Is hypochondria ocd

OCD and Health Anxiety: What’s the Difference?

Many people confuse OCD with health anxiety. While health anxiety can resemble OCD, they are not the same thing.

We all may worry about our wellness from time to time — but if constant health anxiety is interfering with your day-to-day life, it might be time to seek help.

While some people’s obsessive-compulsive disorder (OCD) focuses on their health, health anxiety (sometimes called hypochondriasis) is not a form of OCD, and OCD can involve thoughts and anxieties that aren’t related to illness.

If you’re experiencing OCD, health anxiety, or both, effective treatments are available.

In short, no; health anxiety and OCD are two different concepts.

OCD involves having repetitive, upsetting, intrusive thoughts (obsessions) and feeling the need to address those obsessions with rituals (compulsions), which can also be distressing.

Sometimes obsessions and compulsions focus on a “theme.”

Examples of OCD themes include:

harm OCD, which is where you worry that you’ll hurt yourself or others
symmetry or order OCD, where you feel anxious when things are not in order
religious OCD, where you worry about accidentally or intentionally sinning

It’s also possible for your OCD to revolve around fears of illness.

Contamination OCD is a kind of OCD where you have obsessions and compulsions around dirt and germs, often with an underlying fear that you will become sick.

Typical contamination-related compulsions include:

excessive handwashing
excessive cleaning
seeking reassurance from doctors

It’s also possible to have health-related obsessions and compulsions that aren’t focused on contamination. For example, you might feel the need to repeat a mantra to “protect” yourself against illness or sudden death.

Health anxiety is characterized by irrational worries about having serious medical conditions. Someone with health anxiety might imagine symptoms or misinterpret minor symptoms as a sign that they have a serious health issue.

Health anxiety is not categorized as a specific illness in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5).

However, if you experience significant anxiety about your health, you might be classified as having:

illness anxiety disorder, which is when you have no physical symptoms or only mild symptoms
somatic symptom disorder, which is when you have physical symptoms that you perceive as distressing

We may all feel anxious about our health from time to time. It’s common to be concerned about your health and to worry about the possibility of falling ill. During the COVID-19 pandemic, in particular, many people understandably felt particularly worried about their health.

However, health anxiety goes beyond regular levels of concern. Health anxiety becomes an issue when it interferes with your ability to function. For example, it might interfere with your relationships, school or work performance, and other areas of your everyday life.

Sometimes, people with legitimate illnesses have their symptoms dismissed as illness anxiety disorder. When you’re experiencing this, it isn’t easy to tell whether your concerns are justified or whether you’re having irrational anxieties about your health.

There is no litmus test for this, but either way, you deserve compassionate treatment that takes your concerns seriously, even if they aren’t symptomatic of a physical illness. Having health anxiety is not the same as “faking” or exaggerating illness. It’s a condition that should be taken seriously.

What’s the difference between health anxiety and OCD? It’s easy to mistake one for the other.

Both involve what may seem like irrational anxieties, distressing thoughts about health, and taking excessive steps to avoid falling sick or being diagnosed with an illness.

Because the DSM-5 doesn’t categorize health anxiety as a mental illness, it doesn’t specify any symptoms. However, “health anxiety” refers to being irrationally worried about your health — specifically, that you have a medical condition.

Health anxiety can refer to illness anxiety disorder or somatic symptom disorder.

Illness anxiety disorder

The symptoms of illness anxiety disorder include:

being preoccupied with having or acquiring a serious illness for 6 months or longer (although the specific illness you fear might change during that time) despite having no somatic symptoms
repeatedly checking one’s body for signs of illness
repeatedly checking in with physicians or seeking medical care or the opposite: maladaptively avoiding medical appointments
being very anxious about health
being easily alarmed about personal health issues

To be diagnosed with illness anxiety disorder, the healthcare professional should rule out the possibility that your symptoms are caused by depression and other mental disorders.

Somatic symptom disorder

While illness anxiety disorder can revolve around imagined symptoms, somatic symptom disorder is when real discomfort and symptoms cause you significant distress.

The symptoms of somatic symptom disorder include:

experiencing great distress or disruption due to one or more physical symptoms

excessive thoughts related to those symptoms, especially highly anxious thoughts
excessive time and energy spent on health concerns

This disorder can only be diagnosed if at least one symptom is constantly present, although the nature of the symptom can change over time.

