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Hypochondriacal Concerns: Management Through Understanding.

Vicenzio Holder-Perkins1, Thomas N. Wise, Darren E. Williams

  • 1Departments of Psychiatry and Behavioral Medicine, Inova Fairfax Hospital, Falls Church, Va., and the Department of Psychiatry, Georgetown University School of Medicine, Washington, D.C.

Primary Care Companion to the Journal of Clinical Psychiatry
|March 12, 2004
PubMed
Summary

Medically unexplained symptoms often signal hypochondriacal concerns. Effective management involves assessing illness beliefs and behaviors to address underlying psychosocial difficulties, avoiding unnecessary medical interventions.

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Area of Science:

  • Psychiatry
  • Psychosomatic Medicine
  • Medical Psychology

Background:

  • Medically unexplained complaints are frequently linked to hypochondriacal concerns.
  • Current management strategies for hypochondriasis include naive realism, morbid categorization, and dimensional assessment of illness beliefs and behaviors.

Purpose of the Study:

  • To explore effective management strategies for patients presenting with medically unexplained complaints suggestive of hypochondriasis.
  • To differentiate between approaches that may exacerbate somatization versus those that facilitate targeted psychiatric treatment and cognitive restructuring.

Main Methods:

  • Review of management approaches for hypochondriasis.
  • Analysis of the impact of naive realism on somatization and healthcare utilization.

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  • Examination of the utility of categorical psychiatric diagnoses (e.g., depression, anxiety) for identifying comorbid conditions.
  • Assessment of illness behavior domains (disease conviction, causal beliefs, denial) for cognitive schema analysis.

    • Main Results:

    • Naive realism in managing hypochondriasis can intensify somatization, leading to unnecessary medical tests and treatments.
    • Identifying comorbid psychiatric disorders, such as major depression or anxiety disorders, allows for effective traditional psychiatric interventions.
    • Dimensional assessment of illness beliefs and behaviors enables clinicians to identify and address maladaptive cognitive schemas related to somatic concerns.

    Conclusions:

    • A dimensional approach to assessing illness beliefs and behaviors is crucial for managing hypochondriasis.
    • Addressing cognitive schemas underlying somatic concerns can resolve underlying psychosocial difficulties.
    • Clinicians should consider comorbid psychiatric conditions and avoid management strategies that promote somatization.