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More information about hypochondriasis
Case Examples
What is heightened illness concern?
Heightened Illness concern (HIC) is a common problem that plagues 5-10% of the general population. People with HIC may worry whenever they have an unexplained physical symptom that it could be a sign of a serious disease. People who have a medical illness that is stable may also have HIC if they find themselves worrying too much about it. At times, this problem has been called "hypochondriasis". But the term hypochondriasis has taken on many negative connotations - some people make fun of hypochondriacs because they suspect that "hypochondriacs enjoy their symptoms". That is far from the case. People with hypochondriasis are in fact in great despair - fearing that they are dying or could be dying from a dreaded disease. Because of the negative associations with the term "hypochondriasis", we use the term "heightened illness concern (HIC)". People with HIC worry about illness excessively. Some worry for short periods while others worry for months to years. A person with HIC worries that he or she has or might have a serious illness despite the doctor's evaluation that has ruled out an underlying disease. The person often has a hard time letting go of the fear or belief that a serious disease might be causing the symptoms. HIC is painful for the individual who suffers from it and is distressing for friends and loved ones who find themselves unable to provide enough reassurance to truly relieve that person's fears. People with this problem struggle routinely with intense anxiety and fear, irritability with others who seem not to take their concerns seriously, poor concentration due to the intrusive thoughts or sensations, misunderstanding by friends and family, and either avoidance of medically-related anxiety triggers or compulsive checking for reassurance with loved ones, medical books, or health professionals.
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What are medically unexplained symptoms?
Medically unexplained symptoms refer to symptoms that cause distress or discomfort, which persist or come and go, and for which doctors have not been able to find a satisfactory medical explanation or diagnosis. Typical examples might include headaches, nausea, dizziness, and balance problems. Typically, a patient with medically unexplained symptoms has seen many physicians and has either not felt understood or has felt frustrated by the failure of even good doctors to provide symptom relief.
There are many possible reasons for medically unexplained symptoms and our treatment programs are geared toward helping patients to find better ways to overcome the way in which their symptoms and health concerns are ruling their lives.
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What if I do have an illness but I worry too much about it?
The mind and the body are intertwined. What affects the body will affect the mind. If a person is sick with a medical disease, such as diabetes or arthritis or a multiple sclerosis, there will often be psychological effects as well, including depression and anxiety. Some people however can't let go of the fear and despair that attacks them - and this happens even when their medical illness is under good control. These people too may benefit from our treatment programs because their lives are far too burdened by their fear of illness and of the future.
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What if I worry about illness but I don’t consider myself a hypochondriac?
You are not alone. The term "hypochondriac" is not very popular and it is not even correct. Because the term hypochondriasis can be inaccurate and pejorative, we prefer to use the term "Heightened Illness Concern". There are many people who are otherwise healthy individuals with stable lives and families who suffer from excessive worries and fears of illness. These worries and fears may have been triggered by stress or trauma or they may come out of the blue. Some patients might be very depressed because they are convinced they have a serious illness. Others might be extremely anxious - on some days they have good insight that their fears are irrational while on other days they are riddled with anxiety and think that they might be dying.
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Are there treatment studies I can participate in?
Yes, there are. The good news is that these disorders are treatable and we have a nationally recognized research program that focuses on identifying the most effective treatments to help people with illness fears and unexplained somatic symptoms. Experts at Harvard Medical School and Columbia University have now teamed up to conduct a NIH-funded study to help patients with heightened illness concern. In the context of this research study, we offer specialized, expert treatment that is not widely available elsewhere at no financial cost to the client. Our treatment study is being conducted in Boston under the direction of Dr. Arthur Barsky at the Brigham Women's Hospital and in New York City under the direction of Dr. Brian Fallon at the Columbia Medical Center. For more information about this study, please click here.
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Could there be a physical problem underlying excessive illness fears that might be helped with medication?
This is a good question. Unfortunately, people who suffer with excessive illness worry may not initially recognize that they need psychological help. They believe that they have a serious physical disease underlying their symptoms. We too believe that these patients have a serious problem but we believe it results from abnormalities in the way the brain processes sensory information. We believe that in some patients the nervous system pathways and brain chemistry are not functioning properly and that this malfunctioning causes the patients to have a heightened awareness of physical bodily sensations and an inability to let go of the intense worry about illness. Current research suggests that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy. We expect that because of the latter treatments, as the person gets better, the brain chemistry will readjust to the proper balance seen in healthy individuals. When a person feels better, the brain neurochemistry is helping to shape the feeling. When brain chemistry isn't working right, as a result perhaps of excessive stress or anxiety, the brain actually suffers. It is important therefore for the person afflicted with anxiety or excessive worry to get help.
