

However, it is safe to rule out that there is no organic disease that could explain the symptoms described before starting a psychotherapeutic treatment for hypochondria. These are in particular multiple sclerosis, the severe morbid muscle weakness myasthenia gravis, hormonal disorders, thyroid disorders and tumors.

Investigations with the psychiatrist or psychologist

The examination by the psychiatrist or psychologist consists of an intensive conversation in which various points are discussed. To ensure a reliable diagnosis, modern tests are used. These objectify the suspected diagnosis of hypochondria. Test means questionnaire in this sense. It includes specific questions about the symptoms of hypochondria, such as:

• Does the thought of illness scare you?
• Do you go to the doctor often?
• Are you worried about your health?
• Do you have physical complaints?
• How do you react to the fear of illness?

Such a “hypochondriac test” can also be found on the Internet, for example the “Illness Attitude Scales” (IAS). With the help of such tests it can generally be investigated whether there is hypochondria, which elements of hypochondria are present and how severe these are.

Diagnostic criteria for hypochondria

It is important to distinguish between a temporary worry of being ill and the exaggerated fear of illness. In order to be able to diagnose hypochondria, the following criteria must therefore be fulfilled according to the American Diagnostic Catalog (DSM-V):

• Excessive preoccupation with illness or illness
• Physical symptoms are not present or only in mild form. If severe symptoms are present, employment should be judged to be excessive and inappropriate.
• The person concerned has a high level of anxiety about health concerns and is easily worried about health issues.
• Exaggerated health-related behavior or prevention of health issues
• The fear must last at least six months. However, the dreaded disease can vary.
• Medical examinations yielded negative results. There is no better explanation for the symptoms than hypochondria, especially no general anxiety disorder or panic disorder.

Forms of hypochondria

Experts distinguish between two subtypes of hypochondria: while one group of hypochondriacs increasingly seek medical care, the other group tries to avoid medical care.

A different classification provides the current American classification system for psychiatric diseases: A subset of hypochondria is characterized primarily by physical symptoms, while in the other sub-form anxiety plays a greater role.

Differentiation to other diseases

It can be difficult to distinguish a panic disorder from a hypochondria. While people suffering from a panic disorder fear the acute consequences of illness, hypochondriacs pay particular attention to the long-term perspective rather than the acute situation.

General anxiety disorders, unlike hypochondria, are characterized by a variety of nonspecific concerns.

Unlike people with somatization disorders, hypochondriacs are less concerned with the symptom itself than with its consequences and significance.

OCD may also be considered as an alternative diagnosis of hypochondria. Other delineated, psychiatric disorders are phobias: phobics are afraid of a disease they do not yet have. In contrast, hypochondriacs usually assume that they already have the disease, even if it has not yet appeared.

Hypochondria: treatment

The therapy of hypochondria consists mainly of psychotherapy. With drugs, the hypochondriacal disorder is treated only in severe cases.

For the most part (as with anxiety disorders), cognitive-behavioral psychotherapy is chosen as the therapy method. On the one hand, the goal of this therapy is to change thought patterns (cognitive) of the hypochondriac. For this purpose, the overestimation of the probability of a disease should be reduced. On the other hand behavioral patterns of the patient should be adapted. This concerns above all the constant protection by doctor visits. In addition, declarations of intent can be formulated by the patient. The course of hypochondriac therapy of this direction is divided into different phases:

Cognitive Behavioral Psychotherapy: Introduction

In most cases, psychotherapeutic help is used only years after the onset of hypochondria. The insight of the patient that his suffering is based primarily on an exaggerated fear, must be strengthened especially at the beginning of the therapy. To do this, the therapist will guide the patient from the perceived symptoms to the anxiety. At the end of the therapy session, which lasts several sessions, the goals of the patient are defined.

Cognitive-behavioral psychotherapy: main part

The actual therapy concentrates on two main points: On the one hand, the increased perception of misperceptions should be worked on, on the other hand it is necessary to adapt the behavior of the patient.

The first focus is aimed at the Perception of physical discomfortthat misinterpret a serious anxiety trigger, change. To achieve this, alternative explanations for the discomfort are worked out. This can be done using various experiments.

