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At least 19 recordsLinked to original sources
PubMed1975

A functional classification of hypochondriasis with specific recommendations for treatment.

A review of both past and present psychiatric literature reveals that the concept of hypochondriasis is inexact and confusing. In an attempt to make hypochondriasis a meaningful and useful concept for practicing clinicans, a functional classification is presented that views hypochondriasis from four aspects--(1) as a "warning signal," (2) as a symptom of psychosis, (3) as a symptom of depressive illness, and (4) as a syndrome labelled "true hypochondriasis." Each of these aspects is discussed, with emphasis placed on specific and practical recommendations for treatment.

Adjustment Disorders↗
PubMed1992

Hypochondriasis and obsessive compulsive disorder.

Hypochondriasis and OCD differ conceptually in the degree to which the patient's disease concerns are experienced as an intrusive mental event or a reasonable psychological response to a realistic health threat, in the degree to which the ideation is resisted, and in the presence of somatic sensations and medical help-seeking. There are, however, some similarities between the conditions, including the development of excessive, stereotyped, repetitive behaviors in an attempt to allay their anxiety. Empirical data on the degree of overlap between the conditions are too limited to permit definitive conclusions. The little that we do know, however, suggests that (1) the prevalence of OCD in hypochondriasis is probably elevated, but not extraordinarily so; (2) the prevalence of hypochondriasis in OCD is unknown; (3) fears about disease, illness, and injury are one of the more common forms of obsessions seen in OCD; and (4) there are several ill-defined and largely unexplored conditions, such as disease phobias, which appear to be very similar to both OCD and hypochondriasis. Clinical experience suggests that there may be a subgroup of hypochondriacal patients who are closer to the anxiety disorders in general and to OCD in particular. This subgroup might respond to the newer, antiobsessional, serotonin reuptake blocking agents.

Adult↗
PubMed1992

Psychiatric comorbidity in DSM-III-R hypochondriasis.

Forty-two DSM-III-R hypochondriacs from a general medical clinic were compared with a random sample of 76 outpatients from the same setting. Patients completed a research battery that included a structured diagnostic interview (Diagnostic Interview Schedule) and self-report questionnaires to measure personality disorder caseness, functional impairment, and hypochondriacal symptoms. Psychiatric morbidity in the hypochondriacal sample significantly exceeded that of the comparison sample. Hypochondriacs had twice as many lifetime Axis I diagnoses, twice as many Diagnostic Interview Schedule symptoms, and three times the level of personality disorder caseness as the comparison group. Of the hypochondriacal sample, 88% had one or more additional Axis I disorders, the overlap being greatest with depressive and anxiety disorders. One fifth of the hypochondriacs had somatization disorder, but the two conditions appeared to be phenomenologically distinct. Hypochondriacal patients with coexisting anxiety and/or depressive disorder (secondary hypochondriasis) did not differ greatly from hypochondriacal patients without these comorbid conditions (primary hypochondriasis). Because the nature of hypochondriasis remains unclear and requires further study, we suggest that its nosologic status not be altered in DSM-IV.

Comorbidity↗
PubMed1992

A structured diagnostic interview for hypochondriasis. A proposed criterion standard.

We developed a structured diagnostic interview for DSM-III-R hypochondriasis (SDIH) that is the first such clinician-administered instrument. The SDIH was administered to 88 general medical outpatients who scored above a predetermined cutoff on a hypochondriacal symptom questionnaire, and to 100 comparison patients randomly chosen from among those below the cutoff. Using the joint assessment method, interrater agreement on the DSM-III-R diagnostic criteria was 88% to 97% and agreement on the diagnosis was 96%. Concurrent validity was suggested by a significant correlation between the interview and the primary care physicians' ratings of hypochondriasis. A measure of external validity was demonstrated in that several clinical characteristics thought to be ancillary features of hypochondriasis were significantly more prevalent in interview-positive patients than in interview-negative patients. Finally, the SDIH appeared to have discriminant validity in that patients diagnosed as hypochondriacal had several other clinical features that distinguished them from the patients who scored above the cutoff on hypochondriacal symptomatology, but failed to be diagnosed as hypochondriacal with the SDIH.

Ambulatory Care↗
PubMed1992

Interpretation of bodily symptoms in hypochondriasis.

Although it has been suggested that hypochondriasis is caused by the misinterpretation of innocuous bodily sensations, support for this hypothesis rests largely upon uncontrolled self-report. We investigated the interpretation of ambiguous bodily sensations in three experiments using separate samples of non-clinical subjects differing in level of hypochondriacal concern. Results confirmed that subjects with high hypochondriacal concern endorse more thoughts about illness interpretations of bodily sensations, but reported thought content resembled 'catastrophic' rather than the 'non-emergency' thoughts suggested by Warwick and Salkovskis (Hypochondriasis. Behavior Research and Therapy, 28, 105-117, 1990). Presence of an interpretive bias was further supported in a study of recognition bias for disambiguated versions of ambiguously threatening sentences, although this applied as much to social as to illness threats. A final experiment failed to support the hypothesis of an automatic inference bias, but did show that subjects with high hypochondriacal concern were quicker to correctly identify previously exposed illness words. Thus, reported thoughts are consistent with catastrophic interpretations of common bodily sensations, but interpretive bias may not be limited to illness threat. However, high hypochondriacal subjects do show a more specific enhanced perceptual sensitivity to illness cues, which may play a role in maintaining their concern with bodily symptoms.

