Pediatric Illness Anxiety Disorder (Formerly Hypochondriasis) Treatment & Management

Updated: Jan 30, 2019
  • Author: Maria Sandra Cely-Serrano, MD; Chief Editor: Caroly Pataki, MD  more...
  • Print
Treatment

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. [15] 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. [16] 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. [17] However, studies included in the review used a small number of participants and did not allow for the estimation of effect size. [18]

  • 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. [19]

  • 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. [20, 21, 22]

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. [23]