hypochondriac vs worried well
Quote:
>To physicians on the net:
>How do you tell the difference between hypochondriacs and the worried
>well? Or do you consider there to be any difference?
In DSM III, hypochondriasis refers to the unrealistic interpretation of
physical sensations or symptoms, leading to preoccupation with the fear
of or belief of having a serious disease. Hypochondriasis in the more
general sense of concern about the integrity or functioning of the body
is an easily measurable psychometric variable; people tend to worry about
their body and their bodily sensations to a greater or lesser degree.
Some very "neurotic" people worry about every little ache & pain, some
more stoical types have to be physically unable to carry on before they
seek medical help. Note that hypochondriacal concern is a feature of
depressive disorders, that it, people who are depressed frequently
are more worried than usual that they are physically sick.
Realistic worry (like the woman who worries she'll get {*filter*}
cancer after her mother and sisters had it) is generally not
considered hypochondriacal. However, such anxiety can be a
problem if it gets in the way of adaptive behavior and living
well (e.g., too scared to go get a mammogram).
Nowadays several types of hypochondriasis are recognized:
- Hypochondriasis (or "hypochondriacal neurosis") -
pre{*filter*} symptom is fear of having or belief that one
has a serious disease. In many cases, the feared disease
changes -- patient gets chest pain & thinks: "Its angina,
I'm gonna have a heart attack." Same patient gets abdominal
pain & thinks: "Its colon cancer" etc. These people are the
bread and butter of many family practice offices :)
- Monosymptomatic hypochondriasis - an obsession with having a
particular disease which persists despite reasurrance from
medical tests and doctors; now recognized as a variant of
Obsessive Compulsive Disorder. Cancer phobia used to be the most
common form - now its AIDS phobia. One patient of mine called
the National AIDS hotline so frequently that they knew her by
the sound of her voice ("Oh hello, is this sally from syracuse?")
- Hypochondriacal (or somatic) delusions. These are common in
delusional depression (in which the delusion is typically
nihilistic e.g., "my heart has stopped", or "my guts are rotting)
and schizophrenia (in which the delusions are usually bizarre,
e.g., "I've got a radio transmitter implanted in my head.")
- Body dysmorphic disorder (Dysmorphophobia) - preoccupation
with a slight or imagined bodily defect, commonly seen in
college aged women who complain "the pores on my face are
getting bigger" or "there's something weird about the shape
of my (name a body part)" with no objective findings on exam.
This may also represent a variant of Obsessive Compulsive
Disorder.
Clinically, hypochrondriasis has to be distinquished from somatization
(in which the pre{*filter*} element is physical symptoms in the absenece
of apparent physical disease, rather than worry about being sick)
and malingering or factitous illness (in which the patient claims to be
having or induces symptoms or signs of physical illness, either for
some weird psychological reason (factitious illness) or to get a
monetary reward, get time off work, escape incarceration, etc (malingering).
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suny health science center, syracuse voice: (315) 422-1050
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