Adolescent↗
PubMed1992

Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies.

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.

Attitude to Health↗
PubMed1976

Hypochondriasis in the elderly: a reaction to social stress.

Hypochondriasis in the elderly is often a preventable or reversible syndrome. It can become chronic if the patient finds no relief from social stress or becomes dependent upon medical services as a source of support. When this is recognized, psychotherapeutic intervention is necessary. Although no socioeconomic group is exempt, hypochondriasis in the elderly occurs more often among the lower social classes. Its higher prevalence in this group is attributable to the frequency and severity of social stress and the loss of alternative social opportunities. If psychotherapeutic intervention is necessary, the elderly hypochondriac patient should be helped to recognize social stress as a major source of the problem and to develop a realistic method of coping with it. Apparently the precipitating factors are often in the socioeconomic sphere; hence, social planners should be aware of this fact if the demands on the health care system are to be reduced.

Adaptation, Psychological↗
PubMed1976

Hypochondriasis and the elderly.

Hypochondriasis is poorly understood and poorly treated. Attempts to classify it have been unsatisfactory except for Pilowsky's division into primary and secondary groups. Twenty consecutive cases of hypochondriasis in elderly patients were studied; 4 were of the primary type and 16 of the secondary type. For the primary group, neither family therapy nor hospitalization was needed, and the prognosis was good. In contrast, hospitalization was always advised for the secondary group, and such patients improved while in the hospital. Psychotropic drugs, a therapeutic milieu, and often electroshock therapy were needed to treat depression. After discharge, successful treatment necessitated Day Care programs and the long-term use of family therapy. Treatment was unsuccessful in 8 patients characterized by refusal to become involved in post-discharge Day Care programs and family therapy.

Age Factors↗
PubMed1979

Hypochondriasis and paranoia: similar delusional systems in an institutionalized geriatric population.

Hypochondriasis and paranoia are common psychopathologies of aging. The former may be secondary to depression or organic brain syndrome, whereas the latter may be secondary to sensory impairment or organic brain syndrome. Paranoid schizophrenia, with delusions of grandeur, is rare in later life. The authors classified 273 institutionalized geriatric patients by means of staff ratings into categories such as lucid and alert, confused, hypochondriacal, paranoid, etc. Among confused patients there was a correlation of .45 (p less than .001) between hypochondriasis and paranoia. Even among nonconfused patients, there was a slight positive correlation. The authors concluded that geriatric paranoia and hypochrondriasis have similar structure (delusion) and functions (safeguarding self-esteem and manipulating others). An interpersonal perspective can also provide guidelines for when to treat these conditions.

California↗
PubMed1979

Defensive and arrested developmental aspects of death anxiety, hypochondriasis and depersonalization.

The theoretical distinction between psychopathology based on intrapsychic conflict and psychopathology rooted in a developmental arrest is applied to an analysis of death anxiety, hypochondriasis and depersonalization. The defensive functions of these states are contrasted with instances in which they are symptomatic of interferences with the consolidation of a structurally cohesive and temporally stable self representation. Clinical material is presented to demonstrate that, in their arrested developmental aspects, death anxiety, hypochondriasis and depersonalization are closely related to one another along a continuum of narcissistic decompensation and signal varying degrees or stages of self-fragmentation.

Anxiety↗
PubMed1979

Case conference from Cornell. Case 6: depression and hypochondriasis in a patient with peptic ulcer disease.

We are going to present a patient who was admitted to the hospital with a major depressive disorder. Somatic complaints and hypochondriasis were prominent in her symptomatology and occurred in a setting of known ulcer disease. Dr. Richard Breslow will present the case and a discussion of psychological aspects of ulcer disease. I will discuss the treatment of patients with hypochondriacal depressions.

Depression↗
PubMed1978

Hypochondriasis in an institutional geriatric population: construction of a scale (HSIG).

The staffs at three extended care facilities identified a group of 10 hypochondriacal patients. The research team asked these 10 patients and 59 controls, 27 questions relating to health attitudes and behaviors. Six items were found to be fairly useful in distinguishing hypochondriacal from non-hypochondriacal subjects. These six items were taken as the Hypochondriasis Scale for Institutional Geriatric Patients (HSIG), and each patient scored on the basis of his responses to these six items. This test proved to be one way of distinguishing between hypochondriacal and non-hypochondriacal groups (P less than .005). However, because of the possibility of false positive results, the scale should be used only to confirm staff suspicions of hyponchondriasis and should not be used as part of the clinical intake procedure.

Aged↗
PubMed1976

Monosymptomatic hypochondriasis, abnormal illness behaviour and suicide.

Two cases of chronic monosymptomatic psychogenic eye pain with abnormal illness behaviour are presented. Both failed to respond to a wide variety of treatments, and despite the accepted low suicidal risk in hypochondriasis both killed themselves. The origin, prognosis and therapy of such behaviour are discussed in this context.

Adult↗