Hypochondriasis

Signs and Symptoms

Signs and symptoms include:

• Preoccupation with a serious illness for at least 6 months
• Inability to control fears and worries
• Misinterpreting normal body sensations as symptoms of a disease
• Constant fear of illness despite reassurance of health status by health care providers
• Complaints mostly related to the head, neck, abdomen, and chest often in the form of pain
• Complaints of headache, indigestion, and constipation

What Causes It?

The exact cause of hypochondriasis is not known. Some of the causes include:

• Disturbance in perception such that normal sensations are magnified.
• Having learned apparent benefits of being sick, such as receiving attention. Hypochondriasis may occur in an individual who had a childhood illness or had a sibling with a childhood illness.
• May be related to another psychiatric disorder, such as anxiety or obsessive compulsive disorder. Hypochondriasis may develop from, or be a sign of, one of these other disorders.

Who's Most At Risk?

Risk factors may include:

• Age between 20 and 30 years
• Serious childhood illness or trauma
• Mental disorders, such as anxiety, obsessive-compulsive disorder, personality disorders, and depression

What to Expect at Your Provider's Office

Your health care provider may:

• Perform a physical examination.
• Other tests to determine whether a physical disease is responsible for your reported symptoms.
• Ask specific questions and use psychological tests to rule out anxiety or obsessive-compulsive disorder.
• Consult with a trained specialist, such as a psychologist or a psychiatrist, to aid in the diagnosis and treatment.

Treatment Options

Treatment Plan

In addition to regular visits with a health care provider who will take physical symptoms seriously, people with hypochondriasis may also benefit from psychotherapy. Studies show group therapy, behavior modification, and cognitive therapy work particularly well.

People with hypochondriasis often have other mental health conditions, such as anxiety and depression. Treatment of these conditions is important in treating symptoms of hypochondriasis. Your provider may recommend limiting reading medical books and websites.

Drug Therapies

Doctors typically do notuse drugs to treat hypochondriasis. They may prescribe medication for associated mental health conditions. Antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or paroxetine may improve the anxiety and physical symptoms of hypochondriasis.

Other Procedures

Several types of psychotherapy may help:

• Cognitive behavioral therapy (CBT), a type of talk therapy, can help you deal with symptoms. CBT helps identify thoughts that make the symptoms worse and develop methods of coping with symptoms.
• Behavioral stress management therapy is another kind of psychotherapy. It teaches stress management and relaxation techniques. These techniques help people avoid focusing on illness during stressful situations. Doctors may use it in conjunction with cognitive behavioral therapy.

Complementary and Alternative Therapies

Cognitive behavioral therapy and stress management are the main treatments for hypochondriasis. Participating in mindfulness techniques, such as meditation, may also help patients manage symptoms.

No scientific studies have examined the effect of nutrition on hypochondriasis. However, people with hypochondriasis who also have anxiety or depression may benefit from avoiding alcohol and caffeine.

Following these general nutritional tips may also help reduce risks and symptoms:

• Eliminate all suspected food allergens, preservatives, and chemical food additives.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Reduce significantly or eliminate trans-fatty acids.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses of filtered water daily.
• Exercise moderately, for 30 minutes daily, 5 days a week.

You may consider the following supplements:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, may reduce inflammation and improve immunity. Omega-3 fatty acids interact with blood-thinning medications, such as warfarin (Coumadin) and aspirin. Speak with your provider.
• Melatonin may improve sleep. However, there are no studies on the safety of long-term therapy with melatonin. Ask your provider about potential prescription interactions which can be numerous and can even include birth control pills.

No herbs are specifically used to treat hypochondriasis and no studies show any effectiveness of herbs for hypochondriasis. Because many herbs interact with prescription antidepressants and anxiety medications, make sure your doctor is aware of all medications, herbs, and supplements you take.

• St. John's wort (Hypericum perforatum) may be helpful for some people with symptoms of depression. St. John's wort has several serious drug interactions, including, birth control pills, antidepressants, blood-thinning drugs, and others. Check with your provider if you are taking prescription medications.
• Kava kava (Piper methysticum) is used to relieve stress and anxiety. However, kava kava may have dangerous toxic effects, especially when combined with alcohol. The Food and Drug Administration has issued a warning concerning kava kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
• Bacopa (Bacopa monnieri) was studied for anxiety. Study results are mixed and there are concerns of dangerous side effects. Bacopa may increase the chances of a blockage in the intestines, slow down heart rate and increase fluid secretions in the lung. Speak with your physician.

No studies have examined the effectiveness of specific homeopathic remedies. Homeopaths may consider the following remedies for anxiety and other symptoms of hypochondriasis:

• Aconitum
• Arsenicum album
• Lycopodium
• Phosphorus

Some studies indicate that acupuncture may be useful in treating some symptoms of hypochondriasis. Acupuncture may be useful for symptoms such as:

• Anxiety
• Stress
• Pain
• Sleep disturbances

Massage therapy may help reduce symptoms of hypochondriasis in some people.

Prognosis/Possible Complications

Stress and anxiety may make the symptoms of hypochondriasis worse. Many people may also struggle with costly medical tests and develop a dependency on certain medications. Hypochondriasis is a chronic illness (it persists for a long time), but getting early psychiatric treatment and having a strong motivation to change may increase the chances of getting better.

Following Up

Keep up the regular appointments scheduled with your health care provider.

Supporting Research

Bergquist PE. Therapeutic homeopathy. In: Rakel D, ed. Integrative Medicine. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 115.

Bongiorno PB, Murray MT. Hypericum perforatum (St. John's wort). In: Pizzorno JE, Murray MT, ed. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 99.

Bongiorno PB, Murray MT. Affective disorders. In: Pizzorno JE, Murray MT, ed. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 142.

Cooper K, Gregory JD, Walker I, Lambe S, Salkovskis PM. Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behav Cogn Psychother. 2017;45(2):110-123. PMID: 28229805 www.ncbi.nlm.nih.gov/pubmed/28229805.

Evens A, Vendetta L, Krebs K, Herath P. Medically unexplained neurologic symptoms: a primer for physicians who make the initial encounter. Am J Med. 2015;128(10):1059-1064. PMID: 25910791 www.ncbi.nlm.nih.gov/pubmed/25910791.

Fallon BA, Ahern DK, Pavlicova M, et al. A randomized controlled trial of medication and cognitive-behavioral therapy for hypochondriasis. Am J Psychiatry. 2017;174(8):756-764. PMID: 28659038 www.ncbi.nlm.nih.gov/pubmed/28659038.

Kalanithi L. Hypochondriasis (illness anxiety disorder). In: Ferri FF, ed. Ferri's Clinical Advisor 2019. Philadelphia, PA: Elsevier; 2019: 744.e1-744.e2.

Murray MT. Piper methysticum (Kava). In: Pizzorno JE, Murray MT, ed. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 114.

Pizzorno JE, Paul C, Schauss AG. Fish oils (omega-3 fatty acids, docosahexaenoic acid, eicosapentaenoic acid, dietary fish, and fish oils). In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 91.

Reichert RG. Melatonin. In: Pizzorno JE, Murray MT, eds. Textbook of Natural Medicine. 4th ed. St Louis, MO: Elsevier Churchill Livingstone; 2013:chap 103.

Winter AO. Somatoform disorders. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 103.