David Baxter PhD
Late Founder
Hypochondria
By Mayo Clinic Staff
Nov. 25, 2008
Hypochondria is a chronic mental illness in which you fear having an undiagnosed serious or life-threatening disease. Hypochondria is currently considered a psychosomatic disorder, which means it's a psychological disorder with physical symptoms. However, some researchers believe hypochondria is a form of obsessive-compulsive disorder, and its designation may eventually change.
With hypochondria, you believe that normal bodily sensations or vague symptoms mean that you have an underlying disease. For instance, you may believe that your body's occasional twinges mean you have cancer. Or that forgetting where you placed your car keys means you have Alzheimer's disease. You become so convinced that you seek doctor after doctor in search of a diagnosis. Hypochondria is also called hypochondriasis.
Symptoms
Signs and symptoms of hypochondria include:
Hypochondria can vary in intensity. When you have hypochondria, you may be absolutely sure that you have a certain disease, and getting a diagnosis becomes your primary focus in life. You visit numerous doctors and specialists. If one doctor tells you that you aren't sick, you don't believe it and seek out other opinions. You may seek numerous tests, such as magnetic resonance imaging (MRI), echocardiograms or even exploratory surgery. You may think that the lack of a diagnosis means you're getting poor medical care. You may relentlessly talk about your symptoms or suspected diseases with family and friends.
On the flip side, you may be so fearful that something's wrong that you can't bear to go to the doctor because you believe you'll get bad news.
Or you may have a less intense form of hypochondria. Your worry may always be at the back of your mind even if it doesn't compel you to make frequent medical appointments to find a diagnosis.
When to see a doctor
One of the hallmarks of hypochondria is frequent medical visits. At some point, a doctor, nurse or other health care professional may suggest that you visit a mental health provider for evaluation. Instead, you may simply find a new doctor or nurse.
When you have hypochondria, it seems to make no sense to visit a mental health professional because you know that you have a medical disease. But try to keep an open mind. Be willing to consider the possibility that you have hypochondria. Ask trusted family and friends if they think you'd benefit from a mental health evaluation.
If you realize that your pursuit of a medical diagnosis has essentially taken over your life, that you worry constantly about your health, or that you don't believe doctors who tell you that you're in good health, consider talking to a mental health provider.
Getting diagnosed is important because it can help you get started in treatment earlier. Delaying treatment can allow the hypochondria to become more severe, making it more difficult to treat.
Helping a loved one
If you have a loved one who you think may have symptoms of hypochondria, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.
Causes
The normal human body constantly produces a variety of sensations and symptoms ? a random pain here, a twitch there. Most people never notice these, just ignore them or treat them as the common, everyday sensations that they usually are. But when you have hypochondria, every sensation or symptom, no matter how minor, is evidence to you that you have a serious or life-threatening disease. A headache, for example, signals a brain tumor. A shaky hand signals Parkinson's disease. A cough, lung cancer.
Why one person is able to ignore common bodily sensations while another winds up with hypochondria isn't known ? hypochondria has no specific known cause. Some experts now believe that hypochondria is a type of obsessive-compulsive disorder, and further research may help shed light on that connection and possible causes.
In addition, some research suggests that the body's natural fight-or-flight response may be partly responsible for causing hypochondria. People with hypochondria often feel anxiety. Anxiety can cause a physiological arousal in the body that includes an increased heart rate, shortness of breath, sweating, nausea, dizziness and other sensations. When you have hypochondria, you mistakenly interpret these signs and symptoms as further evidence of illness, which increases your anxiety, and in turn, intensifies your symptoms, creating a vicious cycle.
Risk factors
Factors that may increase the risk of developing or triggering hypochondria include:
Complications
Complications that hypochondria may cause or be associated with include:
Unfortunately, some people with hypochondria may indeed have a physical condition, and it may be overlooked by health care professionals. They may have grown so frustrated with your frequent appointments that they dismiss you without realizing that something truly is wrong this time.
Preparing for your appointment
Your primary health provider may suggest that the two of you discuss your health fears or that you have an evaluation with a mental health provider. Or, if you recognize that your health fears are excessive, you may seek out a mental health evaluation on your own. But if you're like most people with hypochondria, you have a hard time believing that your symptoms and health anxiety could be psychological in nature, and you may refuse an evaluation. But try to keep an open mind and understand that if multiple doctors can't find an underlying health problem, then you may indeed have hypochondria.
