Unlike a conversion
disorder where an individual perceives a functional disorder and
simply use it to escape from uncomfortable situations, hypochondriacs
have no real illness, but is overly obsessed over normal bodily
functions. They read into the sensations of these normal bodily
functions the presence of a feared disease. The main features
of this disorders are:
Because
of misinterpreting bodily symptoms, the patient becomes preoccupied
with ideas or fears of having a serious illness.
Appropriate medical investigation and reassurance do not relieve
these ideas.
These ideas are not delusional (as in Delusional
Disorder) and are not restricted to concern about appearance
(as in Body Dysmorphic
Disorder).
They cause distress that is clinically important or impair work,
social or personal functioning.
They have lasted 6 months or longer.
These ideas are do better explained by Generalized
Anxiety Disorder, Major Depressive
Episode, Obsessive-Compulsive
Disorder, Panic Disorder,
Separation Anxiety
or a different Somatoform
Disorder.
Associated
Features:
Schizophrenia
Major Depression
Dysthymic Disorder
Organic Brain Syndrome
Differential
Diagnosis:
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt has to differentiate
against the following disorders which need to be ruled out to
establish a precise diagnosis.
Major
Depression
Obsessive Compulsive
Disorder
Generalized Anxiety
Disorder
Panic Disorder (can often cause
prominent somatic complaints with no organic basis)
Cause:
This is a chronic illness which usually
develops in middle age or later. Patients become excessively worried
about a physical symptom and cannot shake the idea that something
is seriously wrong with them. They are not overtly delusional
in this belief, but they continue to worry despite evidence to
the contrary. They seek many tests and much reassurance from their
doctor. The patients often seem highly invested in their own suffering.
Males and females are equally affected, and such patients tend
to have obsessive
and/or paranoid
personality traits.
Treatment:
A supportive relationship with a clinician is the main objective
of treatment. The clinician should inform the person that no organic
disease is present, but that continued medical follow-up will
help control the symptoms. The person with hypochondrias feels
real distress, so the symptoms should not be denied or challenged
by others.
Counseling
and Psychotherapy [ See
Counselling Section ]:
The person
should be encouraged to discuss other problems rather than reinforcing
the symptoms. Family cooperation will be helpful. The person with
hypochondrias and the family need to be helped to find ways to
deal with stress other than developing new symptoms.
