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Hypochondria

The hypochondria or hypochondriacal disorder is the fear or conviction of a serious illness, based on the misinterpretation of some important symptoms; This fear persists despite clarifying and reassuring medical explanations and negative diagnostic tests (according to the DSM-IV classification system for psychiatric disorders, this persistence must be greater than 6 months).

This disease is classified within the so-called somatoform disorders, which, in turn, are part of the neurotic ones.

It is difficult to differentiate hypochondriacal patients from people who are not hypochondriac, but who do present some symptoms of this alteration, since the latter is very frequent, since it occurs in between 10% and 20% of the healthy population and, approximately , 45% of patients with neurotic disorders.

In any case, it seems that it affects both sexes equally and that it usually begins at 20-30 years of age.

Hypochondria. Who and how is it produced?

Throughout history, different theories have been developed about the origin of this disease, the only clear data being its purely psychological cause.

As we have already pointed out, it is a disorder of psychological origin, and on whose production mechanism different hypotheses have been elaborated, highlighting the psychoanalytic ones, according to which hypochondria would be the result of a repressed hostility towards the body, and of conflicts related to it. masochism, the dependencies and simultaneous needs of suffering and being loved and with guilt.

Other theories show it as a defense mechanism against affective disorders and low self-esteem .

Symptoms of hypochondria

The main symptom, to which we have already referred, is excessive worry or firm belief of suffering from a major disease, based on the wrong interpretation of different bodily manifestations (either physiological or banal symptoms); thus, for example, the patient may be convinced that he is suffering from heart disease because he seemed to perceive an increase in the intensity of the heartbeat.

The hypochondriac is convinced of the justification of his fears, he really believes that he has some pathology, and this conviction persists despite the reassuring explanations of the doctors and the negative exploratory tests; In fact, he goes to medical consultations on numerous occasions and frequently changes professional, despite which he usually does not comply with the possible treatments that are prescribed (for fear of side effects of the drugs), although there is a risk that self-medicate.

Often times, the hypochondriac tells other people everything he thinks is happening to him, trying to draw attention to his “illness.”

Overall, the patient isolates himself from the outside world by being overly aware of his body, looking for new signs of his imaginary illness, to the point of causing a deterioration in his social, family and work life.

In most cases, the disease becomes chronic, evolving in a recurrent and episodic way, and these episodes can last for months or years.

Diagnosis of hypochondria

As in other diseases, when making the diagnosis, the main thing is to take a medical history and a physical examination, which will be aimed at ruling out a possible organic disease causing the symptoms described by the patient.

Once the probability that there is an organic cause is ruled out, the suspicion of hypochondria can arise due to the insistence of the patient in his conviction of serious disease, and the non-compliance by the latter of the doctor’s instructions (an aspect that differentiates these patients of those with an organic disorder, who do tend to follow them).

When it is clear that the patient is a hypochondriac, it will be necessary to find out whether the hypochondria is primary or secondary to another mental illness; there are psychiatric pathologies that can be accompanied by hypochondriacal features, such as:

  • generalized anxiety disorder
  • the Depression
  • obsessive-compulsive disorder (in which the patient is aware of the unreality of his fear and does accept the doctor’s instructions, although it recurs)
  • hypochondriacal delusional disorder (unlike this, primary hypochondria does not lead to delirium)
  • other somatoform disorders (somatization disorder -in which there are physical symptoms, but they are of psychic origin-, dysmorphic disorder -which is manifested by exaggerated concern for a physical characteristic or defect-, etc.)
  • obsessive-compulsive disorder (in which the patient is aware of the unreality of his fear and does accept the doctor’s instructions, although it recurs)
  • hypochondriacal delusional disorder (unlike this, primary hypochondria does not lead to delirium)
  • other somatoform disorders (somatization disorder -in which there are physical symptoms, but they are of psychic origin-, dysmorphic disorder -which is manifested by exaggerated concern for a physical characteristic or defect-, etc.)

The existence of other psychiatric symptoms leads towards the diagnosis of a psychic illness other than primary hypochondria; the same happens if the patient responds to the appropriate treatment for these other diseases.

The DSM-IV has established a series of diagnostic criteria for hypochondria, which are as follows:

  1. Concern and fear of having, or the conviction of suffering, a serious illness based on the personal interpretation of bodily symptoms.
  2. The concern persists, despite proper medical examinations and explanations.
  3. Worry is not better explained by the presence of generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, major depressive episode, separation anxiety, or other somatoform disorder.
  4. The belief in criterion A is not delusional (unlike somatic-type delusional disorder) and is not limited to concerns about physical appearance (unlike body dysmorphic disorder).
  5. The duration of the disorder is at least 6 months.
  6. Worry produces clinically significant distress or impairment of the individual’s social, occupational, or other important areas of activity.

Treatment of hypochondria

Unfortunately, primary hypochondria does not usually respond completely to any treatment.

However, patients who attend a psychiatric consultation early have a better prognosis (it has been observed that, without treatment, approximately a quarter of patients deteriorate and only a tenth of cases can recover).

Thus, the first objective is to get the patient to consult the psychiatrist, being necessary for this a certain degree of sensitivity, not minimizing their concerns and making them see that this step would be something complementary and not a substitute.

Psychotropic drugs (such as antidepressants) are only useful against other diseases that include hypochondriacal symptoms (secondary hypochondria), or against non-hypochondriacal symptoms (depressive, anxiety…), within a primary hypochondria.

The therapies commonly used are supportive and cognitive-behavioral.

Progressively, an attempt should be made to move the patient’s care from the symptoms that concern him to his social and relational problems.

Finally, the family doctor who follows the evolution of the patient, in parallel with the psychiatrist, must avoid hospitalizations, as well as unnecessary drugs and diagnostic tests, thus achieving, between both professionals, the final objective of the patient’s recovery and non-habituation to the role of the chronic patient.

Unfortunately, there is no effective prevention against this disease. In any case, it is worth noting the importance of an attitude that is not excessively concerned or focused on bodily manifestations, as well as receptivity to the explanations that the doctor provides before any consultation.

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Hello Readers, I am Nikki Bella a Psychology student. I have always been concerned about human behavior and the mental processes that lead us to act and think the way we do. My collaboration as an editor in the psychology area of ​​Well Being Pole has allowed me to investigate further and expand my knowledge in the field of mental health; I have also acquired great knowledge about physical health and well-being, two fundamental bases that are directly related and are part of all mental health.

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