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Hypochondriasis

Introduction:

Hypochondriasis, or hypochondria, is an overwhelming fear that you have a serious disease, even though health care providers can find no evidence of illness. People with hypochondriasis misinterpret normal body sensations as signs of serious illness. Most people occasionally fear they have an illness, but people with hypochondriasis are consumed with fear. This fear is severe and persistent, and interferes with work, as well as relationships. Complaints tend to focus on the head, neck, and trunk, often in the form of pain. Hypochondriasis is somewhat similar to obsessive compulsive disorder, because of the obsession with illness and the compulsion to do something to reduce their anxiety. An estimated 75 - 85% of people who have hypochondriasis also have anxiety, depression, or another mental disorder.



Signs and Symptoms:
  • Preoccupation with a serious illness for at least 6 months
  • Misinterpreting normal body symptoms
  • Persistent fear of illness despite reassurance of health status by health care providers
  • Difficulty maintaining a job, keeping relationships, and performing daily activities


What Causes It?:

No one knows what causes hypochondriasis, but there are several theories, including:

  • Disturbance in perception such that normal sensations are magnified.
  • The belief that an illness may be deserved due to some past real or imagined wrongdoing.
  • Having learned apparent benefits of being sick, such as receiving attention. Hypochondriasis may occur in an individual who had a childhood illness or had a sibling with a childhood illness.
  • May be related to another psychiatric disorder, such as anxiety or obsessive compulsive disorder. Hypochondriasis may develop from, or be a sign of, one of these other disorders.


Who's Most At Risk?:

These factors increase the risk of developing hypochondriasis:

  • Family history of hypochondriasis
  • Recent stressful event (for example, the death of a close friend or relative)
  • Serious childhood illness
  • Mental disorders, such as anxiety, obsessive-compulsive disorder, and depression.


What to Expect at Your Provider's Office:

Your health care provider will perform a physical examination along with other tests to determine whether a physical disease may account for your reported symptoms. Your health care provider will also ask specific questions and use psychological tests to rule out the possibility of other related disorders, such as anxiety or obsessive compulsive disorder. Your doctor may consult with a trained specialist, such as a psychologist or a psychiatrist, to aid in the diagnosis and treatment.



Treatment Options:

Treatment Plan

In addition to regular visits with a health care provider who will take physical symptoms seriously, people with hypochondriasis may also benefit from psychotherapy. Group therapy, behavior modification, and cognitive therapy have been reported to work particularly well (see Surgical and Other Procedures section for more details). People with hypochondriasis often have other mental health conditions, such as anxiety and depression, and treatment of these conditions is important in treating symptoms of hypochondriasis. Your health care provider may recommend limiting reading medical books and websites.

For more information, see Anxiety .

Drug Therapies

Doctors typically don't use drugs to treat hypochondriasis, but they may prescribe medication for associated mental health conditions. Such medications may improve symptoms of hypochondriasis. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, fluvoxamine, or paroxetine, are sometimes prescribed. At least one study found that fluoxetine was well tolerated and moderately effective for hypochondriasis.

Surgical and Other Procedures

Several types of psychotherapy may help:

  • Cognitive behavioral therapy helps identify thoughts that contribute to fears about illness and to correct the misinterpretation of body sensations. This type of therapy teaches people to concentrate less on thoughts and fears of illness and to use relaxation and distraction techniques.
  • Behavioral stress management therapy teaches stress management and relaxation techniques to help people avoid becoming focused on illness during stressful situations. It may be used together with cognitive behavioral therapy.

Complementary and Alternative Therapies

Cognitive behavioral therapy and stress management are the cornerstones of treatment for hypochondriasis. Acupuncture has also been shown to help. Similarly, participating in mindfulness techniques, such as meditation, may help patients manage symptoms. Beyond that, few studies have been done on complementary and alternative therapies for hypochondriasis. Regular appointments with a CAM health care provider may help relieve health-related fears because of the regularity of the visits, the reassurance from a professional, and the focus on wellness and healthy behaviors. Work with someone who is licensed and reputable to develop a solid program of self care and health promotion.

Nutrition

No scientific studies have examined the effect of nutrition on hypochondriasis. However, people with hypochondriasis who also have anxiety or depression may benefit from avoiding alcohol and caffeine.

Following these nutritional tips may also help reduce risks and symptoms:

  • Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat small, frequent meals throughout the day. This helps stabilize blood sugar (which can improve mood) and improve digestion (which may reduce awareness of normal body sensations as food passes through the intestines).
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy, if no allergy), or beans for protein.
  • Use healthy oils for cooking, such as olive oil or vegetable oil.
  • Reduce significantly or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. These fats are also found in French fries, onion rings, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Exercise moderately, for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • A multivitamin daily, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 2 tablespoonfuls oil daily, to help decrease inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin.
  • 5-hydroxytryptophan (5-HTP), 50 mg 2 - 3 times daily, for mood stabilization. Do not use when taking antidepressants or any psychoactive medications unless under the supervision of a doctor. Dangerous side effects can occur.
  • L-theanine, 200 mg 1 - 3 times daily, for nervous system support. If you are already taking medications for anxiety or depression, check with your doctor before taking L-theanine.
  • Melatonin, 1 - 6 mg 1 hour before bedtime, for sleep and immune protection. Ask your health care provider about potential prescription interactions.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

No herbs are specifically used to treat hypochondriasis, but certain herbs used to relieve stress or anxiety may help a person with hypochondriasis become less preoccupied with disease (which tends to worsen during stressful times). Other herbs may help lessen symptoms of hypochondriasis. Because many herbs interact with prescription antidepressants and anxiety medications, make sure your doctor is aware of all medications, herbs, and supplements you take.

