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Is That a Pimple - or Is It the End of the World?

April 20, 2006 By:
Frank Rosci, JE Feature
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Woody Allen portrayed one so well in his films he made us laugh out loud. But to millions of Americans, who live as real-life hypochondriacs, the condition is no laughing matter, but one that keeps them wondering and wandering for answers amid their own complicated, convoluted version of medical-social truth.

"The syndrome of Hypochondriasis (commonly called hypochondria) has been around for a very long time, and is recognized by psychiatry with the diagnostic code 300.7 in the Diagnostic and Statistical Manual of Mental Disorders, the psychiatrists' Bible," said David Baron, D.O., professor and chair of psychiatry at Temple University School of Medicine and Hospital.

"While hypochondriacs may have everything that is medically wrong with them all in their heads, they have issues in regard to physical symptoms that are very, very real to them. Basically, a hypochondriac has a preoccupation that he or she has a serious disease, that, in actuality, is a misinterpretation of a real bodily symptom.

"They may think, for example, that a headache means they have a brain tumor, or that some other completely explainable and totally treatable ailment is a sign of something else," he said.

In other words, Baron continued, hypochondriacs tend to make a mountain out of molehill, while their preoccupation, which also can be with normal bodily functions, such as heartbeat and sweating, can lead to clinically severe stress.

For someone to be considered a hypochondriac, said Baron, that person has to exhibit several characteristics, including that the condition "lasts for at least six months," results in "significant distress or impairment in social, occupational and other important areas of functioning," and "persists despite medical reassurance."

"Hypochondriasis can be very difficult for people afflicted in this way, since they do a lot of doctor-shopping, and ask for the same medical tests over and over again. Even though there is an appropriate and negative medical diagnosis they aren't convinced and, so, persist in their efforts to find a 'cure.' "

This quest can result in a significant and unnecessary outlay of cash and, with today's managed care, the likelihood that numerous tests would not be covered by medical insurance, Baron warned. Also, there are the physical dangers associated with repeated exposure to X-rays, he added.

While science hasn't disclosed an organic cause yet, the question remains: Are hypochondriacs' brains different somehow?

Hypochondriacs, replied the physician, aren't either psychotic or delusional; hypochondria it seems - which can begin at any age but usually in early adulthood - can be triggered by any kind of traumatic event in someone's life.

"It is a chronic thing that can wax and wane, and occurs about equally in men and women. Will anyone die of this? Probably not, and still there is no genuine evidence, except anecdotally, that it occurs in any particular ethnic group or groups, and there is no lab test that will disclose it.

"Ways to treat it include talk therapy," he said, adding that certain drugs to help relieve anxiety and depression could also work.

More Study Needed

The prevalence of Hypochondriasis in the general population is unknown, he admitted, while its prevalence in general medical practice has been reported to be between 4 percent and 9 percent.

It is a subject that needs - and is getting more - study, he concluded.

Treatment isn't often easy because what a therapist hopes to give is reassurance, at the same time working toward focusing attention on unintended consequences.

For example, an estimated 80 percent of hypochondriacs have underlying depressive illness or anxiety, explained Jeanne Meisler, M.D., a Main Line Health System psychiatrist, also in private practice in Bala Cynwyd, while the other 20 percent "afflicted with this very real disease that is episodic and can occur after major stresses" are fairly resistant to psychiatric treatment.

"I think it's especially important for a physician to see these patients every few months to reassure them they're healthy - that nothing indeed is wrong, that all is well. Reassurance is the key to getting through to them."

 

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