Signs and symptoms

Signs and symptoms include a general feeling of illness, anxiety and malaise. The patient may repeatedly complain of abdominal pain and epigastric discomfort, altered bowel habits, headaches, minor cough that the patient may perceive as serious, fever, urinary incontinence or dysuria, dizziness, loss of appetite, palpitations, chest pain, etc.
The symptoms may or may not be related with one another.

Systemic manifestations

There are no specific systemic manifestations. For example, a patient may complain of pain in the lower limb accompanied by stomach ache or he or she may present with a complain of itching all over the body and dizziness.

• Fatigue

  […] overconcern regarding cognitive function are likely not rare, particularly given research showing there is little correlation between objective report of cognitive dysfunction and actual test scores in such conditions as mild traumatic brain injury, chronic fatigue [ncbi.nlm.nih.gov]

  Main focus is on some particular symptoms like gastro-intestinal problems, palpitations, or muscle fatigue. [mindheal.org]

  Many hypochondriacs focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. [en.wikipedia.org]

  Children with somatic symptom disorder worry excessively about physical symptoms that are fairly routine — headaches, stomachaches, nausea or fatigue — which they interpret as signs of serious illness. [childmind.org]

  Symptoms may be specific (such as pain in the abdomen) or vague (such as fatigue). Any part of the body may be the focus of concern. [merckmanuals.com]

• Fear

  When we couldn't find the cause of certain symptoms, there was always the fear that we simply hadn't searched long enough or hard enough. [mayoclinic.org]

  Neither group differed significantly from the other on the number and nature of feared physical symptoms. [ncbi.nlm.nih.gov]

  Compare body image disturbances Preoccupation with the fear of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms Preoccupation with the fear of having, or the idea that one has, a serious disease [icd9data.com]

• Obsessive Thoughts

  I used to go to psychotherapy sessions with multiple different psychotherapists and more often than not the solutions they offered were along the line of “keep as busy as possible not to give in to the thoughts” or “imagine the obsessive thoughts as a [feelinggood.com]

• Incontinence

  The patient may repeatedly complain of abdominal pain and epigastric discomfort, altered bowel habits, headaches, minor cough that the patient may perceive as serious, fever, urinary incontinence or dysuria, dizziness, loss of appetite, palpitations, [symptoma.com]

• Headache

  “I have a headache, I must have a brain tumor.”) [biobehavioralinstitute.com]

  When Charlie has a headache, he becomes convinced that he has a brain tumor. This is a good example of how a normal physical issue, like a headache, could spur fear of a serious disease, like cancer. [study.com]

  A headache will be perceived as a tumor; a sneeze is pneumonia; etc. Add flashcard Cite Random Word of the Day Get the word of the day delivered to your inbox [alleydog.com]

  According to one study, 85 to 90 percent of the most common symptoms, like headaches or pain, can’t be explained by a doctor. What makes it hypochondriasis is simply behavior. One person will say, “I have a headache; I don’t know why. [drlizhale.com]

Work up includes a detailed history and physical examination along with the appropriate tests.

Laboratory testing

There are no diagnostic tests of this condition and a diagnosis is made based on clinical findings and more importantly, the patients history. Screening tests are available and they include:

Whitely Index of Hypochondriasis: it is used for detection, for rating severity and for measuring change per interventions [6].

Health Anxiety Inventory: it reliably distinguishes patients with hypochondriasis from patients with anxiety disorders and healthy controls [7].

Imaging 

Imaging studies are generally not required, however, they may be conducted to check for any underlying abnormalities depending upon the patients symptoms. For example, if a patient complains of chest pain, a chest X-ray, CT scan, and an ECG may be conducted to rule out heart or lung disease.

Test results

To qualify for the diagnosis of hypochondriasis, the symptoms must have been experienced for at least 6 months [8]. When a thorough medical examination does not reveal any sign of disease and yet the patient complains of persistent symptoms despite assurance that he or she is in perfect physical health, he or she may be diagnosed as a hypochondriac.

• Helicobacter Pylori

  He points out that thousands of patients were diagnosed with stress ulcers before the discovery of Helicobacter pylori. "There are many examples of false assumptions because we couldn't identify a medical problem. [mayoclinic.org]

The high prevalence of personality disorders, particularly OCPD, among patients with hypochondriasis suggests that consideration of personality features is important in assessment and therapeutic interventions for hypochondriasis [9].

Medications

Antidepressants and antipsychotics are the mainstay of medicinal treatment of this condition. Commonly used antidepressants include serotonin reuptake inhibitors like Sertralin, Flouxetine, Paroxetine, Clomipramine, etc.

Psychotherapy

This is the primary treatment of hypochondriasis. Patients need to be counselled about hypochondriasis and its manifestations so that they may understand their condition.
Randomised control trials now suggest that cognitive behaviour therapy (CBT) is efficacious in the treatment of hypochondriasis [10]. With regular sessions and physical and mental exercises, the patients may show improvement.

