Pediatric Hypochondriasis Treatment & Management

  • Author: Maria Sandra Cely-Serrano, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Aug 19, 2011
 

Medical Care

The goal of treatment is to aid the patient in managing the fear of serious illness and to help the patient to establish a greater sense of control in managing symptoms that remain. Appropriate education and a supportive relationship with a competent health care provider is the most important aspect of treatment.

Maintain regularly scheduled appointments to review symptoms and evaluate the person's coping mechanisms. At these appointments, acknowledge and explain test results. Merely making the diagnosis and linking it to psychological stressors can often be therapeutic. Telling people with this disorder that their symptoms are imaginary is not helpful. Mental health treatment can involve a variety of modalities (eg, individual psychotherapy, family therapy, group therapy, parent guidance).

  • Individual psychotherapy can use psychodynamic principles to help the child understand unconscious conflicts.
  • Eliminate sources of secondary gain.
  • Cognitive and behavioral approaches can be helpful and may prove to be the therapy of choice. Behavior modification provides incentives, motivation, and rewards to control the symptoms.
    • In adults brief (6 session), individual cognitive behavioral therapy intervention developed specifically to alter hypochondriacal thinking and restructure hypochondriacal beliefs appears to have significant beneficial long-term effects on the symptoms of hypochondriasis.
    • In one adult study, cognitive behavioral therapy and paroxetine were effective short-term treatment for subjects with hypochondriasis.[5] Results from the combined therapy were significantly superior to placebo but did not significantly differ from the results of the individual therapies.
    • A meta-analysis of effectiveness of psychotherapies for hypochondriasis revealed that cognitive therapy, behavioral therapy, cognitive behavioral therapy, and behavioral stress management are effective in reducing the symptoms of hypochondriasis.[6] However, studies included in the review used a small number of participants and did not allow for the estimation of effect size.
  • Family therapy focuses on awareness of familiar patterns of interaction and attempts to improve healthy interpersonal communication.
  • Group therapy provides support to learn how to cope with the symptoms and to learn strategies to improve social skills.
  • Education about the links between a person's psychological and physical states should be provided to the child and his or her parents or caregivers.
  • Development of coping skills, including relaxation techniques, cognitive restructuring, and refocusing, is helpful.
  • Involvement of school personnel and those in other social settings frequented by the child is helpful.

Studies in adults comparing cognitive behavioral therapy (CBT) with short-term psychodynamic psychotherapy (STPP) and no intervention for patients with hypochondriasis suggests that CBT is more effective than STPP in the treatment of hypochondriasis.[7]

Long-term follow-up studies in adults who received selective serotonin reuptake inhibitor (SSRIs) treatment suggest that patients with hypochondriasis who receive treatment with SSRIs achieve remission over long term and interim use may be a factor contributing to better prognosis.[8]

Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Maria Sandra Cely-Serrano, MD  Developmental and Behavioral Pediatrician, Center for Child Development, Florida Hospital

Maria Sandra Cely-Serrano, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Anna Maria Wilms Floet, MD  Assistant Professor, Assistant Professor of Pediatrics, Department of Pediatrics, Behavior and Developmental, University of Maryland School of Medicine

Anna Maria Wilms Floet, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

Angelo P Giardino, MD, PhD  Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc

Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect

Disclosure: Bayer Honoraria Review panel membership; Pfizer Grant/research funds Independent contractor; MedImmune Honoraria Review panel membership; Teva Pharmacutical travel & honoraria Managed Care Advisory Panel; CIGNA Honoraria Physician Advisory Council

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

References

  1. Bleichhardt G, Hiller W. Hypochondriasis and health anxiety in the German population. Br J Health Psychol. Nov 2007;12:511-23. [Medline].

  2. Noyes R Jr, Stuart S, Langbehn DR, et al. Childhood antecedents of hypochondriasis. Psychosomatics. Jul-Aug 2002;43(4):282-9. [Medline].

