Abramowitz / Braddock Hypochondriasis and Health Anxiety

1. Auflage 2011
ISBN: 978-1-61334-325-8
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark

E-Book, Englisch, Band Vol. 19, 104 Seiten

Reihe: Advances in Psychotherapy - Evidence-Based Practice

An essential resource for anyone providing services for individuals with somatoform or anxiety disorders
Cognitive-behavioral therapy is now the treatment of choice for individuals with health anxiety and related problems. The latest research shows that it results in reductions in health-related worries, reassurance-seeking behavior, and phobic avoidance, as well as increases in life satisfaction and everyday functioning.
This compact, easy to understand book by experts Jonathan S. Abramowitz and Autumn E. Braddock opens with an overview of the diagnostic issues and assessment of health anxiety, and delineates a research-based conceptual framework for understanding the development, maintenance, and treatment of this problem.
The focus of the book is a highly practical guide to implementing treatment, packed with helpful clinical pearls, therapist-patient dialogues, illustrative case vignettes, and sample forms and handouts. Readers are equipped with skills for engaging reluctant patients in treatment and tailoring educational, cognitive, and behavioral techniques for health-related anxiety. The book, which also addresses common obstacles in treatment, represents an essential resource for anyone providing services for individuals with somatoform or anxiety disorders.

Autoren/Hrsg.

Abramowitz, Jonathan S.

Braddock, Autumn E.

Braddock, Autumn

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Allgemeinmedizin, Familienmedizin
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie
• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie

