Ritika soni(ASST. PROF.)

1. PRESENTOR: Ms Ritika

2. INTRODUCTION
 Hypochondriasis is a somatoform disorder marked by recurrent
preoccupation with fears of having a life-threatening disease
despite appropriate work-up and medical reassurance.
 The preoccupation may be with specific organ or
disease(cardiac disease) , with bodily functioning, (e.g;
peristalsis, heart beat), or even with minor physical alterations
(e.g: a small sore, or an occasional cough)
 Hypochondriasis is excessive worry about being sick. Those
that suffer from hypochondria are called hypochondriacs.
Hypochondriacs have anxiety that they are constantly ill. They
truly believe that something is wrong with them and visit
doctors frequently to get diagnosed (Doctor’s shopping).

3. DEFINITION
 Hypochondriasis may be defined as an unrealistic or
inaccurate interpretation of physical symptoms or
sensations , leading to preoccupation and fear of having
a serious disease without any organic cause or
psychopathology.
Or
 Hypochondriasis is defined as a persistent
preoccupation with a fear (or belief) of having one (or
more) serious disease based on person’s own
interpretations of normal body function or a minor
physical abnormalities.

4. ONSET
 Hypochondriasis may begin anywhere from teenage
to older years.
 The peak age of onset is in the twenties and thirties.

5. EPIDEMIOLOGY

6. Features of hypochondriasis
 The fear or belief persists despite assurance to the contrary
by showing normal reports to the patient.
 “Doctor shopping” is predictably common in patients
with hypochondriasis
 A preoccupation with medical terms and syndromes is quite
common. The patient tends to change the physician
frequently , in order to get investigated again.
 Becoming easily worried about your health.
 Lack of physical symptoms. If physical symptoms are
present they are mild.[

7. Symptoms of Hypochondria
Some symptoms include:
 frequent doctor visits: If one doctor declares that one is healthy, he
goes to two more (DOCTOR SHOPPING) to make sure because he
truly thinks he is sick and that the initial doctor is missing something.
 Requests for tests and surgery: Even though certain tests and
operations come with risks, hypochondriacs ask for them over and
over again.
 Severe anxiety about health
 Excessive self-diagnosis and research: When hypochondriacs
see a news story or an article online about a new disease, they think
they have it.
 Thoughts that anything unusual with the body means a serious
illness
 Lack of attendance at work or school due to anxiety over possible
illnesses
 Constant attention to blood pressure, heartbeat; constant

9. Etiology: explanatory models
1. Psychodynamic model :
 The development of physical symptoms from
unconscious conflicts may be traced to
Sigmund Freud.
 Psychodynamic defenses, such as repression
and displacement, were regarded as the basis
for hypochondriasis.
 According to this model, in order to remediate
unconscious conflicts, such as aggression and
hostility towards others, physical complaints
serve to reconcile such internally unacceptable
drives.

10. 2.Social learning model
 According to this model, hypochondriasis is a
social transactional process whereby a
patient assumes the ‘sick role’ to obtain a
‘socially acceptable excuse’ or relief from
social or occupational obligations. When a
person becomes ill through no fault of his/her
own, a different set of social rules apply.
 Having an illness ensures that the individual
will be taken care of (to gain sympathy).

11. 3.Cognitive–behavioral model
 According to this model, patients misinterpret
bodily symptoms and amplify their somatic
sensations into fears of having a real, life-
threatening malady .
 Health anxiety refers to concern or preoccupation
regarding health that is appropriate, reality-based
and responds to medical evaluation and
reassurance.( Hypochondriacal psychosis, Body
dysmorphic disorder ,Hypochondriasis
Somatization disorder).
 Such cognitive distortions and consequent
reassurance-seeking behavior may serve to
maintain the disorder .Therefore, targeted therapy

12. 4.Anxiety spectrum disorder
 Hypochondriasis may be conceptualized as a variant
manifestation of an underlying anxiety disorder (AD).
 According to this model, the anxiety originates from the
preoccupation with fear of having a disease, which occurs
despite reassurance.
 Other disorders on the spectrum that share similar etiology
but slightly different phenotypes include OCD, specific phobia
and GAD.
 In fact, a neuroanatomical study demonstrated that
hypochondriasis, OCD and PD may have similar frontal–
striatal and limbic activity in the brain, which was associated
with increased distractibility for irrelevant information.
 This model has immediate treatment implications as most
ADs respond well to pharmacotherapy (for the dysfunctional
neurotransmission) and cognitive–behavior
psychotherapeutic interventions.

13. 5. Genetics
 Family history of hypochondriasis or anxiety
issues

14. others
 Major life stress event
 History of abuse or neglect as a child
 History of childhood illness
 Disturbance in perception that magnifies normal
sensations
 Having another mental disorder (e.g. major
depression, obsessive compulsive disorder,
psychotic disorders)

15. Diagnosis
The ICD-10 defines hypochondriasis as follows:
A. Either one of the following : A persistent belief, of at
least six months' duration, of the presence of a
minimum of two serious physical diseases (of which at
least one must be specifically named by the patient).
 A persistent preoccupation (body dysmorphic
disorder).
B. Preoccupation with the belief and the symptoms
causes persistent distress or interference with
personal functioning in daily living, and leads the
patient to seek medical treatment or investigations (or
equivalent help from local healers).
C. Persistent refusal to accept medical advice that there
is no adequate physical cause for the symptoms or

16. The DSM-IV defines hypochondriasis
according to the following criteria
A. Preoccupation with fears of having, or the
idea that one has, a serious disease based
on the person's misinterpretation of bodily
symptoms.
B. The preoccupation persists despite
appropriate medical evaluation and
reassurance.
C. The preoccupation causes clinically
significant distress or impairment in social,
occupational, or other important areas of

17. MANAGEMEN
T

18. Outline of therapy
recommendations.
1. Establishment of therapeutic alliance
(outcome of psychological therapy)
- Acknowledge patient’s pain and suffering
-Understand symptoms as a form of emotional
communication
-Search for co morbid medical and psychiatric
illness
- Be aware of emotional reactions and/or
judgmental stance towards patient
- Judiciously employ diagnostic evaluation and
referrals

19. 2. Maintenance of therapeutic
relationship
 Reassure the patient that evaluation will be
ongoing
 Focus on care and not cure of patient
 Emphasize that treatment requires regular
scheduled visits
 Explain to the patient that he or she is not ‘crazy’
 Introduce the possibility that psychological factors
(stress) may play a role in amplification of
underlying physical symptoms
 Educate the patient regarding etiology and
treatment if they are ready to listen
 Stay current with routine healthcare maintenance

20. 3. PSYCHOTHERAPY
 Counseling: Sometimes, simply discussing fears can
help.
 Support groups: This is when the patient joins a
group of other people who have hypochondriasis to
discuss experiences and strategies to manage the
disorder.
 Exposure plus response prevention therapy: This
is when a mental health professional helps the patient
confront fears and teaches the patient how to relax
and release anxiety.
 Cognitive–behavioral therapy
 Behavioral stress management
 Problem-solving therapy

21. 4.Pharmacotherapy
 Placebo: Each patient will receive placebo in
10 or 20 mg pills given according to the
schedule.
 Antidepressants: selective serotonin-reuptake
inhibitors, serotonin–norepinephrine-reuptake
inhibitors,tricyclic antidepressants and others
(e.g., mirtazepine and trazodone)
 Antipsychotics: second-generation
antipsychotics (e.g., risperidone, olanzapine
and quetiapine) or pimozide

22. Nursing management