Hypochondria is often mocked and joked about, but these fears are not funny at all. Left untreated, they can cause great suffering and high costs, and there is even evidence that fears of illness can shorten life. Hypo-chondros means below the cartilage. The ancient Greeks thought that the source of the ailment was found below the rib cartilage, more specifically in the spleen. Which, of course, seems a bit bizarre today. In the course of time, the term has acquired a negative meaning. In the sense of an imaginary disease. And this is also wrong. Today, instead of hypochondria, we speak of illness anxiety or Illness Anxiety Disorder or Health Anxiety. It is an "official" illness. It is described in ICD 10, 11 as well as in DSM IV, V. The definitions are similar even if there are differences in the details.
On these pages, the clinical picture, its causes, explanatory models and treatment options are discussed.
Introduction
The question could come from a crossword puzzle: What do the following people have in common?
Charlie Chaplin. Winston Churchill. Frederick the Great, Imanuel Kant, Woody Allen, Thomas Mann, Franz Kafka, Charles Darwin, Ludwig van Beethoven, and Sigmund Freund.
All men, great minds, bright minds? Yes, true, but all of them suffered from increased fear of illness or hypochondria.
We will deal with this in several videos.
To anticipate immediately an important result: Hypochondria is often mocked and joked about, but these fears are by no means funny. Left untreated, they can cause great suffering and high costs, and there is even evidence that fears of illness can shorten life.
Let's start with the word: Hypo-Chondros means below the cartilage. The ancient Greeks, in fact, thought that the source of the ailment was to be found below the cartilage of the ribs, more precisely in the spleen. Which, of course, seems a bit bizarre today.
In the course of time, the term has acquired a negative meaning. In the sense of an imaginary disease. And this is also wrong.
Today, instead of hypochondria, we rather speak of Illness Anxiety Disorder or Health Anxiety.
It is an "official" disorder. It is described in ICD 10, 11 as well as in DSM IV, V. The definitions are similar even if there are differences in the details.
You can see that here.
Here the further distinction of functional, so-called somatoform disorders, hypochondria, illness phobia and illness delusion.
On the other hand, whether hypochondria can really be distinguished from illness phobia is uncertain.
Body perception can be seen as a continuum that can range from very low to completely exaggerated. For example, there are people with nerves of steel who effortlessly forgo anesthesia for a skin suture, while for the squeamish this would be completely unimaginable. We will come to this in detail later.
What are the typical symptoms? About these. It is mainly the constant preoccupation with the subject, the pronounced fear and the only temporary reassurance by experts.
The Internet now plays a major role in the clinical picture. Thereby, the sometimes almost non-stop searching has a double face: On the one hand, the information is supposed to provide clarity, thus reassuring, and on the other hand, exactly the opposite is also the case, as the anxious attention to body signals is intensified by information about dangerous diseases.
The constant researching is sometimes considered as a subtype of hypochondria - so called cyberchondria.
Hypochondria is usually characterized by safety seeking and simultaneous avoidance.
Anxiety about illness is a surprisingly common symptom, affecting a few percent of the population. In medical practices or clinics, however, the percentage is much higher.
In contrast to functional disorders, men and women are equally represented, according to a series of examinations.
About diagnosis: The diagnosis should be made by a specialist, i.e. psychiatrist or psychotherapist. However, a simple, orienting questionnaire can be helpful for a first orientation. It consists of 14 yes/no questions. If you score more than 8 points, it is very likely that you have an illness anxiety. You will find an online version with immediate evaluation.
And now we continue with risk factors, causes and progression
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Risk factors
Risk factors, causes and progression
Let's move on to risk factors, triggers and maintaining factors.
Central to the fear of illness is, of course, the issue of "security" in our personal biography.
Serious and poorly recognized illnesses in the family play an important role.
Another issue is overprotective parents, especially the mother. If they are constantly concerned about a child's health, the child will develop an unrealistic relationship with illness.
A child cannot orient itself and easily takes over such basic emotional feelings from the parents. Thus, we find a cluster of anxious or overprotective parents in the history of people with hypochondriacal fears.
