hypochondria
Clemens Gödel is a freelancer for the medical team.
More about the experts All content is checked by medical journalists.The term hypochondria describes the exaggerated fear of being or becoming ill. Physical symptoms are over-interpreted and misinterpreted by those affected. The thoughts revolve around this fear of illness either permanently or in spurts. Hypochondriacs are mostly looking for medical help and reinsurance. The cause of the hypochondria is not known, but it is suspected to be in impaired thought processes. There is no cure for hypochondria, but those affected can find relief through psychotherapy. Read everything you need to know about hypochondria here.
Some hypochondriacs go to the doctor weekly, others flee from white coats. Both are burdened by a constant and unfounded fear of illness, which without therapy often increases.
Marian Grosser, doctor
Hypochondria: description
The term hypochondria covers a whole spectrum of diseases. It ranges from pronounced health awareness and health-oriented behavior to hypochondriacal delusion - the full picture of hypochondria. The most important characteristic of hypochondria is the fear of illness or being ill, which is intensified by the fact that one's own body perceptions (such as the heartbeat) are misinterpreted.
Because of this pathological fear, which usually severely restricts the quality of life of those affected, hypochondria often resembles a panic or anxiety disorder. In fact, it is counted among the so-called somatoform disorders. This group includes diseases in which emotional discomfort and stress are reflected in physical symptoms. However, this is not the main criterion of hypochondria, which is why its assignment to somatoform disorders is controversial.
Hypochondria: frequency
A number of well-known personalities are or have been said to suffer from hypochondria. These include Charlie Chaplin, Frederick the Great, Woody Allen and Thomas Mann. Overall, around one percent of Germans are probably affected by hypochondria. The full picture of the disease, the hypochondriac madness, can be found in around 0.05 percent of Germans - that is, in five out of 10,000 people. Six percent of the population show mild health-related fears. At university, psychotherapeutic outpatient clinics, hypochondriacs make up a quarter of patients. Worldwide, between two and seven percent of general practitioner patients are affected. Men and women are equally affected.
The number of unreported cases of hypochondriacs is probably much higher, as there are also those affected who do not attract attention in the health system. On the one hand, this can be due to the fact that these hypochondriacs show pronounced avoidance behavior or else they use alternative medicine. As a rule, however, hypochondriacs use the healthcare system unusually often and thus cause high costs.
So far there are no reliable data as to the age at which hypochondria breaks out. One third of the patients stated that they had exaggerated fears about illnesses in childhood. In principle, all age groups as well as men and women can suffer from hypochondria equally. From a statistical point of view, it is mainly people of the lower educational class who are affected. From today's perspective, a genetic predisposition only plays a subordinate role in hypochondria.
Some people develop intermittent hypochondriac seizures after an actual serious illness or experience. But even after the acquisition of new information regarding health and illness, hypochondriac phases can occur - as for example with medical students.
Secondary hypochondria
Especially in the context of schizophrenic diseases and anxiety disorders, hypochondriac symptoms can also appear as a non-independent clinical picture. In this case, the doctor speaks of secondary hypochondria, which is primarily (first) triggered by another disease.
Hypochondria: symptoms
People with hypochondria are very afraid of disease. This fear of being sick can limit life significantly. It includes worrying about pain, disability, suffering and death. Most of the time, the fear does not remain vague, but rather becomes more and more rigid with regard to certain diseases. To this end, hypochondriacs also conduct extensive research and collect all kinds of information relating to the dreaded diseases. Conversations and activities in everyday life are dominated by fear of illness and disrupt social interaction.
In addition, with hypochondria there is the difficulty of enduring insecurity and the urgent need to clarify symptoms. And symptoms of all kinds are perceived in a heightened way: Hypochondriacs pay very close attention to signals from the body, so that they are perceived even at a low intensity. Hypochondriacs are absolutely convinced that they suffer from an illness or will soon develop it. Catastrophic thoughts about one's own state of health are constantly circling in the head of the hypochondriac. This leads to insecurity and fear up to and including severe panic attacks. Those affected are more and more consumed by the suffering.