OCD

On the other hand, OCD is specifically characterized by obsessions and compulsions.

The symptoms of OCD include:

obsessions, which are intrusive, distressing, persistent thoughts, images, or urges
compulsions, which are specific acts you perform repeatedly to stop the thoughts or soothe your distress

According to the DSM-5 criteria for diagnosing OCD, your obsessions and compulsions must take up at least an hour of your day or significantly affect your ability to function.

In OCD, your obsessions and compulsions might revolve around more than just health. For example, if you also experience obsessions and compulsions about safety from crime or natural disasters, it might suggest that OCD is at play, not just health anxiety.

Regardless of whether you have OCD, illness anxiety disorder, or somatic symptom disorder, it can help to seek professional help. All three issues can be treated, and therapy is the first port of call.

Therapists often use cognitive behavioral therapy (CBT) to treat OCD, illness anxiety disorder, and somatic symptom disorder. A specific kind of CBT called exposure and response prevention (ERP) therapy is particularly effective for treating OCD.

Self-care strategies can be helpful for anyone with a mental health disorder or anyone who’s currently experiencing a great deal of stress and anxiety. This can include:

caring for your basic needs by getting enough quality sleep, eating a nutritious and balanced diet, and exercising
spending time with loved ones
attending a support group, either online or in person
engaging in relaxing hobbies, like meditation and journaling
cutting out unnecessary stressors

In some cases, medication can be prescribed for OCD or health anxiety, although this isn’t always necessary.

Health anxiety is not a form of OCD, but it can look similar. Illness anxiety disorder and somatic symptom disorder, however, have very different diagnosis criteria compared to OCD.

Both health anxiety and OCD are treatable. These conditions can be managed through therapy and self-care strategies.

If you suspect you have OCD or health anxiety — or if you’re just feeling particularly anxious about falling ill — you’re not alone. Help is available.

Not sure where to get help? Take a look at Psych Central’s resources on finding a therapist and choosing one that works for you.

Hypochondriasis and its relationship to obsessive-compulsive disorder

Review

. 2000 Sep;23(3):605-16.

doi: 10.1016/s0193-953x(05)70183-0.

B A Fallon¹, A I Qureshi, G Laje, B Klein

Affiliations

Affiliation

¹ Department of Psychiatry, Columbia University, New York, New York, USA.

PMID: 10986730
DOI: 10.1016/s0193-953x(05)70183-0

Review

B A Fallon et al. Psychiatr Clin North Am. 2000 Sep.

. 2000 Sep;23(3):605-16.

doi: 10.1016/s0193-953x(05)70183-0.

Authors

B A Fallon¹, A I Qureshi, G Laje, B Klein

Affiliation

¹ Department of Psychiatry, Columbia University, New York, New York, USA.

PMID: 10986730
DOI: 10. 1016/s0193-953x(05)70183-0

Abstract

Hypochondriasis is a heterogeneous disorder. This was well demonstrated in the study by Kellner et al, which showed that patients with high levels of disease fear tended to be more anxious or phobic, whereas patients with high levels of disease conviction tended to have more and more severe somatic symptoms. Little comorbidity exists to support the statement that hypochondriasis is an obsessive-compulsive spectrum disorder. Although patients exist whose hypochondriac concerns are identical in quality to the intrusive thoughts of patients with OCD, as a group, patients with hypochondriasis do not share a comorbidity profile comparable with that of patients with OCD. The data support a closer relationship between hypochondriasis and somatization disorder than between hypochondriasis and OCD. The family history data is limited by the lack of adequate studies. Using comparable methods of the family history approach, Black's study reported a higher frequency of GAD but not OCD among the relatives of OCD patients--a finding similar to what Noyes found among the relatives of hypochondriac patients; however, using the direct interview method, somatization disorder was the only statistically more common disorder, among relatives of female hypochondriac patients. Therefore, although the parallel in overlap with GAD is suggestive of a commonality between OCD, GAD, and hypochondriasis, the finding of a greater frequency of somatization disorder leans against the hypothesis that hypochondriasis is best considered an OCD spectrum disorder. The pharmacologic treatment data are the one type of biologic evidence that supports a bridge to OCD. The pharmacologic studies suggest that for patients with general hypochondriasis, TCAs are not effective and that higher dosages and longer trials of the SRIs are needed. These pharmacologic observations are comparable with the ones made for patients with OCD but dissimilar to the observations made for depression. The benefit of imipramine among patients with illness phobia must be assessed in placebo-controlled trials among illness phobics and among hypochondriacs. Even more valuable would be a direct comparison of a TCA (e.g., imipramine or desipramine) and a selective SRI (e.g., fluoxetine) to determine whether the response to selective SRIs is greater. Although the pharmacologic data are compelling in supporting the hypothesis that hypochondriasis is an obsessive-compulsive spectrum disorder, the comorbidity data are equally compelling in dispelling that hypothesis. Perhaps future studies clarify the subtypes of hypochondriasis, be they "phobic, obsessive, and depressive," "chronic and episodic," "early onset versus late onset" or some other as yet undetermined subtype. Such clarification may be aided by better instruments to assess the obsessive-compulsive and hypochondria spectrums within individuals and families and by neuropsychological or pharmacologic challenge and neuroimaging studies.

