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HypochondriaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/hypochondria/DS00841
When you have hypochondria, you become obsessed with the idea that you have a serious or life-threatening disease that hasn't been diagnosed yet. This causes significant anxiety that goes on for months or longer, even though there's no clear medical evidence that you have a serious health problem. Hypochondria is also called hypochondriasis.
While having some anxiety about your health is normal, full-blown hypochondria is so consuming that it causes problems with work, relationships or other areas of your life. Severe hypochondria can be completely disabling.
Although hypochondria is a long-term condition, you don't have to live your life constantly worrying about your health. Treatment such as psychological counseling, medications or simply learning about hypochondria may help ease your worries.
Hypochondria symptoms include:
- Having a long-term intense fear or anxiety about having a serious disease or health condition
- Worrying that minor symptoms or bodily sensations mean you have a serious illness
- Seeing doctors repeated times or having involved medical exams such as magnetic resonance imaging (MRI), echocardiograms or exploratory surgery
- Frequently switching doctors — if one doctor tells you that you aren't sick, you may not believe it and seek out other opinions
- Continuously talking about your symptoms or suspected diseases with family and friends
- Obsessively doing health research
- Frequently checking your body for problems, such as lumps or sores
- Frequently checking your vital signs, such as pulse or blood pressure
- Thinking you have a disease after reading or hearing about it
Hypochondria vs. normal worries
Not everyone who worries about health problems has hypochondria. Having symptoms caused by something you and your doctor can't identify clearly can cause anxiety. In some cases, a second opinion or further tests may be in order.
However, if you start to search for ailments that seem to match your symptoms, chances are you'll find something. Minor ailments often share symptoms with more-serious disorders. It's become easier to search out health information on the Internet in recent years. Having easy access to information about every possible thing that could be wrong can fuel your anxiety.
There's nothing wrong with informing yourself. Being an active participant in your own health is an important part of staying well. However, you may be crossing the line into hypochondria if you're consumed by the idea that something is seriously wrong even though you've had appropriate tests and reassurance from your doctor that everything's OK.
When to see a doctor
If you have signs and symptoms of hypochondria, consider talking to a mental health provider such as a psychiatrist, psychologist or licensed counselor. You may decide to take the step yourself or a family member may suggest that you seek help. At some point, a doctor, nurse or other health care professional may suggest that you visit a mental health provider.
It may seem to make no sense to visit a mental health provider when you're certain that you have a medical disease. But try to keep an open mind. Be willing to consider the possibility that your worries are based on your emotions rather than fact. Listen to the opinions of your family members and friends.
Even if you don't have all of the symptoms of hypochondria, it's not a bad idea to talk to a mental health provider about your health worries. Hypochondria or not, ongoing worries about your health can make you miserable. Seeing a mental health provider for health anxiety may help.
Helping a loved one
If you have a loved one with signs and symptoms of hypochondria, have an open and honest discussion about your concerns and the things you've noticed. You may not be able to force someone to seek help for a mental health problem, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. Offer to go to an appointment with him or her.
It's not clear why some people are overwhelmed by the misguided perception that they have a major, undiagnosed health issue. It's thought that personality, life experiences, upbringing and inherited traits may all play a role.
There are similarities between hypochondria and anxiety disorders such as panic disorder and obsessive-compulsive disorder.
Factors that may increase your risk of developing hypochondria include:
- Having a serious illness during childhood
- Knowing family members or others with a serious disease
- The death of a loved one
- Having an anxiety disorder
- Believing good health means that you are free of all physical symptoms or unusual bodily sensations
- Having close family members with hypochondria
- Feeling especially vulnerable to illness or disease
- Having parents who were neglectful or abusive
Hypochondria occurs about equally in men and women. It can develop at any age, even in children, but it most often starts in early adulthood.
Complications of hypochondria can include:
- Health risks associated with unnecessary medical procedures
- Anxiety disorders
- Excessive anger and frustration
- Substance abuse
Hypochondria can be overwhelming and disabling. You may become so obsessed with finding a cause for your physical symptoms that it affects your daily life. You may frequently miss work or school. Your health may be all that you can think about or talk about, which can frustrate family and friends. Common problems linked to hypochondria include:
- Work or school problems
- Relationship difficulties
- Strained relationships with your health providers
- Financial problems related to medical costs
Preparing for your appointment
You may start by seeing your primary health care provider. Or, you may go directly to a mental health provider on your own. But if you're like most people with hypochondria, you have a hard time believing that your symptoms and health anxiety could be psychological in nature. But try to keep an open mind and understand that if multiple doctors can't find an underlying health problem, then you may indeed have hypochondria.
What you can do
Being an active participant in your care can help your efforts to manage your condition. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:
- Why do you think I might have hypochondria?
- How can you be sure that I don't have a serious illness that just hasn't been detected yet?
- Can I get over hypochondria on my own?
- How do you treat hypochondria?
- Will psychological counseling (psychotherapy) help?
- Are there medications that might help?
- How long will treatment take?
- What can I do to help myself?
- Are there any brochures or other printed material that I can take home with me?
