Hypochondriasis

What Causes Hypochondriasis?

The cause of hypochondriasis is unknown. It may be caused by a combination of factors, including biology and external environmental events. Some situations or conditions put a person at increased risk for hypochondriasis. Possible risk factors include:

• Having a severe illness in childhood or having a close family member who is seriously ill
• Having family members with excessive health-related anxiety
• Having a health scare, such as the possibility of cancer that is later ruled out
• History of mental health disorders such as depression or anxiety
• History of abuse or neglect
• Periods of extreme stress
• Traumatic experiences (e.g., rape, violent crime, or domestic abuse)

Is Hypochondriasis Hereditary?

Hypochondriasis is an anxiety disorder, and anxiety seems to have a genetic connection. People with a family history of anxiety disorders have a higher risk of developing an anxiety disorder themselves, suggesting an inherited component to anxiety. However, scientists have not identified a single gene definitively associated with hypochondriasis or other anxiety disorders. Instead, anxiety is likely the result of a coincidence of multiple genetic and environmental factors.

How Is Hypochondriasis Detected?

Early detection of hypochondriasis is important because prompt treatment of the disorder may help the sufferer avoid significant consequences in the future. Worrying about physical health is normal, but worries that persist after a medical professional assures you there is no need for anxiety are a cause for concern.

Left untreated, hypochondriasis can lead to serious social, financial, and mental health-related consequences. The condition is often first diagnosed when health-related fears impair the sufferer’s ability to function, and people around the sufferer begin to notice the impairment.

How Is Hypochondriasis Diagnosed?

Diagnosis of hypochondriasis begins by ruling out medical problems that may be causing symptoms. After these exams, if the doctor suspects that hypochondriasis or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment.

Diagnostic steps may include:

• A physical exam. This exam will be aimed at ruling out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

With the latest edition of the Diagnostic and Statistical of Mental Disorders (DSM-5), hypochondriasis has been replaced as a diagnosable disorder by illness anxiety disorder and somatic symptom disorder. As a result, cases that would once have been diagnosed as hypochondriasis will now usually be diagnosed as one of these two new disorders.

The distinction between the two diagnoses is usually based on the prevalence of physical symptoms. SSD will likely be diagnosed if physical complaints are prominent, while IAD is more likely if physical problems are minimal or non-existent.

After medical causes are ruled out, medical professionals can consider whether the patient meets the diagnostic criteria for IAD. These criteria include:

• Persistent thoughts, worry, or anxiety about having or acquiring a serious illness.
• Few physical symptoms, if any, are present.
• The person has general anxiety about health-related issues.
• The person is fixated on monitoring their health status.
• The anxiety has lasted at least six months.
• Any other mental condition does not better explain the symptoms.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Hypochondriasis Treated?

There is no cure for hypochondriasis. Psychotherapy, usually cognitive behavioral therapy, is the most common course of treatment. Medications may help the mental-health symptoms of the disorder and those of other co-existing disorders, such as depression or anxiety. Serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medications.

How Does Hypochondriasis Progress?

With treatment, some people with hypochondriasis will see improvement in their mental health symptoms. However, untreated hypochondriasis may last indefinitely, with symptoms that periodically improve on their own and emerge again later. Relapses may be triggered by stress.

Hypochondriasis symptoms can cause impairments that produce severe complications. Long-term complications can include:

• Depression or other mental disorders
• Social isolation
• Lack of healthy interpersonal relationships
• Work difficulties or unemployment
• Financial difficulties

How Is Hypochondriasis Prevented?

There is no known way to prevent hypochondriasis. However, prompt treatment may relieve the effects of the disorder and make it less likely that the sufferer will experience severe complications over time.

Hypochondriasis Caregiver Tips

Many people with hypochondriasis, IAD, or SSD also suffer from other brain and mental health-related issues, a situation called co-morbidity. Here are a few of the disorders commonly associated with somatoform disorders:

• More than half of people with IAD also suffer from depression.
• Many people with IAD have a co-existing anxiety disorder, such as generalized anxiety disorder or a phobia.
• Other disorders commonly co-morbid with somatoform disorders include personality disorders and obsessive-compulsive disorder (OCD).

Hypochondriasis Brain Science

Scientists believe that anxiety symptoms come from activity in the parts of the brain that control emotions and our reactions to them. These parts of the brain are called, collectively, the limbic system. The limbic system is associated with anxiety in several ways:

• The amygdala, the part of the brain responsible for detecting threats, may be hyperactive and may misidentify causes for fear or worry when none exist.
• An overactive amygdala may persistently cause the hypothalamus to trigger the hormonal response that produces the physical symptoms of anxiety.
• Communication between the amygdala and the prefrontal cortex (PFC) may be impaired. The PFC is responsible for triggering a rational response to threats, and it may not be able to do so when it is unable to communicate with the amygdala effectively.
• The hippocampus, the part of the brain responsible for processing long-term memory, may be underdeveloped or dysfunctional in the case of anxiety. As a result, it may prefer to retain stress-related memories rather than more rational ones. 