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Obsessive-compulsive disorder

A prominent role among mental illnesses is played by syndromes (complexes of symptoms), united in the group of obsessive-compulsive disorder (OCD), which received its name from the Latin terms obsessio and compulsio.

Obsession (lat. obsessio - taxation, siege, blockade).

Compulsions (lat. compello - I force). 1. Obsessive drives, a kind of obsessive phenomena (obsessions). Characterized by irresistible attraction that arises contrary to the mind, will, feelings. Often they are unacceptable to the patient, contrary to his moral and ethical properties. Unlike impulsive drives, compulsions are not realized. These drives are recognized by the patient as wrong and painfully experienced by them, especially since their very appearance, due to its incomprehensibility, often gives rise to a feeling of fear in the patient 2. The term compulsions is also used in a broader sense to refer to any obsessions in the motor sphere, including obsessive rituals. nine0003

In domestic psychiatry, obsessive states were understood as psychopathological phenomena, characterized by the fact that phenomena of a certain content repeatedly appear in the mind of the patient, accompanied by a painful feeling of coercion [Zinoviev PM, 193I]. For N.s. characteristic involuntary, even against the will, the emergence of obsessions with clear consciousness. Although the obsessions are alien, extraneous in relation to the patient's psyche, the patient is not able to get rid of them. They are closely related to the emotional sphere, accompanied by depressive reactions, anxiety. Being symptomatic, according to S.L. Sukhanov [1912], "parasitic", they do not affect the course of intellectual activity in general, remain alien to thinking, do not lead to a decrease in its level, although they worsen the efficiency and productivity of the patient's mental activity. Throughout the course of the disease, a critical attitude is maintained towards obsessions. N.s. conditionally divided into obsessions in the intellectual-affective (phobia) and motor (compulsions) spheres, but most often several of their types are combined in the structure of the disease of obsessions. The isolation of obsessions that are abstract, affectively indifferent, indifferent in their content, for example, arrhythmomania, is rarely justified; An analysis of the psychogenesis of a neurosis often makes it possible to see a pronounced affective (depressive) background at the basis of the obsessive account. Along with elementary obsessions, the connection of which with psychogeny is obvious, there are “cryptogenic” ones, when the cause of painful experiences is hidden [Svyadoshch L.M., 1959]. N.s. are observed mainly in individuals with a psychasthenic character. This is where apprehensions are especially characteristic. In addition, N.S. occur within the framework of neurosis-like states with sluggish schizophrenia, endogenous depressions, epilepsy, the consequences of a traumatic brain injury, somatic diseases, mainly hypochondria-phobic or nosophobic syndrome. Some researchers distinguish the so-called. "Neurosis of obsessive states", which is characterized by the predominance of obsessive states in the clinical picture - memories that reproduce a psychogenic traumatic situation, thoughts, fears, actions. In genesis play a role: mental trauma; conditioned reflex stimuli that have become pathogenic due to their coincidence with others that previously caused a feeling of fear; situations that have become psychogenic due to the confrontation of opposing tendencies [Svyadoshch A. M., 1982]. It should be noted that these same authors emphasize that N.s.c. occurs with various character traits, but most often in psychasthenic personalities.