- What websites do you recommend visiting?
In addition to your prepared questions, don't hesitate to ask questions at any time during your appointment.
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts and behavior, medical appointments and procedures, and symptoms that make you think you have a serious illness. You may be asked such questions as:
- What symptoms are you having that you think may be caused by a physical illness?
- What treatments, if any, have you had?
- What tests and procedures, if any, have you had?
- What have you tried on your own to feel better or control your symptoms?
- What things make you feel worse?
- How much time do you spend each day thinking about your health?
- How do worries about your health affect your daily life?
- Have friends or family commented about your thoughts or behavior?
- Have any of your relatives had a mental illness?
- What do you hope to gain from treatment?
- What medications or over-the-counter herbs and supplements do you take?
Tests and diagnosis
If your doctor or mental health provider believes you may have hypochondria or another psychological condition, he or she will likely ask a number of questions or have you fill out a psychological questionnaire. If your doctor or mental health provider is concerned that your symptoms could be a sign of physical illness, he or she may order medical tests.
These steps can help pinpoint a diagnosis by ruling out other problems that could be causing your symptoms and checking for any related complications.
Exams and tests may include:
- Physical exam. This generally involves measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
- Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past.
- Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and checking your thyroid function.
Diagnostic criteria for hypochondria
To be diagnosed with hypochondria, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of hypochondria include:
- A preoccupation, lasting for at least six months, that you have a serious illness based on your bodily symptoms
- Worry about this preoccupation
- Difficulty in your social life, work or other daily routines
Treatments and drugs
Treatment for hypochondria can include psychological counseling, education and medications.
- Psychological counseling. Psychological counseling (psychotherapy) is the primary treatment for hypochondria. A form of psychotherapy called cognitive behavioral therapy (CBT) may be the most effective treatment. Cognitive behavioral therapy helps you recognize and stop behavior associated with your anxiety, such as constantly monitoring your body for problems. Sometimes counseling may include exposure therapy, in which you directly confront your health fears in a safe environment and learn skills to cope with these uncomfortable sensations.
- Education about hypochondria. Known as psychoeducation, this type of counseling can help you and your family better understand what hypochondria is, why you have it and how to cope with your health fears.
- Medications. Certain antidepressant medications may be helpful in treating hypochondria. Examples include serotonin reuptake inhibitors (SSRIs) such fluoxetine (Prozac), fluvoxamine (Luvox) and paroxetine (Paxil); and tricyclic antidepressants such as clomipramine (Anafranil) and imipramine (Tofranil). Your doctor may prescribe other medications, particularly if you also have another psychological or physical condition.
Lifestyle and home remedies
In most cases, hypochondria won't get better if you try to treat it on your own. But you can do some things for yourself that will build on professional treatment:
- Stick to your treatment plan. Go to all of your therapy sessions, even if you don't feel like going. Even if you're feeling well, resist any temptation to skip your medications. If you stop, your symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
- Learn about your condition. Education about hypochondria can empower you and motivate you to stick to your treatment plan. Just learning about hypochondria may help ease your worries.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your health anxiety. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
- Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy.
- Avoid drugs and alcohol. Alcohol and illegal drugs can worsen symptoms or increase anxiety and depression. They may also interact with medications you're taking.
- Create a good relationship with your doctors. Your relationship with your doctors can become strained if both you and your doctors feel frustrated about your situation. Be open and honest with your doctors about your concerns. Learn ways to cope with urges to have unnecessary tests and procedures. At the same time, don't neglect checkups or skip visits to your family doctor, especially if you aren't feeling well.
Coping and support
Your hypochondria may never completely go away, but you can learn how to cope with your health anxiety so that it doesn't disrupt your life.
Consider these coping measures:
- Don't doctor shop. Find a health care professional you trust and stick with him or her. Don't continually seek out new doctors or health care professionals to run more tests or perform more procedures. Scheduling regular follow-up visits with your health care provider can help offer reassurance that you're OK.
- Avoid excessive research. For someone with hypochondria, the Internet can be a dangerous place. Don't spend hours researching health information or looking up vague symptoms. Chances are, you'll find something you think you have, fueling your anxiety.
- Skip disease-of-the-week stories. The media is full of stories with dire warnings about "overlooked" or "misdiagnosed" diseases that are just waiting to strike you down. Avoid these stories. They may only increase your anxiety, especially if they include common or vague symptoms.
- Don't get fixated on your body. Resist the urge to continually monitor your pulse or other vital signs or to check your body for signs of disease. Talk to your doctor about what self-checks or self-exams are reasonable for you.
- Ask for help. Ask for support and patience from family and friends who know you have hypochondria. Talking openly to them may help ease their own frustrations about your health anxiety, and they may be able to help you keep perspective.
- Join a support group. Join a hypochondria or anxiety support group. It can help you connect with others who share common concerns, find out more about your condition and learn additional coping strategies.
There's no sure way to prevent hypochondria. Get help as soon as possible if ongoing concerns about your health are getting worse, are making you unhappy or are causing problems. Addressing hypochondria early can reduce its impact on your life.
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