Permanent guest in the waiting room or escape from doctors
To combat their excessive fear, hypochondriacs are increasingly looking for reinsurance - again and again and more often. Many of those affected often examine themselves, run from one doctor to another and also repeatedly ask friends and family for their opinion on the alleged symptoms of the disease. The aim of this communication is to confirm that the suspected disease actually exists. Since this is mostly denied, frustration and dissatisfaction usually arise in hypochondriacs.
On the other hand, there are also hypochondriacs who consciously avoid the health system in order to prevent confrontation. Those affected drive around hospitals and cemeteries, for example.
The intensified search for confirmation of one's own health or illness is a central characteristic of hypochondria. Symptoms and fears can only be successfully alleviated in the short term, so that the cycle soon starts again with the faulty views of the disease.
Conscientious health care
In addition, hypochondriacs are increasingly trying to protect themselves from illness: they conscientiously change their diet, do a lot of sport and adopt a lifestyle that is as healthy as possible.
Certain organs and diseases in focus
Fear of disease in hypochondria mostly affects the gastrointestinal tract, muscles and skeleton, and the nervous system. Diseases such as skin or breast cancer are often the focus of attention. Those affected very often examine the skin or breast for signs of cancer. Often hypochondriacs are very well informed about the disease and see all descriptions fulfilled. It is important that hypochondriacs actually have the symptoms described, they do not simulate them.
Depressive and narcissistic traits
Hypochondriacs are also often depressed and melancholic and can show narcissistic behaviors. Narcissism is particularly noticeable in this context through overestimation and the desire for attention. Some specialists believe that hypochondria is associated with a neurotic personality. This is characterized by a disturbed mental development.
Therapy can help or harm
If help is offered to a hypochondriac in the form of therapy for his alleged illness, this often has a contradictory effect. Instead of an improvement in the condition, there are often more complications, side effects and an intensification of existing symptoms. In addition, the hypochondriac can discover new kinds of symptoms.
Diverse clinical picture
Overall, the clinical picture of hypochondria is very heterogeneous, so that different subtypes are characterized depending on the dominance of individual symptoms. In the course of the disease, health concerns can affect all areas of life and thus lead to a significant reduction in the quality of life. This can lead to conflicts, especially at work and in relationships.
Hypochondria: causes and risk factors
There are several theories about the development of hypochondria, but the cause has not yet been conclusively clarified. In addition, it is often not clear whether hypochondria is a completely separate disease or whether it is primarily a symptom of another disease such as depression.
The generally exaggerated views of the disease, which are mainly shown by the overestimation of the probability and severity of a disease, are considered to be an important basis for the development of hypochondria. The over- and misinterpretation of body signals is a crucial step on the way to severe hypochondriacal phases.
Hypochondriacs are often less self-confident than other people, combined with a feeling of vulnerability. You have the feeling that you have an increased risk of illness.
Hypochondria is also characterized by a desire for attention and help. Those affected have often made the experience that sick people can draw a lot of attention to themselves.
In particular, the depth psychological approach suspects an experience in childhood as the trigger for hypochondria. The diseases that a hypochondriac is particularly afraid of are often related to previous experiences. If there is an increased fear of skin cancer, it may be, for example, that a close relative or the person affected had previously suffered from skin cancer. An earlier confrontation with death can also shape thought and behavior patterns in such a way that hypochondria later develops.
Overall, hypochondria can be interpreted as a coping and self-healing strategy for other problems.
Hypochondria: examinations and diagnosis
Hypochondriacs can get first aid from their general practitioner. This usually has the best overview of real illness concerns and the patient's state of health. In this way, he is usually best able to differentiate between exaggerated fears and actual health risks in the patient.
After an in-depth discussion, the family doctor can refer the patient to a psychiatrist or psychologist. The patient must agree to this, because his willingness is a fundamental condition for initiating therapy for hypochondria.
Before starting psychotherapeutic treatment of hypochondria, however, it must be ruled out with certainty that there is no organic disease that could explain the symptoms described. These are in particular multiple sclerosis, the severe pathological muscle weakness myasthenia gravis, hormonal disorders, thyroid diseases and tumors.
