Illness
anxiety disorder (IAD) formerly called Hypochondriasis, Hypochondria, Healthy
Anxiety, Illness Phobia or Somatic preoccupation is an overwhelming fear that
you have a serious disease based on the misinterpretation of one or more normal
bodily signs, even when Doctors can find no evidence of the illness. The
disorder is not about the presence or absence of illness, but the psychological
reaction.
The term
Hypochondrium can be traced back to 400BC when it was used by Hippocrates to
describe a region of the abdomen. Back then, it was believed that
Hypochondriasis was due to malfunctioning of organs in that region of the
abdomen.
This
condition is seen in 4-20% of the general population, and in 45% of people with
severe psychiatric illnesses. It occurs more in women than men. It occurs at
any age, but commonly seen between 36 to 57 years.
picture credit; Anxiety org.
Features
Symptoms of
Illness anxiety disorder are not under voluntary control and cannot be
explained by physiological causes.
They include;
Excessive
fear, preoccupation or worry over having a serious illness.
The fear
persists despite appropriate medical evaluation and reassurance.
The belief
is not of delusional intensity and is not restricted to a concern about
appearance.
The fear
causes clinically significant distress or impairment.
The
preoccupation lasts for at least 6 months.
The
preoccupation is not explained better by another mood, anxiety, or somatoform
disorder.
Physical
symptoms are not present or if present, only mild. If another illness is
present, or there is a high risk for developing an illness, the person’s
concern is out of proportion.
High level
of anxiety and alarm over personal health status.
Excessive
health-related behaviors (e.g., repeatedly checking body for signs of illness)
or shows abnormal avoidance (e.g., avoiding doctors’ appointments and
hospitals).
Frequently
making medical appointments for reassurance — or, avoiding medical care for
fear of being diagnosed with a serious illness.
Avoiding
people, places or activities for fear of health risks.
Worrying
excessively about a specific medical condition or your risk of developing a
medical condition because it runs in the family.
Having so
much distress about possible illnesses that it become hard for you to function.
Constantly
talking about health and possible illnesses.
Frequently
searching the Internet for causes of symptoms or possible illnesses.
The absence
of physical findings, after series of medical examinations, supports the
diagnosis of hypochondriasis.
Risk
Factors/ Causes
Overprotective
parents or caregivers,
Family
history of hypochondriasis,
Belief,
Excessive health
related Internet use,
Mental
disorders (Psychosomatic disorders and obsessive compulsive disorders),
Epidemics,
pandemics and statistics of outbreaks gives Hypochondriacs an illusion that
they have the disease,
Major
Stress,
Child
abuse/illness,
Neurochemical
deficit,
Pathogenesis
Some
theories have postulated that neurochemical deficits are responsible for this
disorder, such deficits may explain why symptoms overlap, why the disorders are
commonly comorbid, and why effective treatments parallel one another (eg,
selective serotonin reuptake inhibitors [SSRIs]).
Neurochemicals
Implicated in this condition include neurotrophin 3 (NT-3), serotonin (5-HT),
etc.
Diagnosis
There is no
laboratory or radiologic investigation for the diagnosis of Hypochondriasis or Illness
Anxiety Disorder.
Thus
diagnosis can only be done can be done using the ICD-10 or the DSM-IV criteria.
The DSM-IV
defines hypochondriasis according to the following criteria:
A. Preoccupation with fears of having, or
the idea that one has, a serious disease based on the person's
misinterpretation of bodily symptoms.
B. The preoccupation persists despite
appropriate medical evaluation and reassurance.
C. The belief in Criterion A is not of
delusional intensity (as in Delusional Disorder, Somatic Type) and is not
restricted to a circumscribed concern about appearance (as in Body Dysmorphic
Disorder).
D. The preoccupation causes clinically
significant distress or impairment in social, occupational, or other important
areas of functioning.
E. The duration of the disturbance is at
least 6 months.
F. The preoccupation is not better
accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder,
Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another
Somatoform Disorder.
The newly
published DSM-IV replaces the diagnosis of hypochondriasis with "illness
anxiety disorder".
