HYPOCHONDRIA

By Ingvard Wilhelmsen, MD, Ph.D

What is hypochondria?

A person with hypochondria is preoccupied with physical health and body. The diagnosis is used when a person during at least 6 months believes, fears or is convinced that he has a serious disease despite medical reassurance. This fear of disease or preoccupation with symptoms is unpleasant, interferes with the patient's daily life in a negative way and leads to medical examinations and/or treatment. The patient can only temporarily accept assurance that there is no physical explanation to his symptoms.

Is hypochondria a medical diagnosis?

In common language hypochondriac indicates a person who «thinks he is ill» or merely «imagines that he has symptoms». However, hypochondria, or excessive health anxiety, is as serious as any other medical diagnosis. It has always been a part of the official medical diagnostic systems, and still is. Hypochondria must be "positively diagnosed", i.e. it is not enough to exclude physical disease, the exaggerated health anxiety must also be found. Hypochondria is as common in men as in women, and can be found in all age groups and social classes.

What are typical symptoms in hypochondria?

The physical symptoms are always real, but might be "normal" physical signs (like headache, belly pain, dizziness, fatigue etc). which are misinterpreted as more dangerous than they really are. The physical symptoms may change or can be stable over time, and they can be vague or quite specific.

Can hypochondria be treated?

Yes. However, it might take time - and the tendency to have exaggerated health anxiety might not completely vanish (after all it is normal to fear cancer). However, the patient with hypochondria can realize that he has anxiety, and not a serious physical disease, and gradually reduce his anxiety. The patient is not healed when he realizes that he has health anxiety (just as a person can still be afraid of flying even though he knows it), but it is an important first step. When hypochondria begins in conjunction with a major life event (f. inst. your are 40 years old and somebody close to you dies) treatment takes shorter time than if you have always been cautions, anxious and afraid of physical disease.

How is hypochondria treated?

At Deaconess Home Hospital Haraldsplass in Bergen we use cognitive-behavioural treatment, sometimes combined with medication. In the first consultation the patient explains his symptoms, and we make an evaluation whether he has been examined good enough. Of course we never discuss whether the patient has his symptoms or not. Symptoms (like pain, nausea, numbness etc.) are always subjective, and hence "accepted". However, we do discuss how to interpret the symptoms. What do they mean? Most patients believe that something serious must be present. They cannot imagine that symptoms like they have can be caused by f. inst. anxiety.

During the treatment the patient register the thoughts that go through his mind when he notices his physical symptoms. Hypochondriacs choose the most serious, but often least probable, explanation. Headache is not migraine or stress but brain tumor, chest pain is not caused by tense muscles but is serious heart attack and so on. These thoughts are then discussed and alternative explanations are tested out. Often patients with hypochondria have beliefs like: It is normal to feel completely well all the time - A physical symptom is a sign that something serious is wrong in my body - You can be 100% sure that you are completely well - Doctors often misdiagnose cancer. The program includes home work assignments which might be behavioral (less checking of the body, activation etc.) or cognitive work (registration of situations, thoughts, feelings and behavior).

There is an increased interest in hypochondria in the medical community as well as in media (Wall Street Journal).

Usually patients are referred to us from a General Practitioner but also from other hospitals. Some patients contact us directly and are advised by mail.

Current research:

Research fellow Jørn Bødtker is planning an epidemiological study of hypochondriasis. He is also examining if patients with hypochondria have visceral hypersensitivity (in the stomach). Some people have a «sensitive body», ie they notice things that other people do not notice or ignore. If the patients do not have this visceral hypersensitivity their main problem might be the misinterpretation of completely normal bodily symptoms - or there might be a combination of different factors. We are also doing a 1 year prosepctive randomized clinical trial comparing cognitive-behavioral therapy with paroxetin (a serotonin reuptake inhibitor).

Are you a hypochondriac? Test yourself.