Here are other stress factors.
Triggering factors are then usually the combination of a stressful life situation and the simultaneous confrontation with diseases. Own inexplicable body signals, serious diseases in the environment or reports about diseases in the media.
Whether the disease pattern then develops depends strongly on the sustaining factors. Quite decisive is the phenomenon of swelling lowering by attention.
If you direct the attention to any part of the body, then the perception will be increased there. Probably you have not thought about your feet until now. But try to concentrate on the soles of your feet and toes. At some point you will notice a slight tingling sensation there. Now let's imagine that someone close to you suffers terribly from a painful nerve disease in the feet, a polyneuropathy, which started just like that and could hardly be influenced. Now the tingling takes on a threatening component and is thus instantly amplified, as any threatening, dangerous signal is given priority in our perception.
What matters in our perception is not its strength - but its significance. Fear has the greatest effect. With fear, the stimulus threshold for the respective perception is immediately lowered.
Fear can have further psychological and physical consequences. Constant palpation causes lymph nodes to swell, for example, and excessive washing/rubbing irritates the skin or mucous membranes.
Equally aggravating are sleep disturbances, muscle tension, other functional disorders such as gastrointestinal complaints and functional respiratory disorders, especially hyperventilation.
Especially hyperventilation and even more so a panic attack, according to our observation, has a very great significance in the development of body-related anxiety. Very often in such cases we measure abnormal respiratory gases, which among other things lead to electrolyte shifts. More details on the pages about functional respiratory disorders.
Here are the statistics for about 150 participants with body-related anxiety.
In this context, we speak of somatosensory amplification or amplification. A vicious cycle that is self-reinforcing.
The entire inner system gets into a kind of "emergency organization", which then actually leads to measurable neurological changes.
In functional MRI examinations (in which the blood flow in individual brain sections is measured), increased limbic activation and changes in the cerebral blood flow in the striato-frontal area were found in patients with hypochondria. There, similar changes as in obsessive-compulsive and panic disorders are shown. Incidentally, ADHD also shows abnormalities there.
In other words, body anxiety can thus sustainably and measurably change the functional organization of the body.
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The prognosis of pronounced disease anxiety is unfortunately not favorable. Spontaneous cures are rare. If left untreated, the symptoms often become chronic - 70% of cases are said to be chronic.
There are other consequences.
In short: high costs, low quality of life, occupational restrictions, strain on private relationships, and indications of a shortening of life, e.g., due to frequent heart attacks, presumably because of the persistent stress load.
Next, we look at explanatory models
Corona anxiety
Causes
Explanatory models
Explanatory models
Explanatory models
Let us now consider how hypochondriacal fears can be explained.
Disease anxiety is usually directed toward serious or incurable diseases, i.e., cancer, brain tumors, ALS, or similarly serious neurological diseases. Not necessarily common, probable diseases but serious, incurable ones. How does that come about?
We have already heard one consideration. An overprotected childhood, especially with parents who were afraid for a child's health. And another thing - even if this is not part of the hypothesis of overprotection: parents are not so overprotective for no reason. Behind this are often the parents' unspoken fears, which a child picks up indirectly.
There is a second consideration that I think is very plausible. It does not come from me, but from my wife, a psychotherapist and psychiatrist.
The starting point is severe fears or feelings of panic that originate in an early phase of our developmental history. In this period of life, a child is not able to correctly assign the fear and can thus become disoriented or even internally chaotic. Nothing is worse than nameless fear and lack of orientation.
If such old fears are contacted in adulthood, the past threat and inner chaos flare up again. In this situation, the inner self seeks an explanation for the hard-to-bear feeling. What could be the cause? Since the actual cause is difficult to locate in childhood, the source of the threat is now sought in the present.
A severe or even fatal illness, would correspond in its threatening character to the intensity of the fear. The advantage of this explanation: the diffuse fear now receives a name, the inner chaos is limited. There is again a certain inner order and also potential possibilities for action and solution. Now the medical explanation and treatment is sought in order to escape the danger.
