Hypochondria
DSM Classification
(The psychiatry bible)
Hypochondriasis
When a patient remains preoccupied with the fear that they have a serious medical illness despite the fact that medical evaluation has ruled out such an illness, this Somatoform Disorder (1) can be diagnosed. Although the belief is not of delusional intensity, attempts at reassurance fail.
Diagnostic criteria
A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms.
B. The preoccupation persists despite appropriate medical evaluation and reassurance.
C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).
D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The duration of the disturbance is at least 6 months.
F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.
Specify if:
With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable.
Sensible Psychology Definition
Being morbidly preoccupied with your health without cause
The ‘hypochondriac’ either
- constantly worries that perceived symptoms mean they might have a serious illness, or
- believes that perceived symptoms mean they do have a serious or terminal illness.
They may make the same assumptions about other people too.
Anxiety is the driver for this ‘misuse of the imagination’, and these worries in turn raise anxiety levels.
Constantly focusing on the idea of pain, or swelling, or inflammation can act as a form of negative self-hypnosis, actually bringing on, or aggravating, symptoms.
Hypochondria interferes with everyday life, work, sleep, relationships and everything else. Like all psychological conditions, it tends to get worse when background levels of stress are higher than normal.
Hypochondriacs often display a curious ‘double think’, believing they are genuinely sick, but also quite well aware that they are prone to hypochondria.
The genesis of hypochondria
Hypochondria often manifests after the death of a loved one from disease.
“My father was diagnosed with a brain tumour and six weeks later he was dead. Before that I was fine, but ever since then I have worried incessantly about my health. I also imagine my children have got every illness under the sun!”
Hypochondria can also be learned (like any phobia) from a parent or some other significant person.
“My mum was always taking us to the doctors, thinking we were ill. She was convinced she had some serious disease too. In her mind, she’s had all the diseases in the medical encyclopaedia.”
And nowadays, of course, the internet is awash with medical information. This is potentially very useful for all of us, but it’s easy to become obsessed with it and relate everything you read to your own experience, resulting in unnecessary self torment.
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Hypochondria and the endless quest for reassurance
Hypochondria pushes the sufferer to seek reassurance to assuage the terrible anxiety they feel. But this is a cup that cannot be filled. The sufferer may feel reassured for a while after consulting a medical specialist, but then the doubts, like weeds, spring up again:
“What if they missed something? What if they mixed up my test results with someone else’s?”
‘What if’-ing can drive people to feel they are going crazy – and drive them to visit the doctor so often as to make the poor doctor feel they are the one who is going crazy.
The power of belief to alter physical reality
A case in point – A real bump
A man who was being a good citizen and responding to a blood donation campaign unexpectedly fainted while giving blood. He fell backwards and banged the back of his head, causing a painful swelling. This event left him somewhat traumatised, and he found himself haunted by the memory, which would spring on him unpredictably and cause him to feel giddy and nauseous.
He came to see me for help in dealing with this memory, which was easily done using hypnosis and the Rewind Technique. But as we sat talking it over calmly afterwards, he put his hand up to his head and a look of astonishment appeared on his face. “I can feel a swelling there!” he said.
This physical response occurred just from having hypnotically revisited that time.
This is testimony to the power of the mind to generate physical phenomena, and a similar mechanism is at work in hypochondria.
This negative – and unintentional – use of self hypnosis can make the fears seem all the more real. From numbness to tingling in the arms and legs to nausea, learning about and then imagining the symptoms of some illness can result in an all too real sensation of symptoms, further confirming the sense that: “I must have something wrong with me!”
Does the hypochondriac know it’s all in their mind?
Remarkably often, they do. They seem to be able to hold both the notion that “I am ill” and the notion that “I often imagine I am ill” in their heads at the same time.
However, knowing that they are prone to imagining things does not help to relieve the desperate anxiety they feel, nor convince them that they are not ill. It can be disconcerting to sit down with a person who has come to see you for help with their hypochondria while simultaneously trying to convince you (even though they’ve been medically checked out) that they are genuinely very ill.
Hypochondria can last a lifetime but tends to fluctuate in severity. Sometimes it doesn’t rear its head for years, only to return during life upheavals and other stresses. But there are also thousands, perhaps millions, of ex-hypochondriacs walking confidently around.
It can be treated successfully.
Treatment for hypochondria
Psychotherapy or counselling may be used to help the hypochondriac address their fears. Psychodynamic psychotherapy focuses on the idea that hypochondriacs are really displacing their aggression toward others onto themselves by imagining they are ill and encourages the sufferer to work on these ‘conflicts’. Cognitive Behavioural Therapy (CBT) focuses on helping people examine what they think and do with a view to changing their unhealthy habits of mind and behaviour.
As hypochondria is an anxiety-related condition, anti-anxiety medications and/or antidepressants are often prescribed (see Drugs and medications). Ironically, the side effects of these drugs can include some very real physical symptoms which may serve to further convince the hypochondriac that they are, after all, genuinely ill.
The sensible psychology approach
Reassurance may help for a little while but it’s more effective to address the roots of the anxious feelings through solution focused therapy, including hypnosis, that
- teaches the hypochondriac how to reassure themselves with stress management skills
- uses active problem solving to ensure that sources of stress are kept to the minimum
- ensures that the hypochondria isn’t being kept in place by unresolved trauma (possibly relating to illness previously suffered or witnessed) – in our experience unresolved trauma and hypochondria are often connected.
- teaches the sufferer to control their imagination and use it constructively as a tool to make life better, not as a weapon against the self.
Hypnosis is a useful tool to help people disentangle what they can imagine from what they feel. This is a much easier approach than trying to get someone to “try not to think about it” – an approach that rarely works.
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About Mark Tyrrell
Psychology is my passion. I've been a psychotherapist trainer since 1998, specializing in brief, solution focused approaches. I now teach practitioners all over the world via our online courses.
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Notes:
- A ‘Somatoform Disorder’ is a mental disorder characterized by physical symptoms that suggest physical illness or injury – symptoms that cannot be explained fully by a general medical condition, direct effect of a substance, or attributable to another mental disorder.
