Hypochondriasis Follow-up

  • Author: Glen L Xiong, MD; Chief Editor: David Bienenfeld, MD   more...
 
Updated: Aug 3, 2011
 

Inpatient & Outpatient Medications

  • Continue successful long-term trials of medications for patients with hypochondriasis.
  • For patients with comorbid disorders, consider maintenance of those trials because these disorders can initiate and/or exacerbate hypochondriacal symptoms.
Next

Transfer

Physician-to-physician dialogue on the nature of the patient's problems and successful management strategies is useful.

Previous
Next

Complications

  • Patients who are hypochondriacal may be significant consumers of medical care, undergoing repetitive doctor visits, physical examinations, laboratory testing, and other costly, invasive, and potentially dangerous procedures.
  • Physician concerns regarding workups for somatic complaints also may preclude diagnosis of common comorbid disorders (eg, depression) that are quite treatable.
Previous
Next

Prognosis

  • Hypochondriasis is a common disorder in primary care settings.
  • The differential diagnosis includes other somatoform, depressive, anxiety (eg, generalized anxiety disorder, OCD), and psychotic disorders.
  • Biopsychosocial treatment is required to manage this complex disorder, and further research is required to better understand its pathophysiology and interface with other psychiatric conditions. Recognizing the biological similarities between these seemingly disparate disorders may be a useful starting point to begin a more systematic study of novel treatments for hypochondriasis.[67]
  • A system review of six studies on hypochondriasis indicated that 30-50% of patients achieve recovery.[59]
  • A good prognosis appears to be associated with high socioeconomic status, treatment-responsive anxiety or depression, the absence of a personality disorder, and the absence of a related nonpsychiatric medical condition.
  • Most children recover by adolescence or early adulthood.
  • There is a dearth of long-term follow-up studies examining outcomes of patients with hypochondriasis. In a prospective study that examined 58 patients with hypochondriasis who had participated in selective serotonin reuptake inhibitor (SSRI) treatment for 4-16 years (mean 8.6±4.5 y), 40% continued to meet the diagnosis of hypochondriasis. Predictors of continued diagnosis of hypochondriasis include longer duration of hypochondriasis prior to treatment, history of childhood physical punishment, and lower use of SSRI during the treatment period. A large portion of patients with hypochondriasis who received SSRI treatment were able to achieve remission.[55]
Previous
Next

Patient Education

  • Educational approaches provide accurate information, allowing the patient to realize somatic symptoms are exceedingly common, with only a small proportion caused by disease and most compatible with physical health.
  • Accurate information about the relationship of a threatening stimulus and its somatic consequences can influence the severity of autonomic responses, subjective distress, and behavior.
  • Maladaptive iatrogenic beliefs must be countered. Providing a small amount of information at a time and repeating it is best.
  • For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center, Anxiety Center, or Depression Center. Also, see eMedicine's patient education article Chronic Fatigue Syndrome.
  • For mild and short-lived symptoms, the primary medical provider could provide detailed education (symptoms, course, monitoring, diagnosis, and treatment) about the medical condition about which the patient is concerned.
  • Education should additionally focus on the role of anxiety and how anxiety could increase autonomic activity or arousal and, thereby, cause the body to misattribute certain physical sensations and symptoms.
  • For more persistent and chronic hypochondriasis, especially in situations where the patient has already failed treatment with multiple providers, education needs be delivered in small “doses,” when the time is right, and after the establishment of a firm patient-provider relationship.
  • The tailoring of education delivery as applied to mild versus severe symptoms has not been systematically studied.
  • Since hypochondriasis may be precipitated by psychosocial stress, family support is likely to be additionally helpful. However, the role of family education requires further investigation.

