Hypochondria: Causes and Risk Factors

Hypochondriacs often require constant reassurance, sometimes from multiple doctors, family and friends which may represent a big problem. This fear of disease or preoccupation with symptoms is not only unpleasent but it interferes with the patient's daily life in a negative way.

The most common fears are related to illnesses such as ALS, brain tumors, melanoma, and AIDS - the illnesses which are incurable or have a low rate of recovery.

Hypochondria is often associated with obsessive-compulsive disorder (OCD) and anxiety, and can also be brought on by stress. The good news is that with treatment, many hypochondriacs recover from this disorder.

History of the term

The word hypochondria is derived from the ancient Greek terms:

• hypo, which means below, and
• hondros, which means cartilage.

It refers to a set of symptoms which were thought to have been caused by a disorder of the anatomical organs beneath the cartilages of the ribs. This included:

• disorders of the liver and spleen,
• disorder originating beneath the breastbone
• base of the heart,
• junction of the esophagus and the stomach
• diaphragm

Incidence

Because patients with hypochondria usually see their primary care physicians rather than go to mental health clinics or join psychiatric research programs, it is difficult to determine how many people actually suffer from this disorder. Estimates range from 0.8% to 8.5% of the general US population. This condition seems to occur equally in men and women. Children sometimes pretend they are ill in order to avoid going to school but it must be understood that this is not hypochondria. Real hypochondria can be a life-long problem if left untreated. Most people with the disorder refuse referral to a mental health professional.

Effects of hypochondria on general health

It is proven that hypochondria can cause:

• Anxiety attacks or panic attacks
• Depression
• Fear of impending doom
• Loss of appetite
• Decreased libido
• Increased self-consciousness
• Decreased motivation in life.

Symptoms of hypochondria

The main symptom of hypochondria is constant anxiety over some minor symptoms that are otherwise considered to be normal. The person who suffers from this disorder believes that these symptoms are a serious life threatening illness even though there is nothing physically wrong with them.

This disorder is often characterized by:

• irrational fears of being diseased or of dying,
• obsessions over minor bodily symptoms or imperfections,
• doubt and disbeliefs in doctors' diagnosis,                           
• constant self-examination
• self-diagnosis
• preoccupation with one's body
• misinterpretation of symptoms
• symptoms that may shift and change

The most common symptoms that hypochondriacs complain on:

• backache,
• neckache,
• upper abdominal pain,
• palpitations,
• breathlessness,
• faintness,
• fatigue,
• pain in the lower left and right side of the chest,
• kidney pain

Possible causes of hypochondria

Although there seem to be many factors that might play a role in the development of this disorder, no one knows exactly why someone develops hypochondria.

Researches have came to the conclusion that hypochondria usually begins in early adulthood. The symptoms may be triggered by:

• a serious illness in the patient or a loved one,
• the death of a close friend or relative
• periods of increased stress
• well-publicized disease in the media

Who is at risk of developing this disorder?

While there are many possible triggers for hypochondria, there are still some special personality traits and basic assumptions about health and illness which can make one more vulnerable.

There is no doubt that some people are more likely to develop hypochondria. These could be:

• neurotic
• self-critical
• introverted
• narcissistic

Researchers have came to the conclusion that people who think they have a specific inherited weakness, might also be quick to think the worst of any sensation involving that area.

Some experts also claim that people with hypochondria may have a lower threshold for pain tolerance and therefore notice internal sensations that other people may not feel.

Diagnosis of hypochondria

It is very easy to diagnose hypochondria. A simple physical examination should be performed to rule out an underlying organic disease. This should be followed with a psychological evaluation to rule out other related disorders. The patient should also be examined for a mood disorder, such as depression. If there are no underlying physical or psychological disorders, the doctor will conclude that the patient suffers from hypochondria.

Factors which are contributing to hypochondria

Media and the internet often contribute to hypochondria. They show serious illnesses such as cancer and multiple sclerosis as being random, obscure and somewhat inevitable. This may reinforce the hypochondriac to think about various ilnesses.

This condition may occur more often in people who:

• were sick or had sick family members during childhood
• were victims of child abuse
• have various other psychological disorders
• abuse drugs or alcohol

Treatment of hypochondria

Antidepressants

Antidepressants and other medications are sometimes used to treat beliefs and attitudes characteristic to hypochondriacs. The problem is that there is not a lot of evidence to support this practice because not all hypochondriacs suffer from depression. 

Most studies of psychosocial approaches to treating hypochondria are limited by few subjects, lack of control groups, and the absence of long-term follow-up.

Cognitive-behavioral treatment

There were two large, rigorous, randomized controlled studies of cognitive behavior therapy that found it to be effective in treating hypochondria.

In this form of therapy, the patients are assisted in restructuring their beliefs and expectations about health and illness, correcting their misunderstandings about proper medical care, learning how to distract themselves from thinking about their symptoms, and changing their behaviors concerning their symptoms and perceived illness.

All the patients enrolled in the study were randomly assigned to six sessions of cognitive-behavioral therapy and a consultation letter to the patient's primary care physician. Each session was devoted to one of five factors that cause patients to magnify physical symptoms and think they are a sign of serious illness:

• attention and bodily hyper-vigilance,
• beliefs about the cause of symptoms,
• circumstances and context,
• illness and sick role behaviors,
• mood

The patient is not healed when he realizes that he has health anxiety but it is an important first step.

Hypnosis

Hypnosis can effectively help hypochondriacs regain control over thoughts and keep physical symptoms in perspective. Overcoming hypochondria with hypnosis will free a person from the enormous burden of worry and stress associated with symptoms by helping a person to realize that not every ache or pain is a sign of some impending demise.
Negative concerns

Unfortunately, hypnosis has long been portrayed in a negative light by television, films, and other media. Most people have also been led to believe that, while under hypnosis, the subject is unconscious and unaware of their surroundings. These and other misconceptions could not be further from the truth - hypnosis is simply a state of deep relaxation. 

Hypnosis can help you:

• Build self esteem
• Change your eating habits
• Put an end to sleep problems
• Stop smoking
• Manage stress more effectively
• Conquer phobias
• Improve athletic performance

There is not one case on record of anyone being harmed because of, or through, hypnosis. Most people experience a very pleasant energy increase after the session.

Possible complications

There are some complications which could be related to hypochondria. They are:

• There is a possibility that a real disease may be overlooked in people with hypochondria because their previous complaints were unrealistic.
• Complications may result from invasive testing.
• In some cases, it is evidenced that dependence on pain relievers or sedatives may develop.

Tips for hypochondriacs

People who suffer from hypochondria may benefit from one or more of the following exercises:

• Keeping a journal describing what led to the anxiety attacks or panic
• Talking with friends or family members, and taking a different perspective on the symptoms
• Tracking the triggering factors of anxiety, and avoiding them (e.g. self-diagnosis, reading about symptoms)
• Maintaining a healthy lifestyle and positive outlook