Leseproben

1
Description of Health Anxiety
1.1    Terminology
Anxiety is a cognitive, emotional, physiological, and behavioral response to the perception of threat. It occurs when one doubts his or her ability to cope with the perceived threat. Health anxiety refers to inappropriate or excessive health-related fears based on misperceptions of innocuous bodily cues and sensations as indicative of a serious medical problem. Moreover, the individual with health anxiety perceives him or herself as unable to cope with or prevent the perceived threat, in this case the presence of a serious medical illness. 1.2    Definition
Definition of health anxiety and hypochondriasis Anxiety is an adaptive response which prepares us to take action when confronted with possible danger (i.e., the fight or flight response). Some degree of health-related anxiety may therefore be constructive if it motivates a person to take appropriate measures or seek proper medical attention. For example, apprehension concerning shortness of breath in a person with asthma can lead to prompt administration of inhalant bronchodilator medication to prevent respiratory fatigue or even death by suffocation. Clinical health anxiety, on the other hand, is extreme in relation to the actual degree of threat (if any threat even exists). It causes distress and interferes with various domains of functioning, including interpersonal relationships, self-care, work or school, and leisure. Hypochondriasis. Hypochondriasis is classified as a somatoform disorder in DSM-IV-TR (American Psychiatric Association [APA], 2000) and characterized by a preoccupation with fears of having, or the idea that one has, a serious medical condition such as a chronic, life threatening or life-altering sickness (see Table 1). This “disease conviction” is (a) based on a misinterpretation of harmless or minor bodily sensations or perturbations and (b) persists in spite of appropriate medical evaluation and reassurance of good health. The health-related preoccupation might concern specific bodily functions such as peristalsis or heart beat; slight benign abnormalities, signs, and sensations such as an occasional cough, pulled muscle, mole, or bruise on the skin; vague and ambiguous complaints such as “a hollow head” or “weak spine;” or specific organs (e.g., kidneys), body parts (e.g., prostate gland), or diseases (e.g., rabies, cancer). Table 1 Summary of the DSM-IV-TR Diagnostic Criteria for Hypochondriasis A.  Preoccupation with fears of having, or the idea that one has, a serious disease based on the person‘s misinterpretation of bodily symptoms. B.  The preoccupation persists despite appropriate medical evaluation and reassurance. C.  The belief in criterion A is not a delusion and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder). D.  The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. E.  The duration of the disturbance is at least 6 months. F.  The preoccupation is not better accounted for by another Axis I disorder such as Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder. Adapted from the DSM-IV diagnostic criteria for hypochondriasis (American Psychiatric Association [APA], 1994). Adapted with permission. Patients with clinical health anxiety often fixate on the cause, meaning, and authenticity of their complaints. Common expressions of this fixation include excessive seeking of reassurance about the physical complaints (e.g., repeated doctor visits and unnecessary tests), asking questions of medical professionals, seeking information from medical texts and websites, and extensive body checking (e.g., inspecting the skin, inspecting excrement, repeatedly measuring vital signs). Some patients avoid external triggers of health anxiety (e.g., hospitals, people with illnesses). Table 2 lists some common hypochondriacal and health anxiety-related behaviors. Clinical Pearl Hypochondriasis Versus Health Anxiety The term “health anxiety” is beginning to replace the term “hypochondriasis” for the following reasons: 1.   “Health anxiety” provides a clearer and more meaningful description of the emotional and behavioral aspects of this problem. “Hypochondriasis,” on the other hand, derives from the Greek hypo (below) and chondros (cartilage of the breast bone) and was used by ancient Greek physicians to describe unexplained stomach pains. During the 19th Century, this became the male counterpart to hysteria. 2.   Hypochondriasis is but one of several clinical disorders that involve health-related fears and worries. Thus, health anxiety is not a clinical diagnosis per se, but rather a phenomenon that can be present in a number of psychological conditions as well as medical diagnoses that often present with overlapping psychological symptoms (as we describe below). 3.   Whereas the term “health anxiety” is more or less value neutral, “hypochondriasis” has pejorative connotations. Table 2 Examples of Common Hypochondriacal and Health Anxiety-Related Behaviors Checking and assurance-seeking •   Repeated visits to doctors to have symptoms checked •   “Doctor-shopping” to check if the diagnosis is correct •   Repeated Internet searches to find information about a certain symptom •   Repeatedly discussing or asking questions about the feared problem •   Reviewing test results and notes taken during doctor visits •   Persistently mentioning and describing symptoms to others •   Repeatedly reviewing medical texts or journal articles for information about illnesses or body symptoms Body checking •   Repeatedly measuring heart rate, blood pressure, temperature, etc. •   Constantly monitoring levels of “throat tightness,” dizziness, or pain •   Frequently palpating the throat or breasts for lumps •   Checking urine and stool for blood and consistency •   Frequent inspections of sores and moles on the skin Safety signals •   Remain within a certain distance of the doctor’s office, hospital, or medical center •   Keep medications on hand at all times •   Swallowing until it feels “normal” •   Rigid adherence to a strict diet Avoidance •   Hospitals •   People with illnesses •   Television shows, movies, news articles, and other stories about sick people, illnesses, or death •   Physical exertion •   Routine physical exams •   Self-examinations (e.g., breast, testicles) •   Funerals and cemeteries Patients vary in terms of their insight into the excessiveness of their health concerns Poor Insight. Some individuals with hypochondriasis recognize that their health-related fears, preoccupations, and behaviors are excessive (i.e., they have “good insight”). The DSM-IV-TR diagnostic specifier, “with poor insight” is reserved for those who, most of the time, do not realize that their health-related fears and concerns are unrealistic. 1.3    Epidemiology
The lifetime prevalence of hypochondriasis in the general population has been estimated at anywhere between 0.02% and 7.7%. In primary care settings, estimates range from 0.8% to 8.5%. The estimated prevalence is 1.2% among cardiology outpatients and 1.0% among chronic pain patients. Men and women are about equally likely to be affected (APA, 2000). 1.4    Course and Prognosis
Most patients with health anxiety require professional help to avoid long-term suffering Although symptoms of health anxiety may be present at any age, little is known about the average age of onset, or about the prevalence of health anxiety among children. Onset usually occurs in early adulthood, which coincides with the time at which most people assume greater responsibility for maintaining personal health. Other potential onset triggers include increased life stress, a personal experience with illness, the illness or death of a loved one, and exposure to mass media coverage of illnesses. Some health anxiety patients endure a long-term burden of functional impairment and personal distress if effective treatment is not sought. 1.5    Differential Diagnoses
A number of psychological...