Even in the absence of formal research into family education for hypochondriasis, several practical pointers are recommended:

  • The patient needs to give permission to involve family members in diagnosis and treatment planning decisions.
  • Family members need to be told that the physician will not keep secrets from the patient; ie, anything family members tell the physician about the patient will be shared, with direct attribution, to the patient.
  • Family members need to understand that the distress the patient feels is real even if the conviction about illness is false or cannot be substantiated.
  • Family members should not enable overuse of medical services by reinforcing patients’ requests for excessive interventions.
  • Family members should be encouraged to support the outpatient chronic disease model for hypochondriasis as described above.
  • Family members should be educated on the common psychiatric comorbidity of hypochondriasis and help the patient self-monitor for mood and anxiety symptoms and seek help for these separately.
  • Family or couple’s therapy should be considered in patients where family and marital discord is a major source of conflict that is contributing to psychological distress. Alternatively, family therapy should be considered in patients whose symptoms have cause major distress to family dynamics that either seem to perpetuate current symptoms.
  • Given that these patients are often comfortable with computer searches, websites specific to hypochondriasis may be helpful to recommend to patients and families:
Previous
 
Contributor Information and Disclosures
Author

Glen L Xiong, MD  Assistant Clinical Professor, Department of Psychiatry and Behavioral Sciences, Department of Internal Medicine, University of California Davis School of Medicine; Attending Psychiatrist, Sacramento Mental Health Treatment Center; Attending Physician, Sacramento County Primary Care Clinic

Glen L Xiong, MD is a member of the following medical societies: American College of Physicians, American Psychiatric Association, and Sierra Sacramento Valley Medical Society

Disclosure: Lippincott Williams & Wilkins Royalty Book Editor; PGxHealth Consulting fee Consulting; National Alliance for Research in Schizophrenia and Depression Grant/research funds Independent contractor

Coauthor(s)

James A Bourgeois, OD, MD, MPA  Professor, Consultation-Liaison Service, Department Education Coordinator, Vice Chair of Education, Department of Psychiatry and Behavioural Neurosciences, St Joseph's Healthcare, Centre for Mountain Health Services, McMaster University School of Medicine, Canada

James A Bourgeois, OD, MD, MPA is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Peter M Yellowlees, MD, MBBS  Professor of Psychiatry, Director of Health Informatics Program, University of California, Davis, School of Medicine

Disclosure: Medscape Consulting fee Independent contractor

Donald M Hilty, MD  Professor of Clinical Psychiatry, Vice-Chair of Faculty Development, Department of Psychiatry and Behavioral Sciences, University of California, Davis School of Medicine

Donald M Hilty, MD is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Technology in Psychiatry, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Specialty Editor Board

Sarah C Aronson, MD  Associate Professor, Departments of Psychiatry and Medicine, Case Western Reserve School of Medicine/University Hospitals of Cleveland

Sarah C Aronson, MD is a member of the following medical societies: American Academy of Family Physicians, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

David Bienenfeld, MD  Professor of Psychiatry, Vice-Chair and Director of Residency Training, Department of Psychiatry, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Shayna L Marks, BA, MA; Dandan Liu, BA; and Celia Chang, MD to the development and writing of this article.

References

  1. Barsky AJ, Klerman GL. Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry. Mar 1983;140(3):273-83. [Medline].

  2. Fallon BA, Petkova E, Skritskaya N, et al. A double-masked, placebo-controlled study of fluoxeine for hypochondiasis. J Clin Psychopharmcol. December 2008;6:638-45.

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

  4. Hollander E, Stein DJ, Decaria CM, Cohen L, Islam M, Frenkel M. Disorders related to OCD--neurobiology. Clin Neuropharmacol. 1992;15 Suppl 1 Pt A:259A-260A. [Medline].

  5. Wooley SC, Blackwell B, Winget C. A learning theory model of chronic illness behavior: theory, treatment, and research. Psychosom Med. Aug 1978;40(5):379-401. [Medline].

  6. Brondino N, Lanati N, Barale F, Martinelli V, Politi P, Geroldi D. Decreased NT-3 plasma levels and platelet serotonin content in patients with hypochondriasis. J Psychosom Res. Nov 2008;65(5):435-9. [Medline].

  7. Magarinos M, Zafar U, Nissenson K, Blanco C. Epidemiology and treatment of hypochondriasis. CNS Drugs. 2002;16(1):9-22. [Medline].

