hypochondriasm; illness anxiety disorder
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Introduction
Preoccupation with fear of having a serious disease.
Involves one somatic concern* (in contrast to somatoform disorder)
Condition must persist for 6 months[4]
* that somatic concern might be general health[2]
Etiology
- commonly associated with depression[3]
- symptoms considered a form of learned social behavior
- behavior may be a source of secondary gain[3]
Epidemiology
- equally frequent in men & women
- patients are generally older (not true[2])
Pathology
- based on a misinterpretation of bodily symptoms leading to anxious ruminations about disease[3]
Clinical manifestations
- anxiety
- few, mild or no somatic symptoms
- patients are often obsessive
- excessive rumination
- generalized fear of having a serious disease persists despite repeated medical evaluation & reassurance
- reassurance is not willingly accepted even after detailed medical examination
Complications
Differential diagnosis
- delusions
- depression
- generalized anxiety disorder
- easily fatigued, insomnia, restlessness, impairment (>= 6 months)
- somatic symptom disorder
- panic disorder
- anxiety disorder characterized by discrete intense periods of fear & associated symptoms, worry about additional attacks, change in behavior
- functional neurologic disorder/conversion disorder
- physical symptoms (paralysis, abnormal movement, dysphagia, speech disorder, seizures, sensory impairment)
- caregiver stress
Management
- frequent follow-up with brief focused history & physical
- cognitive behavioral therapy[5][6]
- treat depression, major depression, psychotic/delusional depression
More general terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1105-1107
- ↑ 2.0 2.1 2.2 Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 3.0 3.1 3.2 3.3 Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004
Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022 - ↑ 4.0 4.1 Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, DSM-IV-TR, American Psychiatric Association, Washington DC, 2000
- ↑ 5.0 5.1 Journal Watch 24(8):63, 2004 Barsky AJ & Ahern DK, Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 291:1464, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15039413
- ↑ 6.0 6.1 Tyrer P et al Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, Early Online Publication, 18 October 2013 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24139977 <Internet> http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61905-4/abstract
- ↑ Scarella TM, Boland RJ, Barsky AJ. Illness anxiety disorder: psychopathology, epidemiology, clinical characteristics, and treatment. Psychosom Med. 2019;81(5):398-407 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30920464 https://journals.lww.com/psychosomaticmedicine/Abstract/2019/06000/Illness_Anxiety_Disorder__Psychopathology,.2.aspx
- ↑ Newby JM, Hobbs MJ, Mahoney AEJ, Wong SK, Andrews G. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res. 2017 Oct;101:31-37. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28867421