Examinations by a psychiatrist or psychologist
The examination by the psychiatrist or psychologist consists of an intensive conversation in which various points are discussed. Modern tests are used for reliable diagnosis. These objectify the suspected diagnosis of hypochondria. In this sense, test means questionnaire. It includes specific questions about the symptoms of hypochondria such as:
- Does the thought of illness lead you to fear?
- Do you go to the doctor often?
- Are you worried about your health?
- Do you have any physical complaints?
- How do you react to fear of illness?
Such a “hypochondriac test” can also be found on the Internet, for example the “Illness Attitude Scales” (IAS). Such tests can be used to generally examine whether there is hypochondria, which elements of hypochondria are present and how severe it is.
Diagnostic criteria for hypochondria
It is important to distinguish between a temporary worry about being ill and an exaggerated fear of illness. In order to be able to make the diagnosis of hypochondria, the following criteria must therefore be met according to the American diagnosis catalog (DSM-V):
- Excessive preoccupation with being sick or being sick
- There are no physical symptoms or they are only mild. If the symptoms are severe, preoccupation with them should be judged as excessive and inadequate.
- The sufferer has a high level of anxiety about health concerns and is easily concerned about health issues.
- Excessive health-related behavior or avoidance of health issues
- The fear must have persisted for at least six months. However, the dreaded disease can vary.
- Medical examinations gave negative results. There is no better explanation for the symptoms than hypochondria, especially any general anxiety or panic disorder.
Forms of hypochondria
Experts differentiate between two subtypes of hypochondria: while one group of hypochondriacs is making increased use of medical care, the other group tries to avoid medical care.
The current American classification system for psychiatric diseases provides a different classification: One subtype of hypochondria is primarily characterized by physical symptoms, while the other subtype is characterized by fear.
Differentiation from other diseases
It can be difficult to tell the difference between panic disorder and hypochondria. While people suffering from panic disorder fear the acute consequences of illness, hypochondriacs focus primarily on the long-term perspective and not the acute situation.
In contrast to hypochondria, general anxiety disorders are characterized by a multitude of unspecific worries.
In contrast to people with somatization disorders, hypochondriacs are less concerned about the symptom than about the consequences and meaning.
Obsessive-compulsive disorder can also be considered as an alternative diagnosis to hypochondria. Other psychiatric disorders that need to be differentiated are phobias: Phobics are afraid of an illness they do not yet have. Hypochondriacs, on the other hand, usually assume that they already have the disease, even if it has not yet emerged.
Hypochondria: treatment
The therapy of hypochondria consists mainly of psychotherapy. The hypochondriac disorder is only treated with medication in severe cases.
In most cases (as with anxiety disorders), cognitive-behavioral psychotherapy is chosen as the therapeutic method. On the one hand, the aim of this therapy is to change the thinking structures (cognitively) of the hypochondriac. To this end, the overestimation of the likelihood of illness should be reduced. On the other hand, the behavior of the patient should be adapted. This concerns above all the constant security through visits to the doctor. For this purpose, declarations of intent can be formulated by the patient. The course of hypochondriac therapy in this direction is divided into different phases:
Cognitive-behavioral psychotherapy: introduction
In most cases, psychotherapeutic help is only sought years after the onset of hypochondria. The patient's insight that his or her suffering is primarily based on excessive fear must be strengthened, especially at the beginning of therapy. To do this, the therapist will guide the patient from the perceived symptoms to the fear. At the end of the therapy initiation, which lasts several sessions, the goals of the patient are determined.
Cognitive-behavioral psychotherapy: main part
The actual therapy focuses on two focal points: on the one hand, the increased perception of abnormal sensations is to be processed, on the other hand, it is important to adapt the patient's behavior.
The first focus aims to change the perception of the physical abnormalities that misinterpret a serious fear. In order to achieve this, alternative explanations for the abnormal sensations are worked out. This can be done using various experiments.
One of these experiments is what is known as somatosensory enhancement. It is based on the assumption that the perception (sensory) of the symptoms (somato-) is based on increased attention. To make this clear, the hypochondriac is asked to concentrate on an unaffected area of the body for a day, such as a foot. Various symptoms such as pain or tingling are usually reported promptly. Then new and more realistic explanations for these sensations are sought together.