Currently, almost all obsessive-compulsive disorders are united in the International Classification of Diseases under the concept of "obsessive-compulsive disorder".

OKR concepts have undergone a fundamental reassessment over the past 15 years. During this time, the clinical and epidemiological significance of OCD has been completely revised. If it was previously thought that this is a rare condition observed in a small number of people, now it is known that OCD is common and causes a high percentage of morbidity, which requires the urgent attention of psychiatrists around the world. Parallel to this, our understanding of the etiology of OCD has broadened: the vaguely formulated psychoanalytic definition of the past two decades has been replaced by a neurochemical paradigm that explores the neurotransmitter disorders that underlie OCD. And most importantly, pharmacological interventions specifically targeting serotonergic neurotransmission have revolutionized the prospects for recovery for millions of OCD patients worldwide. nine0003

The discovery that intense serotonin reuptake inhibition (SSRI) was the key to effective treatment for OCD was the first step in a revolution and spurred clinical research that showed the efficacy of such selective inhibitors.

As described in ICD-10, the main features of OCD are repetitive intrusive (obsessive) thoughts and compulsive actions (rituals).

In a broad sense, the core of OCD is the syndrome of obsession, which is a condition with a predominance in the clinical picture of feelings, thoughts, fears, memories that arise in addition to the desire of patients, but with awareness of their pain and a critical attitude towards them. Despite the understanding of the unnaturalness, illogicality of obsessions and states, patients are powerless in their attempts to overcome them. Obsessional impulses or ideas are recognized as alien to the personality, but as if coming from within. Obsessions can be the performance of rituals designed to alleviate anxiety, such as washing hands to combat "pollution" and to prevent "infection". Attempts to drive away unwelcome thoughts or urges can lead to severe internal struggle, accompanied by intense anxiety. nine0003

Obsessions in the ICD-10 are included in the group of neurotic disorders.

The prevalence of OCD in the population is quite high. According to some data, it is determined by an indicator of 1.5% (meaning "fresh" cases of diseases) or 2-3%, if episodes of exacerbations observed throughout life are taken into account. Those suffering from obsessive-compulsive disorder make up 1% of all patients receiving treatment in psychiatric institutions. It is believed that men and women are affected approximately equally. nine0003

CLINICAL PICTURE

The problem of obsessive-compulsive disorders attracted the attention of clinicians already at the beginning of the 17th century. They were first described by Platter in 1617. In 1621 E. Barton described an obsessive fear of death. Mentions of obsessions are found in the writings of F. Pinel (1829). I. Balinsky proposed the term "obsessive ideas", which took root in Russian psychiatric literature. In 1871, Westphal coined the term "agoraphobia" to refer to the fear of being in public places. M. Legrand de Sol [1875], analyzing the features of the dynamics of OCD in the form of "insanity of doubt with delusions of touch, points to a gradually becoming more complicated clinical picture - obsessive doubts are replaced by ridiculous fears of" touch "to surrounding objects, motor rituals join, the fulfillment of which is subject to the whole life sick. However, only at the turn of the XIX-XX centuries. researchers were able to more or less clearly describe the clinical picture and give syndromic characteristics of obsessive-compulsive disorders. The onset of the disease usually occurs in adolescence and adolescence. The maximum of clinically defined manifestations of obsessive-compulsive disorder is observed in the age range of 10-25 years. nine0003

Main clinical manifestations of OCD:

Obsessional thoughts - painful, arising against the will, but recognized by the patient as their own, ideas, beliefs, images, which in a stereotyped form forcibly invade the patient's consciousness and which he tries to resist in some way. It is this combination of an inner sense of compulsive urge and efforts to resist it that characterizes obsessional symptoms, but of the two, the degree of effort exerted is the more variable. Obsessive thoughts may take the form of single words, phrases, or lines of poetry; they are usually unpleasant to the patient and may be obscene, blasphemous, or even shocking. nine0003

Obsessional imagery is vivid scenes, often violent or disgusting, including, for example, sexual perversion.

