Hypochondriasis Follow-up

Updated: Aug 02, 2016
  • Author: Debra Kahn, MD; Chief Editor: David Bienenfeld, MD  more...
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Follow-up

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.

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Transfer

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

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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.

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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. [46]

A systematic review of six studies on hypochondriasis indicated that 30-50% of patients achieve recovery. [47]

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. [48]

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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 eMedicineHealth's Mental Health Center and Depression Center.

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:

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