DSM-III-R: "Worry, fear or belief of having a disease serious from the personal interpretation of the signs or physical sensations ". important problems associated with the definition of the DSM-III-R, extendable to the DSM-IV.
Lack of clarity in the conceptualization of hypochondria as "fear of" or "belief of" suffering from a serious illness -> The definition encompasses both patients convinced that they are sick (conviction of illness) and those who fear becoming ill (phobia of disease)
Warwick and Salkovskis: In both cases the anxiety has been conditioned to stimuli associated with the disease, but in the case of the phobia the stimuli are external (hospitals), whereas in hypochondriacal disorder, the stimuli are internal (sensations bodily). Furthermore, the phobic copes with anxiety by avoiding the feared stimulus, while the hypochondriac uses behaviors aimed at neutralizing anxiety.
Marks: When fears involve multiple bodily symptoms and a variety of diseases -> hypochondriasis. When fear focuses on 1 single symptom or disease -> disease phobia or nosophobia.
Fava and Grandi: Hypochondriasis -> It is characterized by resistance to reassuring medical information. Phobia of the disease -> Due to the specificity and longitudinal stability of the symptoms and the phobic quality of the fears (in the form of attacks rather than a constant worry). 2. It affects the diagnostic criterion that the fear of having or the belief that one already has a disease persists Despite medical explanations: Salkovskis and Warwick: This is persisting due to medical information reassuring.
The diagnosis of the disorder depends, not only on the clinical characteristics of the subject, but also on the actions carried out by doctors. Salkovskis and Clark:
- In certain contexts, patients do not have the ability to access medical information. b) Some patients avoid consulting the doctor.
- Hypochondriac patients often seek reassurance by other means.
- The type of information is not defined reassuring which is not effective. Starcevic:
This defining aspect is susceptible to a double interpretation:
- There is something inherent in hypochondria that prevents explanations from being effective.
- Ordinary "common sense" explanations are ineffective in this disorder.
The DSM-IV does not incorporate suggestions or completely correct both problems: It explicitly includes disease phobia within the disorders of anxiety (specific phobia), and points out that the distinction between hypochondria and specific phobia depends on the existence or not of conviction of illness. The question of reassuring information remains unchanged.
Worry and fear of having, or the conviction of having, a disease serious from personal interpretation of somatic symptoms. The concern persists despite appropriate medical examinations and explanations. The belief in criterion A is not delusional (unlike delusional disorder of the type somatic) and is not limited to concerns about physical appearance (unlike dysmorphic disorder bodily). Worry causes clinically significant distress or impairment of the individual's social, occupational, or other important areas of activity. The duration of the disorder is at least 6 months. The worry is not better explained by the presence of generalized anxiety disorder, disorder obsessive-compulsive, panic disorder, major depressive episode, separation anxiety, or other somatoform disorder.
Specify if: With little awareness of illness: if during most of the episode the individual does not realize that the concern about suffering from a serious illness is excessive or unjustified. Patients with hypochondria are worried about the fear of having a disease, while patients with specific phobia are afraid of contracting it or being exposed to it. Characteristic features of hypochondriacs according to Gutsch: Anxiety. Compulsive personality traits.
Low mood. Trends of "doctor shopping". Exacerbation of doctor-patient relationships. Impairment of the capacity for social functions. Impaired ability to function at work. Worry about insignificant pain. Worry about minor coughs. Peristalsis concern. Little social relations. Need to explain his medical history in detail.
Central psychological and clinical characteristics of hypochondria (Warwick and Salkovskis, 1989): Concern for health. Insufficient organic pathology to justify the concerns expressed. Selective attention to body changes or characteristics. Negative interpretation of bodily signs and symptoms. Selective attention and distrust of medical and non-medical information.
Persistent search for explanations / verification of body state / information Barsky, differentiates between 2 types of hypochondriacal conditions: 1. PRIMARY HYPOCHONDRIA: No other psychiatric disorder is present or, if present, it is unrelated to or independent of hypochondria. 2 subtypes:
- Hypochondria as conceptualized in the DSM-III-R.
- Monosymptomatic hypochondria: single and fixed delusional belief of suffering from a disease.
SECONDARY HYPOCHONDRIA
It is subordinate to a more generalized condition, or it is an elicited response to the appearance of stressful events (physical illness that endangers the life or death of a significant person). Transient hypochondria (less than 6 months) refers to a clinical condition that can occur in the context of a medical illness or a stressful situation.
THEORETICAL EXPLANATIONS ON HYPOCHONDRIA PSYCHODYNAMIC PERSPECTIVE (Barsky and Klerman)
As an alternative channel to divert sexual, aggressive or oral impulses to others in the form of physical complaints. As an individual defense against low self-esteem and the experience of the self as worthless, inadequate, or flawed. Traditional PSYCHOSOCIAL TYPE approaches. Two groups of theoretical alternatives: Those that have emphasized the advantages derived from adopting the sick role (receiving care, avoiding responsibilities). Hypochondria as a mode of interpersonal communication. Recently, theories have been developed that conceptualize hypochondria as the manifestation of a
ALTERATION AT THE PERCEPTIVE OR COGNITIVE LEVEL
Barsky et al: Hypochondria as an "amplifying somatic style": Hypochondriac subjects amplify somatic and visceral sensations. It comprises 3 elements:
- Body hypervigilance that leads to increased self-scrutiny and a focus on unpleasant bodily sensations.
- Tendency to select and focus on certain relatively infrequent or faint sensations.
- Propensity to value somatic and visceral sensations as abnormal, pathological and indicative of disease.
Kellner: Certain early experiences predispose the person to attend to somatic symptoms and certain events act as precipitating factors -> The subject begins to thinking that you have a disease -> you feel anxious and worried about the future consequences of the disease -> leads to a selective perception of sensations somatic. What begins as a harmless reaction can lead to hypochondriacal neurosis.
Warwick and Salkovskis: Previous experiences related to illness (own or others) and medical errors lead to the formation of erroneous beliefs or dysfunctional information about symptoms, illness, and health behaviors -> Information consistent with the idea that health status is selectively addressed not good.
Dysfunctional beliefs or problematic assumptions remain inactive until a critical incident (internal or external) mobilizes them -> Appearance of negative automatic thoughts and unpleasant images -> anxiety about health accompanied by their corresponding physiological, behavioral and affective. There are factors involved in the maintenance and exacerbation of health concern. A vicious cycle is established that perpetuates hypochondria.
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