treatment

Last reviewed 01/2018

If the condition is secondary then the treatment should be directed to the primary condition which is often a depressive disorder.

In primary hypochondriacal neurosis:

• there is evidence concerning the effectiveness of interventions such as cognitive therapy (1,2,3). The protocol used by Visser and Boumman is summarised below (3):

  1. Identification of dysfunctional automatic thoughts, i.e. the catastrophic misinterpretations

  • patients asked to monitor bodily sensations, events or other stimuli that would elicit their automatic catastrophic thoughts
  • patients had then to register the automatic thoughts (e.g., "This headache is the first indication for a brain tumour") and the relating emotions (mostly overconcern and fear)
  • during this stage an individual's basic assumptions or core beliefs were also addressed (e.g., "If I feel something irregular in my body, it must be a sign of a serious disease")
    
    

  2. Verbal challenge of the tenability of the hypochondriacal automatic thoughts and basic assumptions

  • the tenability of the hypochondrial automatic thoughts were challenged using basic questions such as: "What is the evidence pro and contra the disease conviction?"; "Would someone else have the same catastrophic thoughts?"; "What will happen if your automatic thoughts are true?"; "Are there any alternative (non-catastrophic) explanations for these physical symptoms or events?"

  
  3. Formulation of realistic or more functional beliefs

  alternative beliefs had to fit neatly with the eliciting stimuli, and their credibility and emotional effects were discussed and scored

  4. Formulation of behavioural experiments to test the credibility of the automatic vs the alternative cognitions

  outcomes of the experiments were discussed in the following session.

  5. homework assignments, consisting of: (a) self-analyses at home, in which hypochondriacal beliefs were monitored, challenged and replaced by more realistic ones; (b) conducting behavioural experiments in which the cognitions were tested

• pharmacotherapy in primary hypochondriasis:
  • there are case reports and clinical case series suggesting that various agents might be helpful for treatment of primary hypochondriasis including clomipramine, fluvoxamine, fluoxetine, and citalopram (4). However well-controlled replication studies are needed to confirm the positive results observed for the treatment of hypochondriasis (4)

Reference:

1. Clark DM et al. Two psychological treatments for hypochondriasis. British Journal of Psychiatry 1998;173: 218–225.
2. Warwick HM et al. A controlled trial of cognitive-behavioural treatment of hypochondriasis. British Journal of Psychiatry 1996;169:189–195.
3. Visser S, Bouman TK. The treatment of hypochondriasis: exposure plus response prevention vs cognitive therapy. Behaviour Research and Therapy 2001; 39 (4): 423-442.
4. Fallon B. Pharmacotherapy of somatoform disorders.Journal of Psychosomatic Research 2004; 56 (4): 455-460