Hypochondriasis Research

Title: Study of Dextromethorphan in OCD and Related Disorders

Stage: Not Yet Recruiting

Principal investigator: Peter J. van Roessel, MD PhD

Stanford University

Palo Alto, CA

The purpose of the study is to assess the tolerability and efficacy of dextromethorphan in combination with fluoxetine for symptom relief in OCD and related disorders.

Obsessive-compulsive disorder (OCD) and the related disorders body dysmorphic disorder (BDD), somatic symptom disorder (SSD), and illness anxiety disorder (IAD) are psychiatric conditions characterized by recurrent, intrusive thoughts, feelings or images (obsessions or preoccupations) and repetitive or ritualized behaviors or avoidance performed to relieve obsession or preoccupation-related anxiety. They are a significant cause of mental health-related disability and are inadequately served by available treatments.

This study tests whether an over-the-counter cough suppressant medicine, dextromethorphan, may offer symptom relief when combined with a low dose of fluoxetine, a standard prescription treatment for OCD and related disorders.

Title: Caloric Vestibular Stimulation for Modulation of Insight in Obsessive-Compulsive Spectrum Disorders

Stage: Recruiting

Principal investigator: Peter J. van Roessel, MD, PhD

Stanford University

Palo Alto, CA 

Obsessive-compulsive and related disorders (OCRD), including obsessive-compulsive disorder and body dysmorphic disorder, are chronic and disabling conditions characterized by recurrent intrusive thoughts and associated compulsive behaviors that affect millions of individuals in the US each year. Individuals affected by OCRD differ in insight or the degree to which they understand their intrusive thoughts to reflect illness. Impairments in insight limit individuals’ motivation to engage in care and predict worse outcomes in those who access treatment.

This study seeks to explore whether unilateral stimulation of the vestibular system, which activates cortical areas hypothesized to underlie clinical insight, may beneficially modulate insight in individuals with OCRD.

Title: Evaluation of Primary Care Behavioral Health (PCBH) With the Addition of Self-help CBT – A Randomized Multicenter Trial (KAIROS)

Stage: Recruiting

Principal investigator: Viktor Kaldo

Linnaeus University

Vaxjo, Sweden

The overarching goal of primary care is to offer all patients individualized and context-sensitive healthcare with high access and continuity. One of the reasons primary care struggles with this goal is that a large proportion of patients suffer from mental and behavioral health problems, alone or in combination with one or several chronic illnesses. Despite many patients needing psychosocial interventions, there is a lack of mental health professionals and clear pathways for these patients.

Primary Care Behavioural Health (PCBH) is an innovative way of organizing primary care, where mental health professionals have more yet shorter visits, strive for same-day access, and have an active consulting role in the primary care team. To help patients achieve relevant behavioral changes, so-called brief interventions are used, which are based on isolated components from psychological treatments such as Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT). Brief interventions usually stretch over 1-4 treatment sessions. Assessments within the model are generally contextual and largely avoid psychiatric diagnostics, instead focussing on the patient’s situation and their associated coping strategies – whether positive or negative. However, these interventions have not been systematically evaluated in the same way that structured CBT has. There is a risk that patients who would have benefitted from structured CBT and a diagnostic assessment are undertreated due to lack of diagnostics and the reduced visit duration and amount.

Data will be collected at primary care centers (PCCs) that already have high fidelity to a PCBH framework. Fidelity will be measured by an expert group as well as using four questionnaires, one for each of mental health professionals, medical doctors, registered nurses, and leadership. These fidelity scales will be validated in a separate study. In addition to fidelity, work environment and satisfaction with the PCBH implementation will be measured.

Patients at the centers will be randomized between receiving contextual assessments followed by brief interventions or a diagnostic assessment, which can lead to treatment with either self-help CBT (if a treatable diagnosis is confirmed and the patient is suitable for self-help CBT) or brief interventions (if self-help CBT is not deemed to be a suitable intervention). The primary comparison is the outcome for patients who either received self-help CBT or are deemed suitable for the intervention based on screening data. At the same time, secondary analyses will look at treatment outcomes for all patients, including those with non-psychiatric problems such as crises, loss, or work- or family-related issues. The study will also look at implementation outcomes for self-help CBT and diagnostic assessments to see if self-help CBT is a feasible addition to the PCBH model.