HYPOCHONDRIASIS
BY Nyakallo and Tieho
Objectives
At the end of this presentation learners should be able to:
• Describe hypochondria
• Identify types of hypochondria
• describe the causes of hypochondria
• Describe the signs and symptoms
• Describe the nursing care of patients with the disorder
SOMATOFORM DISORDERS
• Somatoform disorders refer to a group of mental health conditions
where individuals experience physical symptoms or complaints that
cannot be fully explained by any underlying medical condition or
organic pathology.
• These disorders are characterized by the presence of persistent and
distressing physical symptoms that significantly affect the person’s
daily life, yet there is no identifiable medical cause.
TYPES OF SOMATOFORM
DISORDERS
• Somatization disorder. Somatization disorder is a chronic syndrome of
multiple somatic symptoms that cannot be explained medically and are
associated with psychosocial distress and long-term seeking of
assistance from healthcare professionals.
• Pain disorder. The essential feature of pain disorder is severe and
prolonged pain that causes clinically significant distress or impairment
in social, occupational, or other important areas of functioning.
• Hypochondriasis (Illness Anxiety Disorder). People with this disorder
have a preoccupation with fears of having a serious medical illness,
despite medical reassurance that there is no such illness or the
symptoms are mild.
CONT…
• Conversion disorder (Functional Neurological Symptom Disorder). In
this disorder, individuals experience neurological-like symptoms, such
as weakness, paralysis, seizures, or difficulty swallowing, without any
detectable neurological cause.
• Body dysmorphic disorder. This disorder, formerly called
dysmorphophobia, is characterized by the exaggerated belief that the
body is deformed or defective in some specific way.
CAUSES OF SOMATOFORM
DISORDERS
• Genetic. Studies have shown an increased incidence of somatization
disorder, conversion disorder, and hypochondriasis in first-degree
relatives, implying a possible inheritable disposition.
• Biochemical. Decreased levels of serotonin and endorphins may play a
role in the etiology of pain disorder.
• Psychodynamic. Some psychodynamics view hypochondriasis as an
ego defense mechanism; the psychodynamic theory of conversion
disorder proposes that emotions associated with a traumatic event
that the individual cannot express because of moral or ethical
unacceptability are “converted” into physical symptoms.
CONT…
• Family dynamics. Some families have difficulty expressing emotions openly and
resolving conflicts verbally; when this occurs, the child may become ill, and a shift in
focus is made from the open conflict to the child’s illness, leaving unresolved the
underlying issues that the family cannot confront openly.
• Sociocultural/familial factors. Somatic complaints are often reinforced when the sick
role relieves the individual from the need to deal with a stressful situation, whether it
be within the society or within the family.
• Past experience with physical illness. Personal experience, or the experience of close
family members with serious or life-threatening illness can predispose an individual to
hypochondriasis.
• Cultural and environmental factors. Some cultures and religions carry implicit
sanctions against verbalizing or directly expressing emotional states, thereby indirectly
encouraging “more acceptable” somatic behaviors.
CLINICAL MANIFESTATIONS
• Pain symptoms. Complaints of headache, pain in the abdomen, head, joints,
back, chest, rectum; pain during urination, menstruation, or sexual intercourse.
• Gastrointestinal symptoms. There is nausea, bloating, vomiting (other than
during pregnancy), diarrhea, or intolerance of several foods.
• Sexual symptoms. Sexual indifference, erectile or ejaculatory dysfunction,
irregular menses, excessive menstrual bleeding, and vomiting through
pregnancy.
• Pseudoneurologic symptoms. Conversion symptoms such as impaired
coordination or balance, paralysis or localized weakness, difficulty swallowing
or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or
pain sensation, double vision, blindness, deafness, and seizures.
NURSING MANAGEMENT
• Cognitive-behavioral psychotherapy. Cognitive-behavioral psychotherapy
strategies may be specifically helpful in reducing distress and high medical
use.
• Psychosocial therapies. Psychosocial interventions directed by phsyicians
form the basis for successful treatment; a strong relationship between the
patient and the primary care physician can assist in long-term management.
• Psychoeducation. Psychoeducation can be helpful by letting the patient
know that physical symptoms may be exacerbated by anxiety or other
emotional problems; however, be careful because patients are likely to
resist suggestions that their condition is due to emotional rather than
physical problems.
