Worried Sick: Hypochondriasis

January 24, 2013 — Leave a comment

You might know someone (or be someone) who is always worried about being sick or contracting some horrible disease. We joke about hypochondriacs, but it’s a very real condition that can affect the lives of those with the condition and those who love them.

Imagine you’re experiencing unsettling heart palpitations. Despite every imaginable test, the results consistently return negative. Nada. Nothing! A huge relief, right? Well, not for everyone. Instead of relief, many feel disbelief, insisting that something is terribly wrong.

The term “hypochondriasis” is a medical term that is often misunderstood and has negative connotations. However, when properly used, hypochondriasis is another way to label the experience of having intense worries and fears about disease that persist despite the constant reassurance from medical staff and testing.

Physical sensations like tenderness, dizziness, swelling, palpitations or pain are very real; they are not made up. What becomes problematic is these symptoms are repeatedly misread, regardless of how benign are.

Hypochondriasis is one of the oldest diseases on record. The term was introduced by Hippocrates (who lived 460 B.C. to 370 B.C.) It was an anatomical term called the “hypochondrian,” the space underneath your rib cage where the spleen is. In Hippocratic medicine the spell was thought of as the source of melancholy or black bile.

Today, the term “hypochondriasis” is about to be extinct! Due to the pejorative nature of the term, the disorder will most likely be classified in the about-to-be-released fifth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-5) as “Health Anxiety” with a possible connection to OCD (Obsessive Compulsive Disorder). Currently, it’s a somatoform disorder which a more of a grab-bag of mental illnesses related to the body.

Most of us worry needlessly about being a hypochondriac! According to one study, 85 to 90 percent of the most common symptoms, like headaches or pain, can’t be explained by a doctor. What makes it hypochondriasis is simply behavior. One person will say, “I have a headache; I don’t know why. I’ll take an aspirin!” Another might say, “I have a headache. The doctor can’t determine why…….I have a tumor!”

There are two frequent flyers to physician’s offices: Hypochondriacs and the Worried-Well. The later group responds to health reassurances by saying, “I’m relieved to hear that it’s nothing serious. Whew! That’s just what I wanted to hear. I’m outta here ââ?¬Ë?til next year’s physical, doc. Bye bye!”

The hypochondriacal patient responds to medical reassurance with fear and anger. Their symptoms and complaints are intensified. “What if you missed something? You would take this more seriously if it were happening to you! I’m going to find another doctor who will really listen to me!”

Sadly, sometimes patients are dismissed and it turns out they indeed that had some horrendous illness. We all know that happens…but it is the rare exception! The bottom-line is that more hypochondriacal patients are harmed more by overly aggressive and invasive tests than they are by under-aggressive management of symptoms.

IF YOU OR SOMEONE YOU LOVE IS WORRIED-SICK

RECOGNIZE RISK FACTORS

  • Having a serious illness during childhood
  • Knowing someone who has have been diagnosed with serious disease
  • The death of a loved one
  • Having an anxiety disorder
  • Believing that physical symptoms and unusual bodily sensations are problematic (instead of normal and common)
  • Having close family members with hypochondria
  • Feeling especially vulnerable to illness or disease

ACCEPT STATUS

Accept the reality that you often jump to conclusions and, at this time, that’s just how it is. Say to yourself, “Oops! There is that thought again that my headache is a brain tumor. I often do this and chances of it really being a brain tumor are minuscule. But it’s where my thoughts go and that’s normal for me……now I think I’ll go take out the garbage.”

Worry and anxiety is a vicious cycle; worries lead to more physical symptoms…which leads to more worry and anxiety! Dedicated work with a combined medical and psychological staff can help one “head-off” the negative thought processes and learn to manage anxiety.

TRAIN BRAIN

There is an effective treatment plan for Health Anxiety. Since two-thirds of people suffering with Health Anxiety have coexisting psychiatric disorders, like depression, anxiety, panic disorder and obsessive-compulsive disorder, a combined therapeutic approach works best:

* Psychological counseling

Cognitive Behavioral Therapy ~ CBT is talking therapy focused on helping a person change their destructive and unhelpful patterns of thinking. The key for Health Anxiety is to better cope with and manage symptoms. Exposure therapy has also proven effective in helping a client directly confront health fears in a safe environment, teaching them how to cope with otherwise debilitating sensations.

* Anti-Depressant Medication

SSRI’s (Prozac and Luvox) and Tricyclic antidepressant medications (Tofranil and Anafranil) can help alleviate depression and anxiety often associated with health anxiety.

  • Maintain good working relationships with providers

Visits should be scheduled regularly rather than on an as-needed basis. Physicians can better care for patients by accepting the fact that somatic symptoms, without a medical basis, can be just as distressing as those resulting from actual disease.

AVOID TRIGGERS

  • Cyberchondria – looking aches & pains up on Internet and ruminating
  • Media coverage of inaccurate portrayal of disease risk
  • Publications of statistics regarding chronic illnesses
  • TV shows portraying serious diseases as random, obscure, inevitable.

GET PHYSICAL

Physical activity and exercise can help manage many health anxiety symptoms such as depression, stress, fear and anxiety. Consider walking, running, indoor tennis or swimming, or some other form of exercise.

Another good practice is to avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms of anxiety and depression and they will interact with prescribed medications, as well.

For those wanting to look outside traditional therapies, working with a Clinical Hypnotherapist can also have remarkable effects on anxiety management.

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Dr. Liz Hale

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