Hypochondria: When Health Care Stops Being Healthy

It happens that a person cannot cope with an obsessive desire to find a disease in himself or, on the contrary, tries to avoid everything that theoretically can lead to it. But it can be dealt with – we’ll tell you exactly how.

What is hypochondria

Hypochondria is a state of the human psyche, which manifests itself in constant anxiety to get sick with one or more diseases, or because of the symptoms of these diseases. For example, when a person washes his hands every ten minutes in order to “not catch something”, and wipes everything around with an antiseptic. He does not leave the feeling that he is ill with something or can get ill.

This definition is enshrined in the 11th revision of the International Classification of Diseases (ICD-11), which is valid from January 1, 2022 [1]. According to some data, the number of people with hypochondria in the world ranges from 4,5 to 20%, depending on the research method [2]. Sometimes hypochondria is diagnosed along with another affective disorder, such as depression. But it is not its symptom.

Hypochondria can occur both in the normal functioning of the psyche and in pathological processes. In pathology, hypochondriacal disorder is diagnosed – a type of obsessive-compulsive disorder.

Worrying about your health is normal, especially if we are faced with the manifestation of a symptom of one of the diseases. Until a person has learned its nature, has not passed tests and has not received a doctor’s opinion, excitement is natural and justified.

The line between “normal” hypochondria and passing the norm is expressed in the following symptoms.

Symptoms of hypochondria

• Increased anxiety. If, after the tests and the doctor’s verdict that everything is in order with health, the person calms down and continues to live as before, then the psyche is normal. But when anxiety persists and even intensifies, it can be assumed that these are symptoms of irrational hypochondria.
• Obsessive thoughts about your own health. A person with this disorder constantly turns to new doctors, and if the doctors confirm that there are no health problems, he devalues ​​their verdicts. He will continue to search for the disease and will do everything to refute the “inaccurate” results. In addition, hypochondriacs often avoid the advice of a doctor, appealing to the fact that they still know better that something is wrong with them.
• Violation of the habitual way of life. Fear of the disease and attempts to eliminate it capture a person so much that he can no longer work normally, study, communicate with family and friends.
• The nocebo effect is one of the brightest manifestations of hypochondria. By studying materials describing various symptoms, some people with hypochondria begin to feel them in themselves [3]. The manifestation of this effect means that a person has a somatic syndrome.

Autonomous regulation of some systems in the body is influenced by emotions. If a person’s attention is constantly directed to his body, and anxiety does not stop, under this powerful influence of the psyche, malfunctions in the body can occur. But this is not the main manifestation of hypochondria. For her, it is enough that something “moved” or “pulled” in the body. If we suddenly begin to focus our attention on breathing, then it will change – this is a normal reaction of our nervous system. The same happens with the body.

At the same time, it is important to understand that any process that occurs in the body, including the nervous system and psyche, is real for a person. Phantom pain during amputation of an organ is also real for the person experiencing this pain. Hypochondria is based on this principle. People with hypochondria do not “invent” that something is wrong with them and try to convince everyone of this. The sensations in the body that hypochondriacs obsessively pay attention to are real, as is the anxiety that they are ill with something.

Causes of hypochondria

Hypochondria develops due to a certain personality organization of a person. Often these are anxious, dreary, sensitive people. Hypersensitivity to various physiological manifestations and a low pain threshold can cause a person to misinterpret their own sensations. As a result, he begins to perceive normal bodily signals as signs of illness. But hypochondria does not appear in all “depressed” people, but only in those who have a certain style of explaining processes in the world around them.

Hypochondria sustains itself through irrational, disturbing beliefs, attitudes, and assumptions about health. Anxiety increases the “symptoms” in the body – a person feels it and is even more worried. A vicious circle is forming.

All these installations can occur for various reasons. In some people, these are developmental features transmitted from parents. For others, it is a consequence of negative experience: experienced illnesses, loss of loved ones due to some kind of disease. For others, anxious beliefs appear together with other mental disorders, for example, against the background of depression or schizophrenia.

Treatment of hypochondria

First of all, you need a doctor to make a diagnosis. Only a psychiatrist, psychotherapist or clinical psychologist can make a decision about the presence of a hypochondriacal syndrome. The latter can make a diagnosis, but cannot independently make an official diagnosis.

It is necessary to contact a psychiatrist or psychotherapist when it seems to a person that he has a somatic disease, but for six months not a single doctor has been able to understand which one, and has not been able to prescribe high-quality treatment. If the therapist himself says that it is time to see a psychiatrist, then it is definitely time.

The main treatment for hypochondria is psychotherapy. Scientific evidence suggests that various forms of cognitive behavioral therapy (CBT) are highly effective in treating hypochondria [4]. However, if a person is closer to psychoanalytic psychotherapy or humanistic psychotherapeutic directions, they are also suitable. The difference is only in the duration of therapy. With CBT, treatment for hypochondria can take anywhere from 2 months to six months. With other forms of psychotherapy – from 3 months to a year or longer. It is very important to find the right specialist here.

For severe forms of the disorder, certain types of antidepressants may be prescribed. But in most cases, the use of drug psychotherapy is not recommended. The reason is simple: prescribing drugs can support the hypochondriac’s belief that he has some kind of physical illness.

How does hypochondriasis affect your life?

The concept of psychiatric accounting is a thing of the past. In the early 1990s, in the Russian Federation, instead of the concept of “psychiatric registration”, the concepts of “consultative and medical care” and “dispensary observation” were officially introduced. If the psychiatric record was actually lifelong, then dispensary observation is carried out for patients who are in the ward here and now. An appeal to a psychiatrist with hypochondria refers to consultative and medical assistance and does not leave any trace in the conditional “medical record”.

For this reason, people with hypochondria should not have problems finding employment. Health requirements are set by professional standards: federal laws, orders of ministries and local regulations. However, if a person with hypochondria wants to work where it is important to have a stable psyche, for example, at a school with children, it is worth additionally studying the local requirements of the organization or company for its employees.

The situation with driving a vehicle is much more difficult if there is a diagnosis of hypochondriacal disorder.

On the one hand, there is a decree of the government of our country of 2014, according to which mental and behavioral disorders are medical contraindications for driving [5]. In the list of such disorders according to ICD-10, hypochondriacal disorder was also included as one of the types of neurotic disorders.

On the other hand, the current ICD-11 removed hypochondria from this list. In addition, a person is admitted to the right to drive a vehicle through a medical board, which includes a psychiatrist, albeit in the PND at the place of registration. Even if a person has a history of a visit to a psychiatrist with a hypochondriacal disorder, a psychiatrist on the medical board will make a decision about the mental state at the time of the examination. So driving with hypochondria is possible.

There is one important “but” here. Some drugs prescribed by a psychiatrist to treat hypochondria can cause side effects that make it impossible to drive. Driving while taking these drugs is a serious offense that can result in both a fine and suspension of your driver’s license. The attending physician should warn about such “side effects”, and the client should check the list of side effects in the instructions for the medicine.