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Mind or body? Help for hypochondria
My aunt always seems to think she's ill, or has some kind of major disease. I believe she's imagining things. Could she be a hypochondriac?
Although hypochondria is often assumed to be an imagined illness, it
is a real disease that can wreak havoc in a person's life. A mental disorder
that affects between 4 percent and 9 percent of the population, hypochondria
(excessive anxiety about the state of one's health) can affect anyone,
regardless of gender, age, or ethnicity.
Hypochondria is classified as a somatoform disorder, meaning that a person
has physical symptoms but no underlying medical condition. Other somatoform
disorders include conversion disorder -- loss of physical function, such
as blindness, without physical explanation; somatization disorder -- a
recurring series of physical complaints without physical explanation;
and psychogenic pain disorder -- pain without a physical basis.
"Hypochondria needs to be taken very seriously," says Isidore
Berenbaum, M.D., an assistant professor of psychiatry at Boston University
School of Medicine. "It's important to understand that those suffering
from it are very frightened and need help overcoming their anxiety."
Often preoccupied with minor physical complaints, such as fatigue, headaches,
or dizziness, hypochondriacs fear or believe that they have a major disease,
despite constant reassurance that they are healthy. Hypochondriacs may
even fixate on specific parts of the body or specific diseases. In addition,
someone with hypochondria may obsessively focus on normal functions, such
as heartbeats or sweating. The physical symptoms are generally real, but
might be misinterpreted as more dangerous than they really are.
"Very often, hypochondriacs are extremely aware of somatic symptoms,
and every ache and pain in their body is amplified," says Berenbaum.
"Small changes in skin tone, muscle twitches, even stomachaches can
cause them to worry."
Although experts aren't sure why people are afflicted with hypochondria,
they don't believe genetics plays a role. Hypochondria is often linked
to anxiety and depression and can be triggered by someone else's illness
or death. Also, many hypochondriacs grew up in families where illness
was overemphasized or even rewarded. "To a lesser degree, hypochondria
may be brought on after hearing constantly about a serious illness, or
learning in-depth about a particular disease," Berenbaum adds.
The American Psychiatric Association has established a defined set of
criteria to help diagnose hypochondria. The signs include a preoccupation
with fears of having a serious disease that persists despite medical evaluation
and reassurance; the belief in the disease is not delusional (the person
often understands that his or her fears are out of control and may unsubstantiated);
the preoccupation causes problems with friends, family, or work, or otherwise
disrupts life; and a preoccupation with a disease that lasts six months
or longer. In addition, people with extreme hypochondria often medicate
themselves with nonprescription drugs, make frequent visits to the doctor,
and may experiment with unproven theories.
Primary care doctors, who are usually the first to diagnose hypochondria,
often treat the disorder by scheduling monthly appointments to review
the patient's concerns. "Hypochondriacs need someone to listen to
their fears and care for them, not necessarily cure them of imagined ills,"
says Berenbaum. "Sometimes the best treatment is to provide temporary
reassurance through regular patient visits, and even check-up phone calls."
He adds that psychiatrists are consulted or referrals made to them when
patients exhibit signs of depression or anxiety disorder.
Cognitive-behavioral therapy, which focuses on changing distorted thinking
and altering behavior, has also proven effective in treating hypochondria.
Although the tendency to have exaggerated health anxiety may never disappear,
the hypochondriac can realize that he or she is not suffering a serious
physical disease, and gradually reduce the anxiety.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on hypochondria or other health matters, call 617-638-6767.
4 October 2002
Boston University
Office of University Relations