CONT…
• Providing health teaching. The nurse must help the client establish a
daily routine that includes improved health behaviors.
• Assisting the client to express emotions. Clients may keep a detailed
journal of their physical symptoms; the nurse might ask them to
describe the situation at the time such as whether they were alone or
with others, whether any disagreements were occurring, and so forth.
• Teaching coping strategies. Emotion-focused strategies include
progressive relaxation, deep breathing, guided imagery, and distractions
such as music or other activities; problem-focused coping strategies
include problem-solving methods, applying the process to identified
problems, and role-playing interactions with others
DEFINITION
• Individuals with illness anxiety disorder are extremely conscious of
bodily sensations and changes and may become convinced that a
rapid heart rate indicates they have heart disease or that a small sore
is skin cancer
• Hypochondriac is a term used to describe persons who presents
unrealistic or exaggerated physical complaints.
• it is a somatic symptom disorder that are characterized by physical
symptoms suggesting medical disease but without demonstrable
organic pathology or known pathophysiological mechanism to
account for them.
CAUSES AND RISK FACTORS
• The personality trait of negative affectivity (neuroticism) has been
identified as an independent correlate/risk factor of a high number of
somatic symptoms.
• Comorbid anxiety or depression is common and may exacerbate
symptoms and impairment.
• Somatic symptom disorder is more frequent in individuals with few
years of education and low socioeconomic status, and in those who
have recently experienced stressful or health-related life events.
• Early lifetime adversity such as childhood sexual abuse is also likely
arisk factor for somatic symptom disorder in adults
CONT…
• Persistent somatic symptoms are associated with demographic
features(women, older age, fewer years of education, lower
socioeconomic status, unemployment),
• a reported history of sexual abuse or other childhood adversity,
• concurrent chronic physical illness or mental disorder (depression,
anxiety, persistent depressive disorder, panic), social stress, and
reinforcing social factors such as illness benefits.
• Cognitive factors that affect clinical course include sensitization to pain,
heightened attention to bodily sensations, and attribution of bodily
symptoms to a possible medical illness rather than recognizing them as a
normal phenomenon or psychological stress
SIGNS AND SYMPTOMS
• Ranges from simple preoccupation with illness to delusion
• Primarily mono-symptomatic (occurs with single disease
• It may develop in to multi symptomatic (many disease symptoms)
• Most common areas of the body involved are abdomen, chest and
headache
• Symptoms may be dramatized, or exaggerated in their presentation,
and an excessive amount of time and energy is devoted to worry and
concern about the symptoms
• Anxiety and depression are frequently manifested, and suicidal threats
and attempts are not uncommon
DIAGNOSIS
• Persistent fear of severe illness despite normal tests.
• Frequent doctor visits, reassurance-seeking behaviour.
• DSM-5 Criteria: Preoccupation for at least 6 months, minimal/no
physical symptoms
NURSING CARE
• The goal of cognitive therapy for hypochondriasis is to lead patients to recognize
that their main problem is the fear of suffering from a disease and not suffering
• Patients are also asked to self-monitor the concerns that arise and evaluate the
facts and reasons.
• The therapist also persuades the patient to consider alternative explanations for
the physical signs they usually interpret as a disease.
• Experiments on habits are also used as an attempt to change the patient's
habits of mind.
• In summary, patients are told to focus intensely on specific physical symptoms
and monitor for increased anxiety as they arise.
• Families also need to be included to observe the anxiety that
PSYCHOPHARMACOLOGY
MOA USES SIDE EFFECTS INTERVENTIONS
Selective serotonin Inhibits • Depression • Serotonin • May take 4 -6 weeks to take effect
reuptake inhibitor uptake • Anxiety syndrome • Educate on the importance of
SSRIs of • Affects • Sexual compliance
serotonin = serotonin, dysfunction • Take medication in the morning
sertraline ↑ serotonin norepinephrine & • Stomach • First line drug for depression,
citalopram dopamine issues anxiety
escitalopram • OCD • (Nausea Dry • A client who had suicidal plans may
fluoxetine • Eating disorders mouth / thirst now have the energy due to the
vilazodone Urinary medication to carry out the plans!
retention,
constipation)
References
• Psychiatric nursing-assessment, care plans and medications 9th edition
by Mary C.Townsend
• DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDER 5TH
e.d-text revision DSM-5-TR
