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Hypochondriasis

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis/Possible Complications
• Following Up
• Supporting Research

Hypochondriasis, or hypochondria, is an overwhelming fear that you have a serious disease, even though health care providers can find no evidence of illness. People with hypochondriasis tend to misinterpret normal body sensations as being signs of serious illness. Most people occasionally fear they have an illness, but people with hypochondriasis are preoccupied with their fear, which is severe and persistent and interferes with work as well as relationships. Hypochondriasis is somewhat similar to obsessive-compulsive disorder, because of the obsession with illness and the compulsion to do something to lessen their anxiety. An estimated 75 - 85% of people who have hypochondriasis also have anxiety, depression, or another mental disorder.

Signs and Symptoms

• Preoccupation with a serious illness for at least 6 months
• Misinterpreting normal body symptoms
• Persistent fear of illness despite being reassured by health care providers that you are not ill
• Difficulty maintaining a job, keeping relationships, and performing normal daily activities

What Causes It?

No one knows what causes hypochondriasis, but there are several theories, including the following:

• The belief that an illness may be deserved due to some past real or imagined wrongdoing
• Having learned apparent benefits of being sick, such as receiving attention. Hypochondriasis may occur in an individual who had a childhood illness or had a sibling with a childhood illness.
• May be related to another psychiatric disorder such as anxiety or obsessive-compulsive disorder. In other words, hypochondriasis may develop from or be a sign of one of these other disorders.

Who's Most At Risk?

These factors increase the risk of developing hypochondriasis:

• Being sick as a child with a prolonged illness, or having a sick family member (learning the apparent benefits of being sick)
• Family history of hypochondriasis
• Recent stressful event (for example, the death of a close friend or relative)

What to Expect at Your Provider's Office

Your health care provider will perform a physical examination along with other tests to determine whether a physical disease may account for your reported symptoms. Your health care provider will also ask specific questions and use psychological tests to rule out the possibility of other related disorders such as anxiety or obsessive-compulsive disorder. A trained specialist, such as a psychologist or a psychiatrist, may be consulted to aid in the diagnosis and treatment.

Treatment Options

Treatment Plan

In addition to having regular visits with a health care provider who will take the physical symptoms seriously, people with hypochondriasis may also benefit from psychotherapy. Group therapy, behavior modification, and cognitive therapy have been reported to work particularly well (see section entitled Surgical and Other Procedures for more details). People with hypochondriasis often have other mental health conditions, such as anxiety and depression, and treatment of these conditions is important in treating symptoms of hypochondriasis (see the entry under "Anxiety").

Drug Therapies

Drugs are generally not used to treat hypochondriasis specifically, but for associated mental health conditions. They may improve symptoms of hypochondriasis. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, fluvoxamine, or paroxetine, are sometimes prescribed.

Surgical and Other Procedures

Several types of psychotherapy may help:

• Cognitive-behavioral therapy helps you identify thoughts that contribute to fears about illness and to correct the misinterpretation of body sensations. This type of therapy teaches people to concentrate less on thoughts and fears of illness and to use relaxation and distraction techniques.
• Behavioral-stress management therapy teaches stress management and relaxation techniques to help people avoid becoming focused on illness during stressful situations. It may be used together with cognitive-behavioral therapy.

Complementary and Alternative Therapies

Cognitive-behavioral therapy and stress management are the cornerstones of treatment for hypochondriasis. Acupuncture has also been shown to help. Beyond that, not many studies have been done on complementary and alternative therapies for hypochondriasis. Regular appointments with a CAM health care provider may help relieve health-related fears because of the regularity of the visits, the reassurance from a professional, and the focus on wellness and healthy behaviors. Work with someone who is licensed and reputable to develop a solid program of self-care and health promotion.

