A headache is seen as a clear sign of the presence of a brain tumor. A conjunctivitis is probably indicating the incubation of a hemorrhagic fever. The appearance of a bruise clearly indicates that there are internal lesions due to disease. A discomfort in the arm implies that we are definitely suffering from a heart attack.

Although in some cases the association between the symptoms and diseases I have mentioned is correct, a large part of the population is not alarmed when a particular symptom occurs: almost everyone has had a headache, has had bloodshot eyes, bruises or discomfort and in general it is not due to the suffering of the above diseases.

However, there are people who experience a high level of anxiety when they notice alterations that are generally considered to be minor and are convinced that they are suffering from a serious illness. These are people who suffer from hypochondria .

What is hypochondria?

Hypochondria, currently called disease anxiety disorder in DSM-5 , is a disorder characterized by a high level of fear, worry and anxiety about believing or believing that you have a serious medical illness, or the possibility of having one.

This belief comes from the perception of small alterations or sensations that are interpreted as unequivocal signs of serious disorders . Sometimes it appears after the person himself or someone around him has suffered a long, painful illness or one that has ended with the death of the patient.

What goes on in the mind of the hypochondriac

In cases where there is a conviction of illness, in general people with this disorder seek medical help in order to locate and diagnose the alleged problem, and it is common that in the presence of evidence showing their good health, the explanations do not satisfy them or they do so only temporarily and demand new tests or seek other professionals to confirm their fears. However, there are some people with this disorder who choose to avoid going to the doctor due to the fear of being diagnosed , despite suffering very high anxiety and being convinced that they are ill.

The high level of anxiety regarding their health that these people suffer means that they are constantly focused on the existence of possible symptoms, as well as on carrying out or stopping behaviour in order to check their state of health.

The diagnosis of hypochondria assumes that these symptoms occur over at least six months , although the disease you think you have may vary. This concern should not be confused or due to the existence of another mental disorder such as OCD or somatic-type disorders (although in some cases the high anxiety can lead to a psychosomatic disorder). It is a disorder that can be very disabling and cause a high level of dysfunction in different life domains (both personal and occupational or academic).

Causes of the disorder

Anxiety disorder due to illness or hypochondria has been known since ancient times, and information about it can be found even in classical Greece. Throughout history, different explanations have been tried to establish its etiology. On a psychological level we can find that several schools and currents of thought have been formulating their own explanations.

From the psychodynamic model, hypochondria has often been linked as an expression of internal conflicts originating in distrust towards one’s own body born in childhood, with a transformation of hostility towards others that is redirected towards oneself or the need for dependency or as an attempt by the psyche to respond and defend itself from guilt or low self-esteem. However, this explanation is not scientifically validated.

From a psychosocial approach it is seen as a learned pattern of behaviour that is acquired in the face of the observation that it can lead to benefits. It is proposed that the hypochondriac may be an insecure person who uses the idea of being ill as an unconscious mechanism to draw attention to his environment. It is important to emphasize the fact that it is unconscious and involuntary.

However, one of the explanatory models that has received more consideration is proposed by Warwick and Salkovskis , who considered that in the etiology of hypochondria, harmful previous experiences with respect to health and disease (such as the death of a loved one due to one) can be found in the first place, causing the belief to appear that the symptom always implies something very negative,

These beliefs are activated after a triggering event and cause automatic thoughts of a negative nature to appear, which in turn generate anxiety. This anxiety will be enhanced by the performance of specific behaviors and increased activation at various levels.

Treatment of hypochondria

The treatment of hypochondria may be complicated by the fact that the subject generally tends to maintain the belief that something physical is wrong with him or her. In order to treat hypochondria, first it is necessary to rule out any real pathology and once ruled out, it is necessary to establish a good rapport between therapist and patient.

Initially, the anxious type of symptoms are usually treated first and then move on to those deeper aspects that cause and/or maintain the concern.

1. Psychotherapeutic intervention

Psychotherapy is used in the treatment with techniques generally of a cognitive-behavioral type .The treatment in question is based firstly on helping the subject to detect the beliefs with respect to his state of health and how these affect his life, to subsequently propose the alternative that he may be dealing with a problem related to anxiety and to teach him an explanatory model of the phenomenon (generally that of Warwick and Salkovskis).

After this, work begins on the different activities that the subject carries out as a verification of his or her state, and it is proposed that together they carry out different experiments that counteract the beliefs of the individual. A commitment is established with the patient in such a way that he or she commits not to carry out certain verifying activities, and later indicates that he or she will carry out a small record in which when anxiety arises he or she will write down data in favour and against his or her suspicions so that he or she can question them .

Later, he is helped to make an imaginative exhibition or even a flood of the idea of getting sick or suffering from the disease in question. One should also work on self-focus, showing the importance that this has in exacerbating his discomfort and proposing activities that allow him to vary the focus of attention.

Cognitive restructuring is also very useful to combat dysfunctional beliefs. It is important to incorporate in any programme applied against hypochondria elements that take into account the prevention of relapses. It is also useful to train the environment so that they do not reinforce the symptoms.

2. Pharmacological treatment

There is no specific pharmacological treatment for this type of problem, although sometimes anxiolytics and antidepressants are used to alleviate the subject’s discomfort.

Bibliographic references:

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Avia, M.D. (1993). Hypochondria. Ediciones Martínez Roca S.A., Barcelona.
  • Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J.; de los Ríos, P.; Izquierdo, S.; Román, P.; Hernangómez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.