Hypochondria
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Hypochondria is one of the most misunderstood mental illnesses known to physicians and psychologists today. It is troubling to note how common the disease is and yet it is difficult to diagnose and even more difficult to treat effectively. However, a better understanding of the symptoms and nature of hypochondria is leading to a more informed public and further research into treatment methods for the millions who suffer from an intensely common disease.
Throughout history, hypochondria has been associated with melancholia. In the second century A.D., Galen of Pergamon was the first to link hypochondria with actual physical ailments and depression. Patients were seen as having anxiety that caused stomach problems and an intensive need to ruminate over their illness. Over time, this diagnosis had not changed much until the time of Robert Burton and his infamous book "The Anatomy of Melancholy" in 1621 in which he described "hypochondriacal melancholy. Burton was the first physician to give relief and hope to sufferers of hypochondria through his sound advice and genuine concern for those who claimed affliction.
During the 17th century and 18th Centuries, the disease became in vogue among the upper and middle class. The Renaissance helped encourage the image of the sickly artist who was a bit bizarre and eccentric with claims of illness and mental torment. However, this image quickly faded when in the 19th Century, hypochondria was classified a mental illness.The population has always had a problem with the stigma of mental illness and thus hypochondria fell out of vogue and out of the discussion of medial maladies until the time of Sigmund Freud. Freud's conclusion of the disorder was that since the symptoms were not treatable by a physician and psychoanalysis did not prove any hidden past explanations of the disorder, it was of little interest to doctors of the body or mind. Thus hypochondria has remained on the backburner of diseases of the mind that are little understood in the medical and private sector.
Hypochondriasis is a concentrated fear of having an illness, according to the DSM-IV. Hypochondriacs often misinterpret or exaggerate bodily symptoms. It is also defined as "A disorder of perception and cognition in which somatic sensation is experienced as abnormally intense and is incorrectly attributed to serious medical disease".
Four basic causes of hypochondriasis have been supported by research. The true cause may be a combination of these four theories.
- Amplification of bodily sensations
- Unconscious conflicts
- Learned behavior
- A genetic predisposition
Humans have the ability to attribute pathologic meaning to normal somatic sensations and functions. While many people may accurately attribute swollen lymph nodes to a viral infection, a hypochondriac may believe they have lymphoma. This perception can have damaging effects to the patient's psychological and behavioral health.
Nearly five percent of primary care outpatients are thought to have this illness. The DSM-IV describes several criteria for diagnosis of hypochondriasis. The first is the obvious fear of illness. This preoccupation must persist despite appropriate medical treatment and last for more than six months. Delusions or other mental illnesses should be ruled out. Finally, it should be serious enough to cause distress or impairment in other life areas. A direct diagnosis is rarely made, so as not to upset the patient. This tendency perpetuates the stigma associated with hypochondriasis.
One physician in the 17th century referred to hypochondriacs as "enemies to joy and hope." Fortunately, today's doctors approach such patients in a more professional manner. However they may remain among the least desired patients. Hypochondriacs are perceived as demanding, uncooperative, attention-seeking and manipulative. Also, physicians may have particular difficulty with them because doctors tend to become frustrated or angry, feel undermined or doubted, or even begin to consider their own mortality after working with a hypochondriac.
Such patients may equally detest physicians. After years of being dismissed or patronized, a hypochondriac patient may feel mistrust, disappointment, and resentment toward the medical profession. Patients may also have justified feelings of rejection as physicians try to refer these patients to someone else. One study found that people suffering from hypochondriasis describe physicians as unconcerned, disrespectful, ineffective, hurried, not accepting, not reassuring, unprofessional and inaccessible.
Symptoms of hypochondriasis include anxiety and depression. Also, sufferers may exhibit panic or obsessive-compulsive tendencies. The doctor-patient relationship may be hindered by common personality traits of hypochondriacs, such as masochism and obsessiveness. Symptoms may be very vague to quite specific. Patients have reported such issues as sleep disorders, sexual dysfunction or stomach problems.