What you can do
Being an active participant in your care can help your efforts to manage your condition. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts and behavior, medical appointments and procedures, and symptoms that make you think you have a serious illness. You may be asked such questions as:
If your doctor or mental health provider believes you may have hypochondria or another mental illness, he or she typically orders a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms, and check for any related complications. Your doctor also wants to make sure that you aren't indeed physically ill.
These exams and tests generally include:
To be diagnosed with hypochondria, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of hypochondria include:
Hypochondria is often a chronic condition. It can last for years because it's difficult to overcome deeply ingrained beliefs that you have a physical disease. Getting treatment earlier may offer better improvement of your symptoms, though.
Treatment of hypochondria can be difficult, especially if you aren't a willing and active participant in your care. But effective treatment is often successful. Treatment is often a joint effort between your family doctor and a mental health provider.
Treatment options: Psychotherapy and medications
The two main treatments for hypochondria are:
Psychotherapy is the primary treatment for hypochondria. Some research shows that a form of psychotherapy called cognitive behavioral therapy is most effective for hypochondria. Cognitive behavioral therapy helps you recognize and understand the false beliefs that trigger your health anxiety. It also helps you learn to stop behavior associated with your anxiety, such as constantly monitoring your body for problems, a behavior known as body vigilance. Cognitive behavioral therapy may also include exposure therapy, in which you directly confront your health fears in a safe environment and learn skills to cope with these uncomfortable sensations.
Some evidence shows that psychoeducation is also helpful. Psychoeducation helps you learn about hypochondria, why you have it and how to cope with your health fears.
Medications
Certain antidepressant medications may be helpful in treating hypochondria. Some research indicates that both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may help relieve such symptoms as anxiety, fear of disease and physical (somatic) problems. However, these medications can cause side effects that may actually increase your health anxiety because you may wind up attributing the side effects to a serious physical problem.
Lifestyle and home remedies
In most cases, hypochondria won't get better if you try to treat it on your own. But you can do some things for yourself that will build on your professional treatment plan, such as:
Your hypochondria may never completely go away, but you can learn how to cope with your health anxiety so that it doesn't disrupt your life.
Consider these coping measures:
Because there's no known cause of hypochondria, there's no known particular way to prevent it. However, early recognition and treatment can reduce the impact on your life. Also, if you have a child who has a relative or classmate with a serious illness, it may help to talk openly to your child about any concerns or fears he or she has about illness.
By Mayo Clinic Staff
Nov. 25, 2008
Hypochondria is a chronic mental illness in which you fear having an undiagnosed serious or life-threatening disease. Hypochondria is currently considered a psychosomatic disorder, which means it's a psychological disorder with physical symptoms. However, some researchers believe hypochondria is a form of obsessive-compulsive disorder, and its designation may eventually change.
With hypochondria, you believe that normal bodily sensations or vague symptoms mean that you have an underlying disease. For instance, you may believe that your body's occasional twinges mean you have cancer. Or that forgetting where you placed your car keys means you have Alzheimer's disease. You become so convinced that you seek doctor after doctor in search of a diagnosis. Hypochondria is also called hypochondriasis.
Symptoms
Signs and symptoms of hypochondria include:
- Excessive fear or anxiety about having a particular disease or condition
- Worry that minor symptoms mean you have a serious illness
- Seeking repeated medical exams or consultations
- "Doctor shopping," or frequently switching doctors
- Frustration with doctors or medical care
- Strained social relationships
- Obsessive health research
- Emotional distress
- Frequent checking of your body for problems, such as lumps or sores
- Frequent checking of vital signs, such as pulse or blood pressure
- Inability to be reassured by medical exams
- Thinking you have a disease after reading or hearing about it
- Avoidance of situations that make you feel anxious, such as being in a hospital
Hypochondria can vary in intensity. When you have hypochondria, you may be absolutely sure that you have a certain disease, and getting a diagnosis becomes your primary focus in life. You visit numerous doctors and specialists. If one doctor tells you that you aren't sick, you don't believe it and seek out other opinions. You may seek numerous tests, such as magnetic resonance imaging (MRI), echocardiograms or even exploratory surgery. You may think that the lack of a diagnosis means you're getting poor medical care. You may relentlessly talk about your symptoms or suspected diseases with family and friends.
On the flip side, you may be so fearful that something's wrong that you can't bear to go to the doctor because you believe you'll get bad news.
Or you may have a less intense form of hypochondria. Your worry may always be at the back of your mind even if it doesn't compel you to make frequent medical appointments to find a diagnosis.