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Who gets hypochondriasis or medically unexplained symptoms– the young, the old, the famous?
Anyone at any age can develop these problems - from the child at age 10 to the senior citizen at age 75, from the deli cashier to the academic scientist, from the stay-at-home mom to the female C.E.O. Often the hypochondriacal individual is the butt of jokes, jokes made by others and even by him or herself. The true nightmare of this disorder is not appreciated or adequately portrayed. The inner experience of the hypochondriac is one of daily terror and despair; relentless worry fills the day and night.
Unlike prior eras of history, we now have effective treatments to help people with hypochondriasis and excessive illness concerns. To see if you are eligible to participate in the Boston Health Study click here.
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Why do people with anxiety have lots of intrusive worries and lots of troubling bodily symptoms? Because these feel so real, how can they come from the mind?
Anxiety is associated with both cognitive symptoms and bodily symptoms. The cognitive symptoms stem from the worry, uncertainty, fear, or sense of threat. The bodily symptoms may include dizziness, bloating, headaches, sensation of lump in the throat, palpitations, tingling sensations, shortness of breath, and trouble sleeping. The symptoms that people with anxiety feel are indeed real bodily symptoms that are triggered by abnormally functioning bodily neurochemistry. Medicines that are effective treatments for anxiety and depression can help reduce these troubling bodily symptoms. These medications may work on the norepinephrine or serotonin system of the brain. Fixing the neurochemistry therefore should help to reduce the worry and reduce the intensity and frequency of the troubling physical symptoms. These treatments are not capable of hiding real medical problems - rather they bring the body back to a healthy balance.
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Case 1. "Don't make me go for a check-up" - the Avoider. A 65-year-old woman has been suffering for over 30 year with catastrophic fears that she might be diagnosed with cancer. Because she suspects that any physical symptom is a sign of a serious disease, she dreads going to the doctor for check-ups. She finds herself canceling appointments at the last minute and not following up on doctors' recommendations for routine tests. Because of this avoidance, she has placed her physical health in jeopardy and she lives with daily terror that she has cancer slowly invading her organs.
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Case 2. "Am I going to die doc?" - the Checker. A 35-year-old businessman read an article about Bird Flu and, having been to Indonesia 1 year earlier, he is unable to get out of his mind the possibility that he might have contracted this deadly disease. He is somewhat reassured by the fact that he has not yet become deathly ill, but the fears reemerge with full strength whenever he gets a cough or feels his breathing is heavier than usual. He rushes to the doctor for a check-up and is temporarily reassured when the doctors indicates that there is no possibility he has Bird flu and that really this is just a mild upper respiratory illness. He feels fine for a week or two and then the fears return - either triggered by another article about Bird Flu or by a physical discomfort in his chest. This cycle of fear, checking, reassurance, and then fear again has been going on for the last 12 months and it appears to be getting worse.
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Case 3 with treatment. "The doctors aren't telling me the truth." - the frustrated and angry man. A 25-year-old contractor of Asian origin has become increasingly frustrated and angry with the medical profession because no one has been able to tell him why he has a burning uncomfortable sensation whenever he urinates. He has been to over 4 urologists and has had multiple procedures to identify the cause of these symptoms. The tests have not identified a cause for his symptoms. This man suspects the doctors aren't telling him the true cause of his symptoms - that he has a sexually transmitted disease. He's angered when they refer him to a mental health professional because, as he says, "I have a physical problem not a mental one". He comes reluctantly. After hearing the psychiatrist explain that sometimes a neurochemical imbalance in the brain may lead to increased discomfort over physical symptoms and intrusive worrisome thoughts, he agrees to a trial of a medication known to help reduce obsessive thoughts. This medication, fluoxetine, results in gradual improvement that increases with time.
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Case 4 with treatment. "I've developed lupus"- the despairing coed. A 20-year-old college student finds that she is becoming increasingly unable to focus on her studies as she is dwelling on a barely visible facial discoloration. A premed student, she suspects that she may have developed lupus and that the course of her future is now marked by that serious disease that can lead to severe suffering and death. Whenever she passes a mirror, she feels compelled to see if the skin discoloration has developed into the classic butterfly rash of Lupus; each time as she approaches the mirror, she is filled with terror...but she can't stop herself from checking. This terror and her secondary depression grow. She goes to a physician for an exam, quietly mentions the rash without revealing her suspicion of lupus, and then when the doctor fails to really focus on it, she is too despairing to encourage further exploration. The physician indicates she is physically healthy. The college student is not reassured. She develops trouble sleeping. Each day is filled with greater dread. Finally, she hears about a treatment program for illness fears, comes for help, meets with a therapist for 10 sessions who helps her understand how these symptoms developed and how to cope better, and she experiences a marked improvement of symptoms.
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