| disease | Hypochondria |
| alias | Hypochondriacal Neurosis, Hypochondriasis, Hypochondriacal Neurosis |
Hypochondriasis, also known as hypochondriacal neurosis, primarily refers to a persistent preoccupation among patients with the belief or fear of having one or more serious physical illnesses. Patients complain of physical symptoms and repeatedly seek medical attention. Despite repeated negative medical examinations and doctors' explanations that no evidence of the corresponding disease exists, their concerns remain unresolved, often accompanied by anxiety or depression. Preoccupations or concerns about bodily deformities also fall under this disorder. This condition is relatively rare. According to a nationwide epidemiological survey of neuroses in 12 regions, its overall prevalence rate was only 0.15%. A study by the Psychiatry Department of West China Medical University in a county hospital outpatient clinic found that it accounted for 9.0% of neuroses. However, in a continuous analysis of 500 cases in a psychiatric outpatient clinic, only one case was identified among neuroses, indicating significant variation. International statistics show that this disorder accounts for 1% of total hospitalized patients. There is no gender difference in incidence, with the onset age typically around 40 for men and 50 for women, though it is not uncommon among the elderly.
bubble_chart Etiology
1. Psychosocial Factors: Changes in marital status, separation from children, reduced social interactions with friends, loneliness, disruptions in life stability, and a lack of security can all serve as triggers for the onset of the condition. Some cases are iatrogenic, where inappropriate words, attitudes, or behaviors from doctors lead to patients developing suspicion, or where doctors provide unclear diagnoses and repeatedly order tests, reinforcing the patient's belief that they suffer from a certain illness. Another subset of patients develops hypochondriacal tendencies after experiencing physical illnesses, through self-suggestion or association.
2. Predisposing Factors: A susceptibility predisposition is also an important foundation for the onset of the condition. It has been observed that similar episodes occur among members of the same family. The personality traits of such patients include sensitivity, suspicion, subjectivity, stubbornness, excessive caution, an overemphasis on physical health, and perfectionism. Male patients often exhibit obsessive-compulsive traits prior to the illness, while female patients tend to have histrionic personality characteristics.bubble_chart Clinical Manifestations
1. Hypochondriacal psychological barriers have two manifestations: one is hypochondriacal sensations, where the individual feels increased sensitivity in a certain part of the body or becomes overly focused on it, leading to hypochondria or excessive concern. The patient's descriptions are often vague and inconsistent in terms of location. The other type involves vivid and detailed descriptions, with the patient convinced they have a specific disease, despite knowing it doesn’t actually exist. They demand various tests and seek sympathy from doctors. Even with normal test results, the doctor’s explanations and reassurances fail to dispel their hypochondriacal beliefs, and they may suspect errors in the tests. Consequently, the patient experiences worry, anxiety, distress, and agitation. This is a form of hypochondriacal ideation, a type of overvalued idea, imbued with strong emotional overtones.
2. Pain is the most common symptom of this disorder, affecting about two-thirds of patients. Common sites include the head, lower back, or right iliac fossa. The pain is often described vaguely, sometimes even as whole-body pain, but no physical evidence is found. Patients frequently seek medical help from various specialties without resolution, eventually turning to psychiatry. It is often accompanied by insomnia, anxiety, and depressive symptoms.
The diagnostic criteria are as follows:
1. Meeting the diagnostic criteria for neurosis.
2. Hypochondriacal symptoms as the main clinical manifestation, presenting with at least one of the following:
(1) Excessive worry about physical health or illness, the severity of which is disproportionate to the actual health condition.
(2) Interpreting common physiological phenomena and abnormal sensations as signs of disease.
(3) A persistent hypochondriacal belief, lacking sufficient basis, but not delusional.
3. Repeated medical consultations or requests for medical examinations, but negative results or reasonable explanations from doctors fail to alleviate concerns.
4. Exclusion of diagnoses such as obsessive-compulsive disorder, depression, and paranoid psychosis; hypochondriacal symptoms are not limited to panic attacks.
Hypochondriacal symptoms may occur in other psychiatric disorders, so differentiation should be made with the following conditions:
1. Depression: Most commonly accompanied by hypochondriacal symptoms. In cases of major depressive symptoms, additional biological symptoms such as early morning insomnia, diurnal variation (worse in the morning), weight loss, psychomotor retardation, and self-blame can aid in differentiation. Special attention should be paid to distinguishing masked depression from hypochondriasis. Masked depression conceals the essence of depression with somatic symptoms, but often responds significantly to antidepressant treatment, whereas hypochondriasis is more resistant.
3. Other neuroses: Conditions such as anxiety disorder, neurasthenia, and depressive neurosis may also exhibit hypochondriacal symptoms, but these are secondary. In hypochondriacal neurosis, the hypochondriacal symptoms are primary or the initial symptoms. Paying attention to the sequence of symptom onset and combining it with clinical features makes differentiation straightforward.
bubble_chart Treatment Measures
Primarily psychological therapy, supplemented by pharmacological treatment.
1. Psychological Therapy Initially, listen to the patient's complaints patiently and meticulously, review their various test results, and adopt a sympathetic and caring attitude. Avoid provoking the patient's symptoms or pressuring them to admit that their hypochondriacal beliefs are unfounded, as this often backfires and worsens the situation. Try to steer conversations away from discussing symptoms and instead focus on building a strong rapport with the patient. Family members can be enlisted to assist. Once the patient trusts the doctor, guide them to understand the nature of their condition—that it is not a physical illness but a psychological disorder, which requires psychological methods for treatment. If the patient is highly suggestible, suggestive therapy may be employed, sometimes yielding dramatic results. However, if this fails, it may complicate further treatment. Additionally, changing the patient's environment, adjusting their lifestyle, diverting their attention, or encouraging them to engage in other interesting activities can also lead to some improvement.
2. Pharmacological Treatment To alleviate symptoms such as anxiety, depression, and insomnia, benzodiazepines or tricyclic antidepressants may be prescribed as appropriate. Recent reports suggest that pimozide may be effective for treating isolated hypochondriacal symptoms at a dose of 2–8 mg/day, though this remains experimental. Some studies, however, report limited efficacy.
Patients with acute onset generally have a good prognosis, such as those with depression and anxiety accompanied by hypochondriacal symptoms or those who develop the condition on the basis of other diseases. If the course of the disease generally lasts more than 2 years, it often evolves into a chronic and prolonged state. The prognosis is related to the following factors: a clear psychological cause, the patient's confidence, and active treatment efforts lead to a good prognosis. Those with a hypochondriacal personality are prone to chronicity, while a lack of confidence results in a poor prognosis.