Hypochondriasis does not have a good prognosis as the the condition is prone to worsen over time. Death by the condition itself, however, is rare but it may occur as a consequence of comorbidities such as heart disease, severe schizophrenia, etc. With appropriate treatment such as antidepressant medications and psychotherapy, the prognosis may be improved.

Complications:

Complications of hypochondriasis are twofold. They may be medical; such as development of hypertension, ischemic heart disease, stroke, etc as well as behavioural; such as lifestyle changes, depression, OCD, etc. The patient may sometimes hallucinate and even become suicidal. Indeed, many hypochondriacs have been known to become so depressed that they have attempted suicide which results in a significant mortality rate.

Hypochondriasis does not have a specific etiology. It is considered a psychosomatic disorder, as in a mental illness with physical symptoms [2] and it is a result of a combination of factors. These predisposing factors include a higher than normal awareness of bodily sensations, a high level of interest in signs linked to diseases, an influence of Internet or television regarding diseases, predisposition to anxiety, etc.

Incidence

Hypochondriasis does not have an exact recorded incidence because many cases go misdiagnosed or unreported. However, some studies show a prevalence rate of 0.8-4.5% cases in primary care settings of primary hypochondriasis [3].

Age

It may occur at any age but studies reveal that it has the highest incidence in patients that are young adults.

Sex

Hypochondriasis is known to occur equally in both sexes.

Race

Hypochondriasis has no known predilection to any race or demographic.

Hypochondriasis manifests itself slowly. It is characterised as a somatic amplification disorder- a disorder of perception and cognition [4]. It may begin as a general feeling of ill health and then progress to a firm, albeit wrong, belief that the patient is suffering from a serious disease.

Cognitive theories of hypochondriasis suggest that catastrophic misinterpretations of benign bodily sensations are a core feature for the maintenance of this disorder [5]. The end result of this condition is depression, anxiety, delusion and complications due to other comorbidities.

As hypochondriasis is a psychological condition which may develop at any time, it has no known prevention. However, it is safe to say that a healthy, happy and positive life style may prevent this condition from occurring.

Hypochondriasis is a psychological condition in which a patient perceives that he is ill despite medical evidence to the contrary. Misinterpretation of one or more bodily functions leads patients with hypochondriasis to persistently believe that they have or will contract a serious disease, despite appropriate medical reassurance [1].

• Definition: Hypochondriasis, or health anxiety, is a psychological condition in which a person thinks he is ill even though all physical examinations reveal no underlying condition. Such a person, known as a hypochondriac, mistakes normal body sensations as abnormal and becomes convinced that he is suffering from a disease, when in reality, he is physically healthy.
• Cause: Hypochondriasis may be caused due to other psychological conditions or it may be a result of a highly stressful and a discontent life.
• Symptoms: As it is a psychological disorder in which hypochondriacs delude themselves that they are ill, symptoms can vary widely. Some common presenting symptoms include complains of fever, headaches, abdominal pain, altered bowel habits, malaise, cough, joint pain, fainting spells, etc. Despite complaints of such patients, all laboratory test results and physical examination come negative.
• Treatment: Hypochondriasis is treated by a combination of psychotherapy and antidepressant medications. Other drugs may be prescribed to avoid complications such as heart diseases and other psychological conditions like OCD, schizophrenia, etc.
• Prevention: A healthy, happy life style and a positive outlook may prevent this condition from occurring. 

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision. American Psychiatric Association, Washington DC. 2000.
2. Ford, Allison. "Hypochondria: Can you worry yourself sick?" Divine Caroline. Divine Caroline. Retrieved Oct 27, 2014.
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4. Avia MD, M.A. Ruiz. Recommendations for the Treatment of Hypochondriac Patients. Journal of Contemporary Psychotherapy. 35.3(2005):301-313.
5. Schreiber F, Neng JM, Heimlich C, Whitthoft M, Weck F. Implicit affective evaluation bias in hypochondriasis: findings from the Affect Misattribution Procedure. J Anxiety Disord. 2014 Oct 28;(7):671-8. Doi 10.1016/j.janxdis.2014.07.004 EPub. PMID 25124504.
6. Speckens AE, Spinhoven P, Sloekers PP, Bolt JH, van Hemert AM. A validation study of the Whitely Index, the Illness Attitude Scales and the Somatosensory Amplification Scales in general medical and general practice patients. J Psychosol Res. Jan 1996;40(1):95-104 [Medline].
7. Salkovskis PM, Rines KA, Warwick HM, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. July 2002;32(5):843-53.
8. Goldberg RJ, MD. Practical Guide to the Care of the Psychiatric Patient. 3rd ed. 2007. Pa: Moseby-Elsevier: USA.
9. Sakai R, Nestoruic Y, Nolido NY, Barsky AJ. The prevalence of personality disorders in hypochondriasis. J Clin Psychiatry. 2010 jan;71(1):41-7. Doi: 10.4088/JCP.08m04838blu. PMID 20129004 PubMed.
10. Visser S, Bouman TK. The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behav Res Ther. Apr 2001;39(4):423-42.