Nutrition

No scientific studies have examined the effect of nutrition on hypochondriasis. However, people with hypochondriasis who also have anxiety or depression may benefit from avoiding alcohol and caffeine. In general, it makes good sense for a person with hypochondriasis to eat a healthy diet, including the following:

• Eat plenty of fresh fruits, vegetables, and whole grains.
• Limit sugar, dairy, and refined, processed foods.
• Drink at least eight glasses of water each day to reduce constipation and other gastrointestinal complaints.
• Eat small, frequent meals throughout the day. This helps stabilize blood sugar (which can improve mood) and improve digestion (which may reduce awareness of normal body sensations as food passes through the intestines).

The following supplements may promote general health and well-being:

• Multivitamin (one per day)
• Calcium (1,000 mg per day) and magnesium (400 - 600 mg per day) may help support the nervous system and reduce the effects of stress. Taking too much calcium may lead to constipation and too much magnesium to gas, bloating, and diarrhea. If that happens, reduce the dose.
• Vitamin B complex (50 - 100 mg per day), including pantothenic acid (B ₅ ) and pyridoxine (B ₆ )
• Probiotics, including Lactobacillus acidophilus, to help decrease bowel symptoms
• 5-hydroxytryptophan or 5-HTP (100 mg three times per day) may elevate levels of serotonin, helping relieve symptoms of depression and anxiety. Do not take 5-HTP if you take a prescription antidepressant.

Herbs

No herbs are specifically used to treat hypochondriasis, but certain herbs used to relieve stress or anxiety may also help a person with hypochondriasis become less preoccupied with disease (which tends to worsen during stressful times). Other herbs may help lessen symptoms of hypochondriasis. Because many herbs interact with prescription antidepressants and anti-anxiety medications, make sure your doctor is aware of all medications, herbs, and supplements you take.

• Echinacea ( Echinacea spp., doses vary from 300 mg - 900 mg per day) to reduce frequency and duration of colds. Because echinacea can interact with other medications, take it only under your doctor's supervision.
• Kava kava ( Piper methysticum, 100 - 200 mg two to four times a day) for mild to moderate anxiety. The FDA has issued a warning concerning kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days and tell your doctor before taking it.
• Valerian ( Valeriana officinalis, 120 mg three times per day) and lemon balm ( Melissa officinalis) for mild to moderate anxiety or insomnia. Valerian may interact with other drugs that have a sedative effect, such as benzodiazepines, barbiturates, narcotics, antidepressants, and antihistamines. Do not take valerian if you are pregnant or nursing. Valerian can also affect the liver, so do not take it if you have liver problems. Lemon balm may also help relieve gastrointestinal symptoms (such as constipation, gas, bloating, nausea).
• Oat straw ( Avena sativa ) to assist recovery from cold or other illnesses and strengthen a weakened constitution. It also contains fiber, which can help decrease bowel symptoms.
• Passionflower ( Passiflora incarnata ) for restlessness, nervous stress, anxiety, rapid heartbeat related to anxiety, and sleep disorders. Dose is 3 cups tea per day, made by steeping 2 g in one cup boiling water, strain, and cool. Or take 45 - 60 drops of liquid extract.
• St. John's wort ( Hypericum perforatum, 300 mg three times per day) for symptoms of depression and anxiety. St. John's wort can interact with other drugs you may be taking, including antidepressants, birth control, and other medications, and should be avoided during pregnancy or when nursing. Talk to your doctor before using St. John's wort with any other medications.

Homeopathy

Few studies have examined the effectiveness of specific homeopathic remedies. Some health care professionals, however, believe that homeopathy promotes a sense of well-being and may relieve feelings of anxiety and depression often associated with hypochondriasis. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Aconitum -- for a sense of panic and fear. This remedy is most appropriate for people who believe that they are so sick they are going to die.
• Arsenicum album -- for anxiety and fear of dying. This remedy is most appropriate for people who call the doctor often and are difficult to reassure or children who may be worried about everything and tend to act more sick than they actually are.
• Lycopodium -- for general fear and anxiety about health. This remedy is most appropriate for stressed people who complain often of stomach problems.
• Phosphorus -- for general anxiety about health. This remedy is most appropriate for people who have a fear that something bad will happen (sense of impending doom) and may latch onto the fears of others, but tend to be easily reassured.