  8. Kellner R. Hypochondriasis and somatization. JAMA. Nov 20 1987;258(19):2718-22. [Medline].

  9. Gureje O, Ustum TB, Simon GE:. The syndrome of hypochondriasis: a cross-national study in primary care. Psychol Med;. 1997;27:1001-10.

  10. Barsky AJ, Ettner SL, Horsky J, Bates DW. Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care. Jul 2001;39(7):705-15. [Medline].

  11. Barsky AJ, Ahern DK, Bailey ED, Saintfort R, Liu EB, Peekna HM. Hypochondriacal patients' appraisal of health and physical risks. Am J Psychiatry. May 2001;158(5):783-7. [Medline].

  12. Holder-Perkins V, Wise TN, Williams DE. Hypochondriacal Concerns: Management Through Understanding. Prim Care Companion J Clin Psychiatry. Aug 2000;2(4):117-121. [Medline].

  13. Lipowski ZJ. Somatization: a borderland between medicine and psychiatry. CMAJ. Sep 15 1986;135(6):609-14. [Medline].

  14. Barsky AJ, Wyshak G, Klerman GL. Psychiatric comorbidity in DSM-III-R hypochondriasis. Arch Gen Psychiatry. Feb 1992;49(2):101-8. [Medline].

  15. Ball RA, Clare AW. Symptoms and social adjustment in Jewish depressives. Br J Psychiatry. Mar 1990;156:379-83. [Medline].

  16. Jones LR, Mabe PA 3rd, Riley WT. Illness coping strategies and hypochondriacal traits among medical inpatients. Int J Psychiatry Med. 1989;19(4):327-39. [Medline].

  17. Atmaca M, Korkmaz H, Korkmaz S. P wave dispersion in patients with hypochondriasis. Neurosci Lett. Nov 26 2010;485(3):148-50. [Medline].

  18. Smith RC. Somatization disorder: defining its role in clinical medicine. J Gen Intern Med. Mar-Apr 1991;6(2):168-75. [Medline].

  19. Stefansson JG, Messina JA, Meyerowitz S. Hysterical neurosis, conversion type: clinical and epidemiological considerations. Acta Psychiatr Scand. Feb 1976;53(2):119-38. [Medline].

  20. Toone BK. Disorders of hysterical conversion. In: Bass C, ed. Physical Symptoms and Psychological Illness. London, UK: Blackwell Scientific; 1990:207-34.

  21. de Leon J, Bott A, Simpson GM. Dysmorphophobia: body dysmorphic disorder or delusional disorder, somatic subtype?. Compr Psychiatry. Nov-Dec 1989;30(6):457-72. [Medline].

  22. Bienvenu OJ, Samuels JF, Wuyek LA, Liang KY, Wang Y, Grados MA, et al. Is obsessive-compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. May 13 2011;1-13. [Medline].

  23. van den Heuvel OA, Mataix-Cols D, Zwitser G, Cath DC, van der Werf YD, Groenewegen HJ, et al. Common limbic and frontal-striatal disturbances in patients with obsessive compulsive disorder, panic disorder and hypochondriasis. Psychol Med. May 5 2011;1-12. [Medline].

  24. Hollifield M, Tuttle L, Paine S, Kellner R. Hypochondriasis and somatization related to personality and attitudes toward self. Psychosomatics. Sep-Oct 1999;40(5):387-95. [Medline].

  25. Xiong GL, Bougeois JA, Chang CH, Liu D, Hilty DM. Hypochondriasis: common presentations and treatment strategies in primary care and specialty settings. Therapy. 2007;(4):3:323-38.

  26. Salkovskis PM, Rimes KA, Warwick HM, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. Jul 2002;32(5):843-53. [Medline].

  27. Campo JV, Di Lorenzo C, Chiappetta L, Bridge J, Colborn DK, Gartner JC Jr, et al. Adult outcomes of pediatric recurrent abdominal pain: do they just grow out of it?. Pediatrics. Jul 2001;108(1):E1. [Medline].

  28. Noyes R Jr, Stuart S, Langbehn DR, Happel RL, Longley SL, Yagla SJ. Childhood antecedents of hypochondriasis. Psychosomatics. Jul-Aug 2002;43(4):282-9. [Medline].