When to see a doctor
One of the hallmarks of hypochondria is frequent medical visits. At some point, a doctor, nurse or other health care professional may suggest that you visit a mental health provider for evaluation. Instead, you may simply find a new doctor or nurse.
When you have hypochondria, it seems to make no sense to visit a mental health professional because you know that you have a medical disease. But try to keep an open mind. Be willing to consider the possibility that you have hypochondria. Ask trusted family and friends if they think you'd benefit from a mental health evaluation.
If you realize that your pursuit of a medical diagnosis has essentially taken over your life, that you worry constantly about your health, or that you don't believe doctors who tell you that you're in good health, consider talking to a mental health provider.
Getting diagnosed is important because it can help you get started in treatment earlier. Delaying treatment can allow the hypochondria to become more severe, making it more difficult to treat.
Helping a loved one
If you have a loved one who you think may have symptoms of hypochondria, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her.
Causes
The normal human body constantly produces a variety of sensations and symptoms ? a random pain here, a twitch there. Most people never notice these, just ignore them or treat them as the common, everyday sensations that they usually are. But when you have hypochondria, every sensation or symptom, no matter how minor, is evidence to you that you have a serious or life-threatening disease. A headache, for example, signals a brain tumor. A shaky hand signals Parkinson's disease. A cough, lung cancer.
Why one person is able to ignore common bodily sensations while another winds up with hypochondria isn't known ? hypochondria has no specific known cause. Some experts now believe that hypochondria is a type of obsessive-compulsive disorder, and further research may help shed light on that connection and possible causes.
In addition, some research suggests that the body's natural fight-or-flight response may be partly responsible for causing hypochondria. People with hypochondria often feel anxiety. Anxiety can cause a physiological arousal in the body that includes an increased heart rate, shortness of breath, sweating, nausea, dizziness and other sensations. When you have hypochondria, you mistakenly interpret these signs and symptoms as further evidence of illness, which increases your anxiety, and in turn, intensifies your symptoms, creating a vicious cycle.
Risk factors
Factors that may increase the risk of developing or triggering hypochondria include:
- Having a serious illness during childhood
- Knowing family members or others with a serious disease
- The death of a loved one
- Having an anxiety disorder
- A rigid belief that being in good health means that you are free of all physical symptoms or sensations
- Having close family members with hypochondria
- Feeling especially vulnerable to illness or disease
Complications
Complications that hypochondria may cause or be associated with include:
- Health risks associated with unnecessary medical procedures
- Work or school problems
- Relationship difficulties
- Depression
- Anxiety disorders
- Substance abuse
- Excessive anger and frustration
- Strained relationships with your health providers
- Financial problems related to medical costs
Unfortunately, some people with hypochondria may indeed have a physical condition, and it may be overlooked by health care professionals. They may have grown so frustrated with your frequent appointments that they dismiss you without realizing that something truly is wrong this time.
Preparing for your appointment
Your primary health provider may suggest that the two of you discuss your health fears or that you have an evaluation with a mental health provider. Or, if you recognize that your health fears are excessive, you may seek out a mental health evaluation on your own. But if you're like most people with hypochondria, you have a hard time believing that your symptoms and health anxiety could be psychological in nature, and you may refuse an evaluation. But try to keep an open mind and understand that if multiple doctors can't find an underlying health problem, then you may indeed have hypochondria.
What you can do
Being an active participant in your care can help your efforts to manage your condition. One way to do this is by preparing for your appointment. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These questions may include:
- Why do you think I might have hypochondria?
- How can you be sure that I don't have a serious illness that just hasn't been detected yet?
- Can I get over hypochondria on my own?
- How do you treat hypochondria?
- Will psychotherapy help?
- Are there medications that might help?
- How long will treatment take?
- What can I do to help myself?
- Are there any brochures or other printed material that I can take home with me?
- What Web sites do you recommend visiting?
What to expect from your doctor
During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts and behavior, medical appointments and procedures, and symptoms that make you think you have a serious illness. You may be asked such questions as:
- How is your daily life affected by your symptoms?
- How much time do you spend each day thinking about your health?
- What treatments, if any, have you had?
- What tests and procedures, if any, have you had?
- What have you tried on your own to feel better or control your symptoms?
- What things make you feel worse?
- Have friends or family commented about your thoughts or behavior?
- Have any relatives had a mental illness?
- What do you hope to gain from treatment?
- What medications or over-the-counter herbs and supplements do you take?
