July 14, 2003 Hypochondriasis, or excessive worry over one's health, is a psychiatric disorder that can affect every aspect of a person's life -- especially interpersonal relationships. University of Iowa researchers are finding ways to study the condition and how it affects relationships, including patient-doctor interaction.
Hypochondriasis involves preoccupation with a fear of having or developing a serious illness, despite lack of physical evidence of illness. It affects 4 to 9 percent of family practice or primary care outpatients, according to Russell Noyes, M.D., professor emeritus of psychiatry in the UI Roy J. and Lucille A. Carver College of Medicine.
Noyes and co-investigator Scott Stuart, M.D., UI associate professor of psychiatry, studied the interpersonal model of hypochondriasis, which regards the condition as a care-eliciting behavior. By communicating their anxiety and distress over physical symptoms to other people, patients with hypochondriasis hope to obtain care and concern.
The investigators studied the interpersonal model by assessing primary care outpatients for hypochondriasis and attachment style, which is the way in which people form relationships with others. The findings appeared in the March-April 2003 issue of Psychosomatic Medicine.
"The study we did was the first demonstration applying this model," Noyes said. "People are securely attached or not so securely attached to people who are important in their lives. What we showed was that hypochondriacal people are insecurely attached."
Patients who are insecurely attached in other relationships are also likely to feel insecure in the physician-patient relationship, which can lead to problems with health care satisfaction. Often encountering what they interpret as rejection from physicians, people with hypochondriasis go "doctor shopping," searching for a physician to reassure them in some way, Noyes said.
In a separate study published in 2000, Noyes and Stuart found that hypochondriacal and non-hypochondriacal patients interviewed about recent health problems and medical care both gave equal numbers of positive comments about physicians, but the hypochondriacal patients made significantly more negative comments overall. Many of these patients saw physicians as unskilled and uncaring, and felt their relationship with the physician had suffered because of poor communication. Physicians need to be more aware of hypochondriasis to improve physician-patient relationships, Noyes said.
"Doctors don't do a very good job of recognizing hypochondriasis and they rarely diagnosis it, but it is a real psychiatric disorder and source of distress," Noyes said. "One of the reasons they fail to recognize hypochondriasis is that it comes in a disguised form -- the patient presents physical symptoms and the doctor examines and finds no physical explanation, then dismisses the patient.
"Another problem is that, until recently, there haven't been good treatments for hypochondriasis, and we tend to diagnose things we have treatments for," Noyes added.
While there have been preliminary trials with antidepressant medications like Prozac, hypochondriasis is generally treated with cognitive behavioral therapy. This therapy teaches hypochondriacal patients what generates their symptoms and how to overcome worrisome thoughts. Interpersonal therapy is designed to identify a patient's interpersonal problems and help the patient correct them, Noyes said.
"It's been a neglected subject, and in the past, there's been considerable pessimism over treatment of hypochondriasis. Doctors have regarded these as 'difficult' people to treat, and patients have not been satisfied with the care they've received," Noyes said. "The most important thing is to establish this as a valid diagnosis for which there is effective treatment, and that's beginning to occur."
As part of the interpersonal study, Noyes and Stuart found some evidence that childhood adversity -- such as physical or sexual abuse, becoming seriously ill as a child, or having parents that are neglectful or overly attentive during a child's illness -- can contribute to hypochondriasis in adulthood. The researchers found that as many as a third of the hypochondriacal patients in the study reported a serious childhood illness, much higher than in the patients who were not hypochondriacal.
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