One of these experiments is the so-called somatosensory amplification. It is based on the assumption that the perception (sensory) of the symptoms (somato-) is based on increased attention. To illustrate this, the hypochondriac is prompted to concentrate for one day on an unaffected area of ​​the body, for example a foot. Prompt is then usually reported on various symptoms such as pain or tingling. Together, new and more realistic explanations are sought for these sensations.

In addition, the connection between anxiety or panic attacks and triggering (stress) factors in hypochondria is revealed. This can be written, for example, disease anxiety logs. With their help, relationships between stress and anxiety can be shown.

The aim of all procedures is the development of alternative explanations for the symptoms that trigger the hypochondriac anxiety of being ill. For back pain, for example, this would be a permanent malpractice.

The second central starting point of psychotherapy in hypochondria is reducing the so-called seeking security behavior, This behavior includes the frequent examination of one’s own body, the constant desire for reinsurance and the avoidance of health issues and places such as hospitals. These patterns of behavior give relief to the hypochondriac in the short term. However, as the patient often has to repeat them in order to feel safe, his life is significantly impaired.

To remedy this situation, the hypochondriac should first describe the type of reinsurance. This can be, for example, the constant search of the skin for fear of skin cancer. Together with the therapist, consequences of this behavior are analyzed. On this basis, a letter of intent can be prepared, which will be further specified later. For example, it can be specified that the hypochondriac examines its skin only once a month. This must be substantiated with understandable arguments. It is important that the hypochondriac has a record of it. This allows for retrospective reinsurance for himself, as well as the analysis of relapses into old patterns of behavior.

Also useful in the treatment of hypochondria is the direct confrontation with anxiety-triggering situations, which the hypochondriac normally evades (the same is done in the treatment of an anxiety disorder). Some hypochondriacs, for example, avoid shaking hands with strangers for fear of becoming infected with pathogens. The confrontation with such an anxiety-filled situation can at first only be done in thought, as the patient imagines the scenario, mentally pursuing this idea and enduring it. Such confrontations can also be carried out in real terms. The patient should try to endure the situation without the usual protective reactions. Certain triggering situations can also be discussed and analyzed.

Cognitive-behavioral psychotherapy: graduation

At the end of psychotherapeutic therapy for hypochondria, the explanations and analyzes that have been worked out are summarized and vividly presented. Then arguments for and against the disease assumptions are discussed. It is important to distinguish between realistic and improbable arguments and to emphasize these differences.

The basis of the entire therapy must be the deliberately made decision of the hypochondriac to accept the therapy. The therapy is based on an eye-to-eye conversation from beginning to end, allowing the patient to develop new ways of thinking. The therapy is intended to enable those affected to consciously improve the handling of hypochondria in order to reduce their own suffering.

It is essential to explain to the patient the hypochondria, to secure the understanding and thus to help the hypochondriac. In order to meet these demands, a good relationship between patient and therapist is irreplaceable.

drugs

There are hardly any good studies on the drug therapy of hypochondria. In most cases, so-called selective serotonin reuptake inhibitors (SSRIs), especially fluoxetine, have been tested. They are used in many psychiatric illnesses. Serotonin is an important messenger in the brain, whose concentration is increased by this group of drugs. This is to improve the hypochondriacal symptoms. However, there is no investigation as to whether the effect persists after the end of therapy.

Which therapy works best?

In a comparison of psychotherapy, drug treatment, and no treatment, psychotherapy and drug were equally effective. Studies suggest that the positive therapeutic effect of psychotherapy lasts longer after cessation. Hypochondria, which arises as a result of other (psychiatric) disease (secondary hypochondria), can usually be successfully controlled by therapy of this disease.

Hypochondria: disease course and prognosis

Hypochondria can be in crisis. These crises can be triggered by situations that evoke certain associations or memories. Handling it can be significantly improved by a therapy.

Severe forms of hypochondria lead to impairments in all areas of life. In addition to working life, relationships with other people can also suffer.

Although the hypochondria can not be cured, however, a successful treatment can significantly reduce the suffering. Studies have shown that especially severely ill hypochondriacs benefit from cognitive-behavioral psychotherapy and experience relief. In general, the longer the hypochondria already exist and the heavier it is, the worse the prognosis. In addition, existing illnesses (especially mental illness such as anxiety or depression) can worsen the outcome of therapy. Such diseases must therefore be treated intensively at the same time.

Especially young patients have a great chance of getting them through therapy with their hypochondria can handle better.