hypochondria is very frequent in the population. It is characterized by the feeling and / or the idea of being sick, without however having valid or justifiable bases of reality.
Concerns about your own body can be present differently. Sometimes fears manifest themselves under certain conditions, at certain moments in life, or in the face of certain events or certain news (for example the illness of a peer). Other times the fears are more structured, in personalities with particular traits (for example in obsessive personalities ), up to more frankly pathological forms.
Transient hypochondriac reactions can occur as a result of severe stress , most commonly after the death or serious illness of a person who is important to the patient.
The hypochondriac tends to interpret trivial alterations, such as a headache, a functional heart disorder, or a viral respiratory infection, as evidence of a serious illness.
It often happens that fears are concentrated on a single organ, the functioning of which becomes a source of extreme concern for the patient.
The general practitioner and the hypochondriac patient
The therapeutic figure who is initially consulted most often by the hypochondriac patient is the general practitioner (or general practitioner). In fact, it is he who finds himself first and foremost facing the problems of these subjects. Excessively worried about their state of health, they persistently complain of numerous somatic ailments. However, they are not reflected in the various laboratory or radiological analyzes, the outcome of which is invariably negative.
What the doctor can easily detect, in these cases, is the disproportion between the extent of the disorder and the degree of apprehension with which the patient reports it. The latter does not accept the reassurance he receives from the caregiver, but, on the contrary, may react with anger or disbelief, rather than with relief. Especially when he is told that his symptoms, in the light of the negative results of the various tests carried out, are not attributable to any organic disease.
Furthermore, it is not uncommon for the patient to interpret the request for diagnostic tests made by the doctor exactly as confirming that his suspicion of being suffering from a serious illness is well founded. The very lack of any evidence of organic disease leaves him equally worried about the feeling that some pathology might have escaped diagnostic investigations anyway.
Therefore these patients, disappointed by the answers that their trusted doctor can provide to their ailments, begin to consult various specialists. They transfer their hypochondriac themes in many fields of medicine, such as cardiology, dermatology, otolaryngology, infectious disease, gastroenterology, gynecology, oncology.
The relationship with the hypochondriac patient
Moreover, a correct management of the therapeutic relationship cannot exempt the doctor from carefully considering every new symptom reported by hypochondriacal subjects. In fact, it is obvious that even these patients can, in the course of their life, undergo organic pathologies. Precisely in these cases the risk of underestimating the disorders is higher, with evident consequences also of a medico-legal nature.
In this sense, periodic medical checks are considered useful , planning visits at fixed and regular intervals. This is to reassure patients that they are not neglected and that their complaints are taken into consideration. In order to avoid the risk of reinforcing cyclic hypochondriac behavior, the practitioner should involve the patient as much as possible in the decision-making process. At the same time, however, it must avoid that an excess of reassurance feeds an unconscious circuit of seeking comfort as an end in itself.
It is clear that the presence of these dynamics makes Hypochondria among the most difficult and complex pathologies to treat in general medicine. Doctors soon realize that these patients’ symptoms are refractory to all standard medical therapies. In particular, it is the very nature of the doctor-patient relationship that proves problematic, as we are dealing with suspicious, often critical patients. They tend to devalue the work of their doctor, even though they are frequent visitors to the clinic, often in possession of a certain medical culture (albeit confused and approximate). They can arouse negative “countertransference” feelings, evoking in the caregiver an attitude of rejection or in any case of little consideration towards them.
Work on the relationship rather than the symptom
To adequately cope with these dynamics, doctors should change their concept of care. Shifting the objective from the attempt to intervene directly on the symptoms to a work focused on improving the therapeutic relationship . Moreover, this is experienced by the patient as a fundamental channel for conveying his own experience of suffering and therefore as important as the symptom itself.
These patients are prone to get irritated when they are told they “have nothing”, meaning that their ailments have no identifiable cause. This is because this contradicts their bodily and subjective experience. It does not help to try to empty the symptom of its pathological meaning, risking to provoke oppositional feelings on the part of the patient, who feels his physical experience trivialized and misunderstood. On the contrary, the physician should suggest the possibility that the perceived disturbances are mediated and amplified by a specific anxious reactivity that can distort in a pejorative sense the entity of bodily perceptions.
This approach methodology also aims to underline the importance of the psychological dimension in the genesis of somatic sensations and therefore to propose a style of therapeutic relationship that takes this element into account.
The referral of the hypochondriac patient to psychological treatment
However, a certain degree of resistance on the part of hypochondriac patients to undertake psychological or psychiatric treatments is frequently found in the clinical practice of general medicine . They are greeted with reluctance, sometimes even with the suspicion that it is a ploy of their doctor to avoid taking care of them.
The main obstacle in this sense is precisely the difficulty in having these problems considered from a different point of view from the exclusively somatic one. It is difficult to make these patients aware that they are essentially carriers of an anxiety disorder , centered on the fear of being suffering from a serious physical illness.
Many patients are reluctant to admit depressive area symptoms , while depressive symptoms are frequently expressed in somatic form (see masked depression ). This occurs especially in the elderly population, as an adaptive response to social and family problems.
Psychotherapy and psychotropic drugs
Good results can be obtained through short-term psychotherapeutic interventions type cognitive-behavioral . They are based on the clarification of the meaning of the symptoms, on body relaxation techniques, on the modification of dysfunctional thinking styles and behavior of maintenance of the problem.
Any decision to propose a psychotropic drug must be taken after an adequate preparatory work aimed at establishing a correct therapeutic alliance. A premature prescription could damage the relationship with the patient. It should in fact be considered that often the organic side effects of these drugs would risk further fueling concerns about one’s health. The administration of drugs must therefore be cautious and in a context that does not fuel the search for non-existent miraculous therapies, where possible always accompanied by psychotherapeutic support .