  29. Fiddler M, Jackson J, Kapur N, Wells A, Creed F:. Childhood adversity and frequent medical consultations. Gen Hosp Psychiatry. 2004;26:367-77.

  30. Durso FT, Reardon R, Shore WJ, Delys SM:. Memory processes and hypochondriacal tendencies. J Nerv Ment Dis. 1992;179(5):279-83.

  31. Gottlieb GL. Hypochondriasis: A psychosomatic problem in the elderly. Adv Psychosom Med. 1989;19:67-84.

  32. Stein EM. When is hypochondriasis not hypochondriasis? Geriatrics. 2003;58(3):41-2.

  33. Tyrer P, Cooper S, Tyrer H, Salkovskis P, Crawford M, Green J, et al. CHAMP: Cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial. BMC Psychiatry. Jun 14 2011;11:99. [Medline]. [Full Text].

  34. Kellner R, Abbott P, Pathak D, Winslow WW, Umland BE. Hypochondriacal beliefs and attitudes in family practice and psychiatric patients. Int J Psychiatry Med. 1983-1984;13(2):127-39. [Medline].

  35. Speckens AE, Spinhoven P, Sloekers PP, Bolk JH, van Hemert AM. A validation study of the Whitely Index, the Illness Attitude Scales, and the Somatosensory Amplification Scale in general medical and general practice patients. J Psychosom Res. Jan 1996;40(1):95-104. [Medline].

  36. Janca A, Isaac M, Bennett LA, Tacchini G. Somatoform disorders in different cultures--a mail questionnaire survey. Soc Psychiatry Psychiatr Epidemiol. Jan 1995;30(1):44-8. [Medline].

  37. Harrington P. Obsessive compulsive disorder with associated hypochondriasis. BMJ. May 10 2008;336(7652):1070-1. [Medline].

  38. Looper KJ, Kirmayer LJ. Behavioral medicine approaches to somatoform disorders. J Consult Clin Psychol. Jun 2002;70(3):810-27. [Medline].

  39. Visser S, Bouman TK. The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behav Res Ther. Apr 2001;39(4):423-42. [Medline].

  40. Kroenke K, Swindle R. Cognitive-behavioral therapy for somatization and symptom syndromes: a critical review of controlled clinical trials. Psychother Psychosom. Jul-Aug 2000;69(4):205-15. [Medline].

  41. Visser S, Bouman TK. Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies. Behav Res Ther. May 1992;30(3):301-6. [Medline].

  42. Kellner R. Psychotherapeutic strategies in hypochondriasis: a clinical study. Am J Psychother. Apr 1982;36(2):146-57. [Medline].

  43. House A. Hypochondriasis and related disorders. Assessment and management of patients referred for a psychiatric opinion. Gen Hosp Psychiatry. May 1989;11(3):156-65. [Medline].

  44. Klimes I, Mayou RA, Pearce MJ, Coles L, Fagg JR. Psychological treatment for atypical non-cardiac chest pain: a controlled evaluation. Psychol Med. Aug 1990;20(3):605-11. [Medline].

  45. Pearce MJ, Mayou RA, Klimes I. The management of atypical non-cardiac chest pain. Q J Med. Sep 1990;76(281):991-6. [Medline].

  46. Walker J, Vincent N, Furer P, Cox B, Kjernisted K. Treatment preference in hypochondriasis. J Behav Ther Exp Psychiatry. Dec 1999;30(4):251-8. [Medline].

  47. Hiller W, Leibbrand R, Rief W, Fichter MM. Predictors of course and outcome in hypochondriasis after cognitive-behavioral treatment. Psychother Psychosom. Nov-Dec 2002;71(6):318-25. [Medline].

  48. Barsky AJ. Hypochondriasis. Medical management and psychiatric treatment. Psychosomatics. Jan-Feb 1996;37(1):48-56. [Medline].

  49. Avia MD, Ruiz MA, Olivares ME, Crespo M, Guisado AB, Sánchez A. The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients. Behav Res Ther. Jan 1996;34(1):23-31. [Medline].

