Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Hypochondriasis Treatment & Management

  • Author: Maria Sandra Cely-Serrano, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Mar 19, 2015
 

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.[14] 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.[15] 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. [16]
  • 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.[17, 18, 19]

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.[20]

 
 
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, Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Angelo P Giardino, MD, MPH, PhD Professor and Section Head, Academic General Pediatrics, Baylor College of Medicine; Senior Vice President and Chief Quality Officer, Texas Children’s Hospital

Angelo P Giardino, MD, MPH, 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, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Received grant/research funds from Health Resources and Services Administration (HRSA) Integrated Community Systems for CSHCN Grant for other; Received advisory board from Baxter Healthcare Corporation for board membership.

Acknowledgements

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.

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

  2. Esposito M, Roccella M, Gallai B, Parisi L, Lavano SM, Marotta R, et al. Maternal personality profile of children affected by migraine. Neuropsychiatr Dis Treat. 2013. 9:1351-8. [Medline]. [Full Text].

  3. 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. 1994 Dec. 62(6):1213-21. [Medline].

  4. Rask CU, Elberling H, Skovgaard AM, Thomsen PH, Fink P. Parental-reported health anxiety symptoms in 5- to 7-year-old children: the Copenhagen Child Cohort CCC 2000. Psychosomatics. 2012 Jan-Feb. 53(1):58-67. [Medline].

  5. Schwenzer M, Mathiak K. Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts. Psychol Health. 2011 Aug. 26(8):965-73. [Medline].

  6. Rask CU. Functional somatic symptoms in 5-7 year old children: assessment, prevalence and co-occurrence. Dan Med J. 2012 Nov. 59(11):B4537. [Medline].

  7. Bailer J, Witthöft M, Wagner H, Mier D, Diener C, Rist F. Childhood maltreatment is associated with depression but not with hypochondriasis in later life. J Psychosom Res. 2014 Aug. 77(2):104-8. [Medline].

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

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

  10. Torres AR, Ferrão YA, Shavitt RG, Diniz JB, Costa DL, do Rosário MC, et al. Panic Disorder and Agoraphobia in OCD patients: clinical profile and possible treatment implications. Compr Psychiatry. 2014 Apr. 55(3):588-97. [Medline].

  11. Weck F, Neng JM, Richtberg S, Stangier U. The restrictive concept of good health in patients with hypochondriasis. J Anxiety Disord. 2012 Dec. 26(8):792-8. [Medline].

  12. Muse K, McManus F, Leung C, Meghreblian B, Williams JM. Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. J Anxiety Disord. 2012 Jan. 26(1):189-96. [Medline].

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

  14. 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. 2007 jan. 164(1):91-9. [Medline].

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

  16. Eilenberg T, Kronstrand L, Fink P, Frostholm L. Acceptance and commitment group therapy for health anxiety - Results from a pilot study. J Anxiety Disord. 2013 Jun. 27(5):461-8. [Medline].

  17. 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. 2011 Feb. 41(2):431-41. [Medline].

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

  19. Weck F. Treatment of Mental Hypochondriasis: A Case Report. Psychiatr Q. 2013 Aug 10. [Medline].

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

  21. Undefined.

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

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

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

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

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

  27. 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. 1999 Sep. 38(9):1093-101. [Medline].

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

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

  30. 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. 1999 Jul. 38(7):852-60. [Medline].

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

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

  33. 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. 1997 Oct. 36(10):1329-38. [Medline].

  34. 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].

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

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

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

  38. 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. 2000 Mar. 101(3):194-208. [Medline].

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

  40. 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].

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

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.