So, if a person feels threatened by a bad hypochondriac fear, then in the depth early fears, which are difficult to locate, could be responsible for it.
Thus it also becomes understandable why "despite medical reassurance" the fear does not disappear. Of course, the original fear from childhood is not really calmed by inconspicuous laboratory or X-ray findings.
You know such mechanisms from other situations. If you are walking alone through a dark, lonely forest and look around a bit anxiously, the shadows may turn into threatening figures. What happened? Our cerebrum has concocted an explanation of where the fear might come from. Now it's true again: there are dangerous beings out there, they scare me. But in fact, fear created these beings in the first place.
The next video is finally about therapy.
About therapy.
There are three common difficulties in the treatment of fear of disease
1. doubts often remain as to whether a disease does not exist. Some of the feared diseases, e.g. ALS, cannot be ruled out with certainty. Therefore, countless diagnostic efforts are common, which in the end create uncertainty rather than certainty.
2. psychotherapy may even be feared, as the inner self seeks to avoid touching early wounds.
3. functional symptoms such as dizziness, palpitations, gastrointestinal distress or tingling are indeed common. As long as symptoms such as abdominal pain are present, it is hard not to think of colon cancer.
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Therapy
Therapy
There are three common difficulties in the treatment of fear of illness.
1. doubts often remain as to whether a disease does not exist. Some of the feared diseases, e.g. ALS, cannot be ruled out with certainty. Therefore, countless diagnostic efforts are common, which in the end create uncertainty rather than certainty.
2. psychotherapy may even be feared, as the inner self seeks to avoid touching early wounds.
3. functional symptoms such as dizziness, palpitations, gastrointestinal distress or tingling are indeed common. As long as symptoms such as abdominal pain are present, it is hard not to think of colorectal cancer.
What can a therapy look like?
Although this is not our primary approach, there are studies showing that psychotropic drugs work better than placebo. Presumably, their effect is nonspecific and based on sedation.
There is unanimity that psychotherapy is effective. Most studies have been done with cognitive behavioral therapy, but different types of therapy are probably effective.
Here you can see some of the issues that can come up in psychotherapy. Of course, exploring the sources of anxiety and how to deal with it are of central importance.
In order to contact the physical side as well, a third element is necessary in addition to psychotherapy, namely body-based therapy.
Here, a re-evaluation of signals on a physical level is to be achieved through gradual confrontation. Soothing elements such as touch, warmth and massages are at the beginning. They provide for relaxation and the reduction of the fear adhesion.
Afterwards, signals are to be generated in the regions that arouse the most fear - but now in a soothing way. If an area of the body has repeatedly experienced that no danger but on the contrary well-being emanates from it, then the exaggerated attention can be reduced. The nerve afferents in the periphery and in the central nervous system lose their increased excitability.
An analogous example: If you hear a siren in your sleep at night, you may wake up. But if you grew up in a city like New York, the rise and fall of sirens is part of the normal nighttime soundscape. A night without sirens would have a completely different meaning. What's the deal? No ambulance? No police? That could be very irritating.
We train in a similar way to block out signals. Not avoidance but exposure to safety is the name of the game.
Re-evaluation of body signals
Normalization of breathing
In most cases, respiratory therapy is also useful, which is a very effective remedy for anxiety, panic, dizziness, and misperceptions. - More about this on our pages.
Let's summarize: There are many forms of anxiety that can torment us humans. They range from animal phobias, fear of flying or tunnels, fear of injections, social phobias to panic attacks or generalized anxiety disorder.
One of these fears is the fear of illness. To a small extent, it is normal and useful. It protects our health. But increased hypochondriacal anxiety can become an illness and significantly limit life.
But there is effective help. Therapy should take place on three levels.
Cognitively, we need clear direction. What is true about the fears? What should be investigated? What should not? Where does the fear come from?
Emotionally, we need safety, stability, reassurance, and processing of the child's fear.
Physically, it is about re-evaluating physical signals. Where there was fear, a neutral even better a soothing signal should emerge, which can then be slowly faded out through repeated exposure.
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