  • St. John's wort (Hypericum perforatum) standardized extract, 300 mg 2 - 3 times per day, for depression. St. John's wort has serious drug interactions, including, but not limited to, birth control pills. Check with your health care provider if you are taking prescription medications for possible drug interactions with St. John's wort.
  • Kava kava (Piper methysticum) standardized extract, 100 - 250 mg 1 - 3 times a day as needed for stress and anxiety. The Food and Drug Administration has issued a warning concerning kava kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
  • Bacopa (Bacopa monniera) standardized extract, 50 - 100 mg 3 times a day, for stress and anxiety. Some researchers are concerned that Bacopa may increase secretions in the gastrointestinal tract, urinary tract, and lungs, and therefore, may not be appropriate for people with certain medical conditions. Speak with your physician. 

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Some health care professionals, however, believe that homeopathy promotes a sense of well being and may relieve feelings of anxiety and depression often associated with hypochondriasis. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Aconitum -- for a sense of panic and fear. This remedy is most appropriate for people who believe they are so sick they are going to die.
  • Arsenicum album -- for anxiety and fear of dying. This remedy is most appropriate for people who call the doctor often and are difficult to reassure, or children who may be worried about everything and tend to act more sick than they actually are.
  • Lycopodium -- for general fear and anxiety about health. This remedy is most appropriate for stressed people who complain of stomach problems.
  • Phosphorus -- for general anxiety about health. This remedy is most appropriate for people who fear that something bad will happen (a sense of impending doom), and may latch onto the fears of others, but tend to be easily reassured.

Acupuncture

Several studies indicate that acupuncture may be useful in treating hypochondriasis. Acupuncturists believe the procedure balances the flow of energy (qi) in the body. This balancing effect may be particularly helpful for people who have distorted perceptions of normal body sensations. Acupuncture may be useful for:

  • Relieving ongoing fear and apprehension
  • Reducing symptoms of emotional stress
  • Lessening stress and pain
  • Regulating sleep patterns
  • Improving energy

Massage

Some health care providers believe that regular visits to a massage therapist (which include techniques to relieve stress) may help reduce symptoms of hypochondriasis. It is possible, however, that for some people, having regular massages could draw attention to their physical complaints, and increase their symptoms.



Prognosis/Possible Complications:

Stress and anxiety may make the symptoms of hypochondriasis worse. Many people may also struggle with costly medical tests and develop a dependency on certain medications. Hypochondriasis is a chronic illness (it persists for a long time), but getting early psychiatric treatment and having a strong motivation to change may increase the chances of getting better. Some reports suggest that one third to one half of patients improve over time, and one tenth recover completely.



Following Up:

Try to maintain a healthy relationship with your primary health care provider. Your health care provider will want to schedule regular appointments to monitor your symptoms.



Supporting Research:

Fallon BA, Petkova E, Skritskaya N, Sanchez-Lacay A, Schneier F, Vermes D, Cheng J, Liebowitz MR. A double-masked, placebo-controlled study of fluoxetine for hypochondriasis. J Clin Psychopharmacol. 2008;28(6):638-45.

Ferri: Ferri's Clinical Advisor 2013, 1st ed. Hypochondriasis. St. Louis, MO: Mosby. 2012.

Hedman E, Ljotsson B, Andersson E, Ruck C, Andersson G, Lindefors N. Effectiveness and cost offset analysis of group CBT for hypochondriasis delivered in a psychiatric setting: an open trial. Cogn Behav Ther. 2010; 39(4):239-50.

Hedman E, Andersson G, Andersson E, et al. Internet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial. Br J Psychiatry. 2011; 198(3):230-6.

Jellin JM, Gregory P, Batz F, Hitchens K, et al. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, Calif: Therapeutic Research Facility; 2000.

Marx: Rosen's Emergency Medicine, 7th ed. St. Louis, MO: Mosby. 2009.

Molin G. Probiotics in foods not containing milk or milk constituents, with special reference to Lactobacillus plantarum 299v. Am J Clin Nutr. 2001;73(2 Suppl):380S-385S.

Ravindran AV, da Silva TL, Ravindran LN, Richeter MA, Rector NA. Obsessive-compulsive spectrum disorders: a review of the evidence-based treatments. Can J Psychiatry. 2009;54(5):331-43.

Weck F, Neng JM, Richtberg S, Stangier U. Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis. Psychosomatics. 2012; 53(2): 148-54.

Williams MJ, McManus F, Muse K, Williams JM. Mindfulness-based cognitive therapy for severe health anxiety (hypochondriasis): an interpretative phenomenological analysis of patients' experiences. Br J Clin Psychol. 2011; 50(4):379-97.




Review Date: 12/8/2012
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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