Acupuncture

Several studies indicate that acupuncture may be useful in treating hypochondriasis. Acupuncturists believe the procedure balances the flow of energy (qi) in the body. This balancing effect may be particularly helpful for people who have distorted perceptions of normal body sensations. Acupuncture may be useful for:

• Relieving ongoing fear and apprehension
• Reducing symptoms of emotional stress
• Lessening stress and pain
• Regulating sleep patterns
• Improving energy

Massage

Some health care providers believe that regular visits to a massage therapist (which include techniques to relieve stress) may help reduce symptoms of hypochondriasis. It is possible, however, that for some people, having regular massages could draw attention to their physical complaints, and increase their symptoms.

Prognosis/Possible Complications

Stress and anxiety may make the symptoms of hypochondriasis worse. Many people may also struggle with costly medical tests and develop a dependency on certain medications. Hypochondriasis is a chronic illness (it persists for a long time), but getting early psychiatric treatment and having a strong motivation to change may increase the chances of getting better. Some reports suggest that one-third to one-half of patients improve over time, and one-tenth recover completely.

Following Up

Try to maintain a healthy relationship with your primary health care provider. Your health care provider will want to schedule regular appointments to monitor your symptoms.

Supporting Research

Adams RD, Victor M, Ropper AH. Principles of Neurology . 6th ed. New York, NY: McGraw-Hill; 1997:1523-1524.

Blumenthal M, ed. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines . Boston, Mass: Integrative Medicine Communications; 1998:156-157, 160-161, 214-215.

Blumenthal M, Goldberg A, Brinckmann J, eds. Herbal Medicine: Expanded Commission E Monographs. Newton, Mass: Integrative Medicine Communications; 2000:221-225, 230-232, 281-286, 293-295, 359-366.

Clark DM, Salkovskis PM, Hackmann A, et al. Two psychological treatments for hypochondriasis. A randomised controlled trial. Br J Psychiatry. 1998;173:218-225.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3 ^rd ed. New York, NY: Penguin Putnam; 1997: 334.

Enright SJ. Fortnightly review: Cognitive behaviour therapy -- clinical applications. BMJ . 1997;314(7097):1811-1816.

Fagen TS, Wool CA. Conjoint therapy: psychiatry and music therapy in the treatment of psychosomatic illness. Int J Arts Med. 1999;6(1):4-9.

Gramling SE, Clawson EP, McDonald MK. Perceptual and cognitive abnormality model of hypochondriasis: amplification and physiological reactivity in women. Psychosom Med. 1996;58(5):423-431.

Hales RE, Yudofsky SC, Talbott JA. Textbook of Psychiatry. 3rd ed. Washington, DC: American Psychiatric Press, Inc; 1999:683-686.

Helms J. Acupuncture Energetics. Berkeley, Calif: Medical Acupuncture Press; 1995:31-32.

Jellin JM, Gregory P, Batz F, Hitchens K, et al. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database . 3rd ed. Stockton, Calif: Therapeutic Research Facility; 2000.

Jonas WB, Jacobs J. Healing with Homeopathy: The Doctors' Guide. New York, NY: Warner Books; 1996: 249.

Kochetkov VD, Mikhailova AA, Dallakian IG. Reflexotherapy of neurotic patients with depressive-hypochondriacal manifestations [in Russian]. Zh Nevropatol Psikhiatr Im S S Korsakova . 1983;83(12):1853-1855.

Molin G. Probiotics in foods not containing milk or milk constituents, with special reference to Lactobacillus plantarum 299v. Am J Clin Nutr. 2001;73(2 Suppl):380S-385S.

Noyes R Jr, Kathol RG, Fisher MM, Phillips BM, Suelzer MT, Holt CS. The validity of DSM-III-R hypochondriasis. Arch Gen Psychiatry . 1993;50(12):961-970.

Romoli M, Giommi A. Ear acupuncture in psychosomatic medicine: the importance of the sanjiao (triple heater) area. Acupunct Electrother Res. 1993;18(3-4):185-194.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 44.

Warwick HM, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry . 1996;169(2):189-195.

• Review Date: 12/2/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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