Hypochondriac neurosis is a symptom complex that occurs in people with anxious and suspicious character traits and is accompanied by a pronounced and increasing concern about their health. The patient attributes to himself various diseases and pathological processes, which are usually accompanied by somatovegetative manifestations, as well as sometimes anxiety and depression. The diagnosis is established on the basis of a clinical examination (establishment of mental status), collection of complaints and anamnesis. Treatment includes psychotherapeutic measures, symptomatic treatment, physiotherapy, auto-training, etc.
F45.2 Hypochondriac disorder
Hypochondriac neurosis or hypochondria syndrome in neurology is represented by an inadequate attitude of a person to his health. The disease can develop against the background of any somatic pathology or without it, with a gradual tendency to the predominance of psychopathological symptoms.
This kind of neurosis is represented by a condition in which there is an excessive fear for one’s health, a tendency to attribute diseases to oneself that do not exist. Hypochondria accompanies almost all types of neuroses, and therefore is important in the differentiation of neuroses and neurosis-like states. The most susceptible to the disease are children (most often teenagers, over 14 years old) and the elderly. Women suffer from neurosis more often than men. The total proportion of such patients is about 14%.
Biological prerequisites for the development of hypochondriac neurosis are childhood or old age, the consequences of non-rough cerebral lesions (perinatal, early childhood, with limitations of cerebral homeostasis).
The psychological prerequisites should include the accentuation of personality, that is, the emphasis of a person on the grief experienced, stress, the current situation, suspiciousness, and so on. A long-term illness of a loved one, death and other similar stressful situations can lead to the development of fear of the possibility of suffering something similar.
Social factors of the development of the disease are due to the influence of the family (parents); excessive guardianship can become a predisposing factor for the development of hypochondria in a child, and later in an adult. Hereditary factors (genetic) also play an important role in the development of neurosis.
There are true and para-hypochondriac neuroses. The true ones, in turn, are divided into sensogenic and ideogenic.
Paraipochondriac disorders can manifest in any person who has experienced serious stress or long-term exposure to a traumatic factor. Despite all the apparent similarity with neurosis, a person finds the strength to cope with the current situation.
True or “pure” hypochondriacal neuroses are characterized by a condition in which the patient has no desire or desire to cope with the problem himself.
The clinical picture of neurosis can be divided into symptom complexes: hypochondria of parents (excessive fear for the life and health of children), hypochondria of children (fear of children for the health of their parents), induced (for example, under the influence of neighbors in the ward), iatrogenic (caused by the actions of medical personnel).
The general deterioration of the condition and mood is characteristic: dejection, unwillingness to do anything, apathy, followed by aggression and irritability, sleep disorders (insomnia), loss of appetite and others.
Patients are characterized by constant fear (phobia) for their health and the state of the body. Such patients try on every disease and constantly seek medical help. Such actions are intrusive.
There may be some somatic manifestations, such as headache, dizziness, palpitations, shortness of breath, pain in the heart and others. They are perceived by patients as symptoms of severe (and sometimes quite rare) diseases (cancerous tumors, heart attack, tuberculosis, etc.). Patients position their conditions in the form of similar complaints: “breathing stops”, “heart freezes”, “temple is numb”, etc. Sometimes patients insist on surgical intervention (Munchausen syndrome).
The diagnosis is established on the basis of the patient’s history of psychogenic factor (stress), accentuation of personality and neurotic manifestations (relevant complaints and determination of his state of health).
In order to differentiate neurosis from pathologies of organic origin, a tomographic examination (CT or MRI of the brain) may be prescribed.
Electroencephalography (EEG) is also prescribed, revealing the irregularity and instability of the cortical rhythm of waves, atypical severity of alpha waves in the frontal lobes of the cortex, polymorphic slow waves.
Differential diagnosis of hypochondriac neurosis should be carried out with other types of neurosis (depressive neurosis, phobic and hysterical neurosis). It is also necessary to differentiate the disease from manifestations of an organic nature, namely from schizophrenia. With the latter, delusional states are noted, which does not happen with hypochondriac neurosis. Complaints about the state of health in schizophrenia are bizarre.
Psychotherapy is of great importance in the treatment of this type of neurosis. In this matter, the personality of a doctor who is able to listen to the patient, take his side, and sincerely empathize with him is of great importance. The doctor’s tactic is to be extremely attentive and careful. In a conversation with a patient, a neurologist convinces that there is no threat to his life and health, explains the essence of the problem and tries to entice the patient to the opposite side of the disease. Psychotherapeutic influence is exerted on the causal psychogenic factor, based on the more important components of the patient’s life – family, work, friends, love, faith, etc.
Symptomatic treatment consists in normalizing sleep, for this purpose, anxiolytics (benzodiazepines – medazepam, lorazepam, oxazepam) are prescribed. These drugs can be without sedative effect. With vegetative disorders, adrenoblockers work well. Tranquilizers with mild psychotropic activity (beta-blockers, calcium antagonists – nifedipine, verapamil) can be used.
Of the non-drug effects, auto-training and physiotherapy (coniferous salt baths or radon baths, general darsonvalization) are effective.
Prognosis and prevention
Nonspecific prevention of the disease consists in proper and adequate upbringing and attitude to the child, introducing him to a healthy lifestyle and sports. In case of problems of hypochondriacal nature or other anxiety states, timely treatment to an adult or pediatric neurologist, a medical psychologist is necessary. Consultations and supervision of the above-mentioned specialists are also required for those who have experienced severe stress or loss of loved ones.
The prognosis of the pathological process is quite favorable, especially with timely psychological assistance and correction of the mental state.