  3. Abramowitz JS, Moore EL. An experimental analysis of hypochondriasis. Behav Res Ther. Mar 2007;45(3):413-24. [Medline].

  4. Sakai R, Nestoriuc Y, Nolido NV, Barsky AJ. The prevalence of personality disorders in hypochondriasis. J Clin Psychiatry. Jan 2010;71(1):41-7. [Medline].

  5. [Best Evidence] Greeven A. van Balkom AJ. Visser S. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a control randomized trial. American Journal of Psychiatry. jan 2007;164(1):91-9. [Medline].

  6. Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database Syst Rev. Oct 17 2007;CD006520. [Medline].

  7. Sorensen P, Birket-Smith M, Wattar U, Buemann I, Salkovskis P. A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychol Med. Feb 2011;41(2):431-41. [Medline].

  8. 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].

  9. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  10. Abramowitz JS, Deacon BJ. Severe health anxiety: why it persists and how to treat it. Compr Ther. Spring 2004;30(1):44-9. [Medline].

  11. Albrecht S, Naugle AE. Psychological assessment and treatment of somatization: adolescents with medically unexplained neurologic symptoms. Adolesc Med. Oct 2002;13(3):625-41. [Medline].

  12. Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. Mar 24 2004;291(12):1464-70. [Medline].

  13. Barsky AJ, Coeytaux RR, Sarnie MK, Cleary PD. Hypochondriacal patients' beliefs about good health. Am J Psychiatry. Jul 1993;150(7):1085-9. [Medline].

  14. Bouman TK, Visser S. Cognitive and behavioural treatment of hypochondriasis. Psychother Psychosom. Jul-Oct 1998;67(4-5):214-21. [Medline].

  15. Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ. Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry. Sep 1999;38(9):1093-101. [Medline].

  16. Campo JV, Reich MD. Somatoform disorders. In: Netherton S, Walker CE, Holmes D, eds. Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York, NY: Oxford Univ Press; 1999:320-43.

  17. Lewis M, ed. Child and Adolescent Psychiatry? A Comprehensive Textbook. Williams & Wilkins; 1996.

  18. Egger HL, Costello EJ, Erkanli A, Angold A. Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry. Jul 1999;38(7):852-60. [Medline].

  19. Escobar JI, Gara M, Waitzkin H, et al. DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry. May 1998;20(3):155-9. [Medline].

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

  21. Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. Oct 1997;36(10):1329-38. [Medline].

  22. Haugaard JJ. Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated:somatization and other somatoform disorders. Child Maltreat. 2004;May 9(2):169-76. [Medline].

  23. Hiller W, Leibbrand R, Rief W, Fichter MM. Differentiating hypochondriasis from panic disorder. J Anxiety Disord. 2005;19(1):29-49. [Medline].

  24. Hitchcock PB, Mathews A. Interpretation of bodily symptoms in hypochondriasis. Behav Res Ther. May 1992;30(3):223-34. [Medline].

  25. Kellner R. Somatization and Hypochondriasis. New York, NY: Praeger-Greenwood; 1986.

  26. Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand. Mar 2000;101(3):194-208. [Medline].

  27. Livingston R, Witt A, Smith GR. Families who somatize. J Dev Behav Pediatr. Feb 1995;16(1):42-6. [Medline].

  28. Longley SL, Watson D, Noyes R Jr. Assessment of the hypochondriasis domain: the multidimentional inventory of hypochondriacal traits (MIHT). Psychol Assess. 2005;Mar 17(1):3-14. [Medline].

  29. Noyes R Jr, Happel RL, Yagla SJ. Correlates of hypochondriasis in a nonclinical population. Psychosomatics. Nov-Dec 1999;40(6):461-9. [Medline].

  30. Walker LS, Garber J, Greene JW. Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. J Consult Clin Psychol. Dec 1994;62(6):1213-21. [Medline].

  31. Warwick HM, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry. Aug 1996;169(2):189-95. [Medline].

 
Previous
Next
 
 
 
 
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.