Treating Hypochondriacs Starts with Mindfulness

As a doctor or a mental health professional, you probably receive many messages every day on your phone from people who are worried about their health. The past one and a half years have got us all very stressed, with each cough wondering whether we are slowly developing symptoms for the deadly disease. Enter COVID-19, exit all sanity. It's not uncommon for many people to judge for themselves the state of their current health, WebMD at their disposal. We are all human, and we're built with survival instincts. This means we tend to do everything in our power to stay on top of things, to recover as quickly as we can, to survive. However, people that suffer from hypochondria or, as it's called, Illness Anxiety Disorder (IAD) misread into their symptoms, existent or non-existent, and develop a fear of a serious illness they may not be afflicted with. 

Usually, in cases of hypochondriac patients, they will persistently visit their doctors or physicians in pursuit of figuring out their ailment. Getting disappointed every time their tests come back negative for any significant discrepancies. Experts believe this is a serious and real issue that mental health professionals should take up instead of physicians. Hence, this article provides therapists with a general structure and outline for diagnosing and treating someone with IAD. We will go through the reasons behind a person developing hypochondria, ways to diagnose it properly, and ways to treating it. 

Hypochondriacs – who are they?

For all hypochondriacs out there, they're divided into two categories: care-seeking and care-avoidant. One will be anxious to get all the help they can. The other will build up their anxiety trying to avoid any treatment. This disorder is not to be confused with somatic symptom disorder, where physical symptoms are present, but the reason for them being present cannot be pinpointed.

Hypochondria is, at its core, severe anxiety. A person can develop the disorder through a myriad of reasons, such as having a history of family illnesses that may have taken loved ones away or even pre-existing conditions in themselves during their childhood. Trauma is a significant contributing factor that can come through physical, verbal, or sexual abuse over the years. It is also prevalent in people with anxious parents who suffocate their children by sheltering them, thinking they're preventing these children harm. This disease also presents itself in people that suffer from anxiety, depression, and other co-morbidities. A study revealed that people suffering from hypochondria also suffer from other psychiatric disorders. These include obsessive-compulsive disorder and substance abuse disorders. The study also showed that these people are three times more likely to develop or already have a personality disorder. 

As stated before, this is a game of the mind, where you're tricked into thinking that there is something wrong with you. It has a lot to do with a person's surroundings, beliefs, their relationships with people. Most hypochondriacs will refuse to socialize with people or even leave the house for fear of falling ill. There will also be an element of distrust while dealing with them. 

Diagnosing Hypochondria

As a mental health professional, a patient suffering from hypochondria will most likely be recommended to you by another physician or by the patient's family or friends. It is essential to understand that this patient has already been through a lot, checking off all physical ailments on the list, and is still concerned why no doctor or test has found something worthwhile to diagnose. Hence, it would be best if you prepared for all possible outcomes of your first interaction. Most of the time, being told that nothing is physically wrong with you can upset or anger you if you're suffering from hypochondria. It can contribute to distrust between the patient and treatment, and they can forgo coming to the hospital altogether. 

It is tricky to diagnose someone with this disorder. However, as a therapist, there are certain behaviors that you can focus on that will help in defining the severity of the problem. These behaviors are:

• focusing entirely on their physical symptoms instead of their worries or anxieties 
• exaggerated behavior to back up the symptoms 
• obsessing on normal body functions and conditions
• treating a minor illness as something more significant and more complex
• having trouble function normally in daily life 
• ignoring family, friends, or any other kind of social interactions 
• frequent medical appointments to the doctor or physician 
• routine medical appointments for the same symptoms and condition
• mentally occupied by a medical condition, either something new or a part of the family's medical history
• existing co-morbidities of anxiety, depression, or other

It is important to remember that these symptoms need to be sought out in frequency, duration, and severity. Often it can help to talk to the person's family or loved ones. They can help by identifying these behaviors and helping you understand their patient history. As a therapist, you can also look into any noteworthy events in the patient's life that may have caused the onset of this disorder. These include trauma, a significant crisis in early childhood, history of childhood illness, etc. Patients can also be screened for somatization, anxiety, depression, and alcohol abuse as a way of identifying underlying co-morbidities. 

It is essential to diagnose the disorder right away. Otherwise, there can be a severe risk to a patient's 

• finances and medical bills because of frequent tests 
• social health and interaction with family and peers 
• work or day-to-day routine life 

Treating People with IAD

Hypochondria (or IAD) is at its heart a mental disorder rather than a physical one and should be treated as such. It is recommended that therapists become their patient's primary caregivers (PCP) to check their treatments and progress. This entails providing the patient therapy exclusive to the IAD disorder. Several methods can do this. 

Psychotherapies have been proven to work for cases like these, specifically Cognitive Behavioral Therapy (CBT), a kind of talking therapy that explores relationships between feelings and response behaviors. It has helped with anxiety disorders which are the underlying pattern behind IAD. In combination with CBT, scientists recommend using Cognitive stress management therapy as a complementary treatment. This is mainly for patients suffering from anxiety to learn how to control their cognitive behavior and responses while facing fear or having a panic attack. 

There are several methods to approaching these techniques. In behavior therapy, meditation and mindfulness practices are a huge part of the patient's recovery. Mindfulness practices are tied with talking therapies and journaling techniques. Mindfulness is all about focusing on here and now and being grateful for all you have in the present. Be it your health, something exciting and new happening in life, work, etc. It allows you to work through all your anxieties and fears. This is where journaling comes in. Writing down your intentions, expectations, fears, dreams, and affirmations is like a daily cleanse from having them roam around in your head. It can be very beneficial for your patient's health. You can provide them with daily meditative activities or journaling prompts. Then, they can come back to you to discuss them. 

Hence, talking therapy and journaling is the best way you can help your patients. It is a way to map behaviors as they are happening and generate different mental exercises to control these behaviors and ensure that it doesn't lead back to those same fears and anxieties. 

However, many mental health professionals also treat their patients with anti-depressants or benzodiazepines such as Prozac and Luvox. These drugs are used to treat patients with one anxiety disorder and suffer from panic attacks. However, to keep track of these treatments, it is a must for you as a PCP to ensure that your patients are present for regular therapy. There should be no discontinuation of the entire treatment since this can lead to even disastrous outcomes. 

Finally, we are left with physical therapy as a possible treatment. There is not much research to back up this as a viable option. However, it is recommended that to making your patients feel better, a big part is making them care for their health. Suppose they're eating right, going out for exercise, listening to what their body needs. They need to be taught to be okay with different bodily functions such as increasing heart rate, or sweat, or even getting a few bumps and bruises each time. To ensure a person properly heals, you as their therapist need to provide the tools to build trust between what their body needs and what their mind wants. 

Indeed, hypochondria may never go away, but it can be treated. A patient needs to have the liberty to handle a relapse and contact their PCP's before spiral into anxiety. There should be consistent checkups and proper communication. This will ensure speedy progress for the patient.