In addition, the connection between fear or panic attacks and triggering (stress) factors in hypochondria is revealed. Fear of illness protocols can be written for this purpose, for example. With their help, connections between stress and fear of illness can be shown.
The aim of all procedures is to develop alternative explanations for the symptoms that trigger the hypochondriac's fear of being sick. In the case of back pain, for example, this would be a permanent bad posture.
The second central starting point of psychotherapy for hypochondria is to reduce the so-called safety-seeking behavior. These behaviors include examining your own body frequently, constantly craving reassurance, and avoiding health topics and locations such as hospitals. These behavioral patterns give the hypochondriac temporary relief. However, since the patient often has to repeat them over and over again in order to feel safe, his life is significantly impaired.
To remedy this, the hypochondriac should first describe the type of reinsurance. This can be, for example, constantly searching the skin for fear of skin cancer. The consequences of this behavior are analyzed together with the therapist. On this basis, a declaration of intent can be drawn up, which will be further specified in the further course. For example, it can be stipulated that the hypochondriac only examines his skin in detail once a month. This must be backed up with understandable arguments. It is important that the hypochondriac keep a record of this. This enables retrospective reinsurance for himself, but also the analysis of relapses into old behavior patterns.
When treating hypochondria, direct confrontation with fear-inducing situations, which the hypochondriac normally evades (the same is done in the therapy of an anxiety disorder), is also useful. For example, some hypochondriacs avoid shaking hands with strangers out of fear of being infected with pathogens. The confrontation with such a fearful situation can initially only take place in thought, in that the patient imagines the scenario, pursues this idea mentally and endures it. Such confrontations can also be carried out in real life. The patient should try to endure the situation without the protective reactions normally carried out. Certain triggering situations can also be discussed and analyzed.
Cognitive-behavioral psychotherapy: Degree
At the end of the psychotherapeutic therapy for hypochondria, the explanations and analyzes that have been developed are summarized and clearly presented. Then arguments for and against the disease assumptions are discussed. It is important to distinguish between realistic and improbable arguments and to highlight these differences.
The basis of the entire therapy must be the conscious decision made by the hypochondriac to accept the therapy. The therapy is based from beginning to end on a conversation at eye level, whereby the patient develops new ways of thinking himself. The therapy is intended to enable those affected to consciously improve their handling of hypochondria in order to reduce their own suffering.
It is of essential importance to explain the hypochondria to the patient, to ensure understanding and thus to provide help to the hypochondriac. In order to meet these demands, a good relationship between patient and therapist is indispensable.
Medication
There are hardly any good studies on drug therapy for hypochondria. So-called selective serotonin reuptake inhibitors (SSRI), especially fluoxetine, have mostly been tested. They are used for many psychiatric illnesses. Serotonin is an important messenger substance in the brain, the concentration of which is increased by this group of drugs. This is to improve the symptoms of hypochondria. However, there are no studies as to whether the effects persist even after the therapy has ended.
Which therapy works best?
In a comparison of psychotherapy, drug treatment and no treatment, psychotherapy and drug were found to be equally effective. Studies suggest that the positive therapeutic effect of psychotherapy lasts longer even after it has ended. Hypochondria that arises as a result of other (psychiatric) illnesses (secondary hypochondria) can usually be successfully combated by treating this illness.
Hypochondria: disease course and prognosis
The hypochondria can develop in crises. These crises can be triggered by situations that arouse certain associations or memories. Dealing with this can be significantly improved through therapy.
Severe forms of hypochondria lead to impairments in all areas of life. In addition to professional life, relationships with other people can also suffer as a result.
Although the hypochondria cannot be cured, successful therapy can significantly reduce the suffering. Studies have shown that seriously ill hypochondriacs in particular benefit from cognitive-behavioral psychotherapy and experience relief. In general, the longer the hypochondria has existed and the more severe it is, the worse the prognosis. Additional illnesses (especially psychological ones such as anxiety or depression) can worsen the therapy result. Such diseases must therefore be treated intensively at the same time.
Young patients in particular have a great chance of being able to cope better with their hypochondria through therapy.
Tags: palliative medicine alternative medicine gpp