If your doctor or mental health provider believes you may have hypochondria or another mental illness, he or she typically orders a series of medical and psychological tests and exams. These can help pinpoint a diagnosis, rule out other problems that could be causing your symptoms, and check for any related complications. Your doctor also wants to make sure that you aren't indeed physically ill.
These exams and tests generally include:
- Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
- Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
- Psychological evaluation. A doctor or mental health provider will talk to you about your thoughts, feelings and behavior patterns. He or she will ask about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past.
To be diagnosed with hypochondria, you must meet the symptom criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of hypochondria include:
- A preoccupation, lasting for at least six months, that you have a serious illness based on your bodily symptoms
- Distress about this preoccupation
- Impairment in your social life, work or other daily routines
Hypochondria is often a chronic condition. It can last for years because it's difficult to overcome deeply ingrained beliefs that you have a physical disease. Getting treatment earlier may offer better improvement of your symptoms, though.
Treatment of hypochondria can be difficult, especially if you aren't a willing and active participant in your care. But effective treatment is often successful. Treatment is often a joint effort between your family doctor and a mental health provider.
Treatment options: Psychotherapy and medications
The two main treatments for hypochondria are:
- Psychotherapy
- Medications
Psychotherapy is the primary treatment for hypochondria. Some research shows that a form of psychotherapy called cognitive behavioral therapy is most effective for hypochondria. Cognitive behavioral therapy helps you recognize and understand the false beliefs that trigger your health anxiety. It also helps you learn to stop behavior associated with your anxiety, such as constantly monitoring your body for problems, a behavior known as body vigilance. Cognitive behavioral therapy may also include exposure therapy, in which you directly confront your health fears in a safe environment and learn skills to cope with these uncomfortable sensations.
Some evidence shows that psychoeducation is also helpful. Psychoeducation helps you learn about hypochondria, why you have it and how to cope with your health fears.
Medications
Certain antidepressant medications may be helpful in treating hypochondria. Some research indicates that both selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs) may help relieve such symptoms as anxiety, fear of disease and physical (somatic) problems. However, these medications can cause side effects that may actually increase your health anxiety because you may wind up attributing the side effects to a serious physical problem.
Lifestyle and home remedies
In most cases, hypochondria won't get better if you try to treat it on your own. But you can do some things for yourself that will build on your professional treatment plan, such as:
- Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going.
- Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
- Learn about your condition. Education about hypochondria can empower you and motivate you to stick to your treatment plan.
- Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your health fears. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
- Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy.
- Avoid drugs and alcohol. Alcohol and illicit drugs can worsen symptoms or increase anxiety and depression. They may also interact with medications you take.
- Create a good relationship with your doctors. Your relationship with your doctors can become strained if both you and your doctors feel frustrated about your situation. Be open and honest with your doctors about your concerns. Learn ways to cope with urges to have unnecessary tests and procedures. At the same time, don't neglect checkups or skip visits to your family doctor, especially if you aren't feeling well.
Your hypochondria may never completely go away, but you can learn how to cope with your health anxiety so that it doesn't disrupt your life.
Consider these coping measures:
- Don't doctor shop. Find a health care professional you trust and stick with him or her. Don't "doctor shop," or continually seek out new doctors or health care professionals to run more tests or perform more procedures. Scheduling regular follow-up visits with your health care professional can help offer reassurance that you're OK.
- Avoid excessive research. For someone with hypochondria, the Internet is like being the proverbial kid in a candy store. Don't spend hours researching health information or looking up vague symptoms. Chances are, you'll find something you think you have, fueling your anxiety.
- Skip disease-of-the-week stories. Consumer magazines are often full of stories with dire warnings about "overlooked" or "misdiagnosed" diseases that are just waiting to strike you down. Avoid reading these stories. They may only increase your anxiety, especially if they include common or vague symptoms.
- Take a break from body vigilance. Resist the urge to continually monitor your pulse or other vital signs or to check your body for signs of disease, such as lumps or sores. But because it's important to be aware of some signs and symptoms, talk to your doctor about what self-checks or self-exams are reasonable for you.
- Get support. Ask for support and patience from family and friends who know you have hypochondria. Talking openly to them may help defray their own frustrations about your health anxiety, and they may be able to help you keep perspective.
- Join a group. Join a hypochondria or anxiety support group. You may bond with people who share common concerns, and you may also learn additional coping strategies.
Because there's no known cause of hypochondria, there's no known particular way to prevent it. However, early recognition and treatment can reduce the impact on your life. Also, if you have a child who has a relative or classmate with a serious illness, it may help to talk openly to your child about any concerns or fears he or she has about illness.