  50. Ford CV, Long KD. Group psychotherapy of somatizing patients. Psychother Psychosom. 1977;28(1-4):294-304. [Medline].

  51. Bouman TK. A community-based psychoeducational group approach to hypochondriasis. Psychother Psychosom. Nov-Dec 2002;71(6):326-32. [Medline].

  52. Lidbeck J. Group therapy for somatization disorders in primary care: maintenance of treatment goals of short cognitive-behavioural treatment one-and-a-half-year follow-up. Acta Psychiatr Scand. Jun 2003;107(6):449-56. [Medline].

  53. [Best Evidence] Greeven A, van Balkom AJ, Visser S, et al. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry. Jan 2007;164(1):91-9. [Medline].

  54. Thomson A, Page L. Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006520. DOI: 10.1002/14651858.CD006520.pub2.

  55. Schweitzer PJ, Zafar U, Pavlicova M, Fallon BA. Long-term follow-up of hypochondriasis after selective serotonin reuptake inhibitor treatment. J Clin Psychopharmacol. Jun 2011;31(3):365-8. [Medline].

  56. Stone AB. Treatment of hypochondriasis with clomipramine. J Clin Psychiatry. May 1993;54(5):200-1. [Medline].

  57. Wesner RB, Noyes R Jr. Imipramine an effective treatment for illness phobia. J Affect Disord. May-Jun 1991;22(1-2):43-8. [Medline].

  58. Fallon BA, Schneier FR, Marshall R, et al. The pharmacotherapy of hypochondriasis. Psychopharmacol Bull. 1996;32(4):607-11. [Medline].

  59. olde Hartman TC, Borghuis MS, Lucassen PL, van de Laar FA, Speckens AE, van Weel C. Medically unexplained symptoms, somatisation disorder and hypochondriasis: course and prognosis. A systematic review. J Psychosom Res. May 2009;66(5):363-77. [Medline].

  60. Phillips KA. Body dysmorphic disorder: clinical features and drug treatment. CNS Drugs. 1995;3:30-40.

  61. Fallon BA, Liebowitz MR, Salman E, Schneier FR, Jusino C, Hollander E. Fluoxetine for hypochondriacal patients without major depression. J Clin Psychopharmacol. Dec 1993;13(6):438-41. [Medline].

  62. Cetin M, Ebrinç S, Agargün MY, Yigit S. Risperidone for the treatment of monosymptomatic hypochondriacal psychosis. J Clin Psychiatry. Aug 1999;60(8):554. [Medline].

  63. Hamann K, Avnstorp C. Delusions of infestation treated by pimozide: a double-blind crossover clinical study. Acta Derm Venereol. 1982;62(1):55-8. [Medline].

  64. Reilly TM, Jopling WH, Beard AW. Successful treatment with pimozide of delusional parasitosis. Br J Dermatol. Apr 1978;98(4):457-9. [Medline].

  65. Bursztajn H, Barsky AJ. Facilitating patient acceptance of a psychiatric referral. Arch Intern Med. Jan 1985;145(1):73-5. [Medline].

  66. Medical Economics Staff. Medical Economics. In: Physicians' Desk Reference. 58th ed. Monvale, NJ; 2004.

  67. Kellner R. Prognosis of treated hypochondriasis. A clinical study. Acta Psychiatr Scand. Feb 1983;67(2):69-79. [Medline].

  68. Adler G. The physician and the hypochondriacal patient. N Engl J Med. Jun 4 1981;304(23):1394-6. [Medline].

  69. Fallon BA, Javitch JA, Hollander E, Liebowitz MR. Hypochondriasis and obsessive compulsive disorder: overlaps in diagnosis and treatment. J Clin Psychiatry. Nov 1991;52(11):457-60. [Medline].

 
Previous
Next
 
Pathological cycle of bodily concern and anxiety in hypochondriasis.
Mood, cultural, developmental, and environmental factors that influence hypochondriasis.
Factors that maintain anxiety in patients with hypochondriasis.
A cognitive model of the development of anxiety with hypochondriasis.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.