The ICD-10
defines hypochondriasis as follows:
A. Either one of the following:
A persistent belief, of at least
six months' duration, of the presence of a maximum of two serious physical
diseases (of which at least one must be specifically named by the patient).
A persistent preoccupation with a
presumed deformity or disfigurement (body dysmorphic disorder).
B. Preoccupation with the belief and the
symptoms causes persistent distress or interference with personal functioning
in daily living, and leads the patient to seek medical treatment or
investigations (or equivalent help from local healers).
C. Persistent refusal to accept medical
advice that there is no adequate physical cause for the symptoms or physical
abnormality, except for short periods of up to a few weeks at a time
immediately after or during medical investigations.
D. Most commonly used exclusion criteria:
not occurring only during any of the schizophrenia and related disorders
(F20-F29, particularly F22) or any of the mood disorders (F30-F39).
The Illness
Attitude Scale (29 items, 15 min, English only) is used for detection and to
assess severity.
The Whitely
Index of Hypochondriasis (14 items, 5 min, >14 languages) is used for
detection, for rating severity, and for measuring change per interventions.
Differential Diagnosis
Other
conditions that should be considered when diagnosing Illness Anxiety Disorder
or Hypochondriasis are;
Schizophrenia,
Somatic
Symptom Disorders,
Body Dysmorphic
Disorders,
Conversion
Disorders,
Personality
Disorders
Depression,
Anxiety
Disorders,
Delusional Disorders.
In this
case, the following screening tools are useful in distinguishing Illness
Anxiety Disorder from the rest;
The Health Anxiety Inventory (HAI) (long
version; short version of 14 items, 5 min) reliably distinguishes patients with
hypochondriasis from patients with anxiety disorders or healthy controls.
The Somatoform Disorders Symptom Checklist
(65 yes-or-no items, 20 min, >5 languages) screens for hypochondriasis,
somatization disorder, BDD, and others.
Treatment
Depending
on the severity, patients with illness anxiety disorder may require hospital admission,
but mild cases may not.
The
following methods are recommended for the management of Hypochondriasis;
Education
& Reassurance; here the patient is made to understand the manifestations of
hypochondriasis and reassurance is given consistently.
Psychotherapy;
using Cognitive behavioral therapy.
Psychosurgery
in severe cases,
Lifestyle;
Patients with illness anxiety disorders/ hypochondriasis are advised to avoid
alcohol, caffeine and nicotine. Regular exercise and quality sleep is also
recommended here.
Drugs; this
is only recommended in addition to the above methods to prevent complications
or reduce symptoms in some cases. The drugs used include; Benzodiazepines (Alprazolam),
Antidepressant (Sertraline, Paroxetine, Fluoxetine, Venlafaxine, clomipramine,
Imipramine, Citalopram, etc.), Antipsychotics (Pimozide, Risperidone,
Olanzapine) or Beta adrenergic receptor blocker (Propranolol). Multivitamin supplements
(Vitamin A, B, C, E and D.)
Complications
Social
complications; Family and marital issues, Unemployment, bankruptcy from overuse
of expensive laboratory or medical facilities,
Complications
from investigation procedures,
Suicidal
thoughts/ Suicide
Disability
Costly
medical bills
Complications
from testing procedures
Disability
and unemployment
Marital or
family problems
Prognosis
It has a
good prognosis, especially in patients with high economic status. Sometimes the
symptoms last from months to years with long quiescent periods
1/3rd
of the patients improve significantly.
Most
children with hypochondriasis recover before adolescence or by early adulthood
References
Ehrlich, S.,
2014. Hypochondriasis. University Of Maryland Medical center.
Mayo Clinic,
2015. Illness Anxiety Disorder. Mayo Clinic.
Neziroglu, F.,
1998. Hypochondriasis: A Fresh Outlook on Treatment. Psychiatric times.
Olatunji, B.,
Deacon, B. & Abramowitz, J., 2009. Is hypochondriasis an anxiety disorder? The
British Journal of Psychiatry.
Warwick, H.,
1998. Cognitive therapy in the treatment of hypochondriasis. Advances in
Psychiatric Treatment, 4, pp.285–295.
Xiong, G.,
2013. Hypochondriasis. Medscape.
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