Obsessional impulses are urges to do things that are usually destructive, dangerous or shameful; for example, jumping into the road in front of a moving car, injuring a child, or shouting obscene words while in society.

Obsessional rituals include both mental activities (eg, counting repeatedly in a particular way, or repeating certain words) and repetitive but meaningless acts (eg, washing hands twenty or more times a day). Some of them have an understandable connection with the obsessive thoughts that preceded them, for example, repeated washing of hands - with thoughts of infection. Other rituals (for example, regularly laying out clothes in some complex system before putting them on) do not have such a connection. Some patients feel an irresistible urge to repeat such actions a certain number of times; if that fails, they are forced to start all over again. Patients are invariably aware that their rituals are illogical and usually try to hide them. Some fear that such symptoms are a sign of the onset of insanity. Both obsessive thoughts and rituals inevitably lead to problems in daily activities. nine0003

Obsessive rumination (“mental chewing gum”) is an internal debate in which the arguments for and against even the simplest everyday actions are endlessly revised. Some obsessive doubts relate to actions that may have been incorrectly performed or not completed, such as turning off the gas stove faucet or locking the door; others concern actions that could harm other people (for example, the possibility of driving past a cyclist in a car, knocking him down). Sometimes doubts are associated with a possible violation of religious prescriptions and rituals - “remorse of conscience”. nine0003

Compulsive actions - repetitive stereotypical actions, sometimes acquiring the character of protective rituals. The latter are aimed at preventing any objectively unlikely events that are dangerous for the patient or his relatives.

In addition to the above, in a number of obsessive-compulsive disorders, a number of well-defined symptom complexes stand out, and among them are obsessive doubts, contrasting obsessions, obsessive fears - phobias (from the Greek. phobos).

nine0002 Obsessive thoughts and compulsive rituals may intensify in certain situations; for example, obsessive thoughts about harming other people often become more persistent in the kitchen or some other place where knives are kept.

Since patients often avoid such situations, there may be a superficial resemblance to the characteristic avoidance pattern found in phobic anxiety disorder. Anxiety is an important component of obsessive-compulsive disorders. Some rituals reduce anxiety, while after others it increases. Obsessions often develop as part of depression. In some patients, this appears to be a psychologically understandable reaction to obsessive-compulsive symptoms, but in other patients, recurrent episodes of depressive mood occur independently. nine0003

Obsessions (obsessions) are divided into figurative or sensual, accompanied by the development of affect (often painful) and obsessions of affectively neutral content.

Sensual obsessions include obsessive doubts, memories, ideas, drives, actions, fears, an obsessive feeling of antipathy, an obsessive fear of habitual actions.

Obsessive doubts - intrusively arising contrary to logic and reason, uncertainty about the correctness of committed and committed actions. The content of doubts is different: obsessive everyday fears (whether the door is locked, whether windows or water taps are closed tightly enough, whether gas and electricity are turned off), doubts related to official activities (whether this or that document is written correctly, whether the addresses on business papers are mixed up , whether inaccurate figures are indicated, whether orders are correctly formulated or executed), etc. Despite repeated verification of the committed action, doubts, as a rule, do not disappear, causing psychological discomfort in the person suffering from this kind of obsession. nine0003

Obsessive memories include persistent, irresistible painful memories of any sad, unpleasant or shameful events for the patient, accompanied by a sense of shame, remorse. They dominate the mind of the patient, despite the efforts and efforts not to think about them.

Obsessive impulses - urges to commit one or another tough or extremely dangerous action, accompanied by a feeling of horror, fear, confusion with the inability to get rid of it. The patient is seized, for example, by the desire to throw himself under a passing train or push a loved one under it, to kill his wife or child in an extremely cruel way. At the same time, patients are painfully afraid that this or that action will be implemented. nine0003

Manifestations of obsessive ideas can be different. In some cases, this is a vivid "vision" of the results of obsessive drives, when patients imagine the result of a cruel act committed. In other cases, obsessive ideas, often referred to as mastering, appear in the form of implausible, sometimes absurd situations that patients take for real. An example of obsessive ideas is the patient's conviction that the buried relative was alive, and the patient painfully imagines and experiences the suffering of the deceased in the grave. At the height of obsessive ideas, the consciousness of their absurdity, implausibility disappears and, on the contrary, confidence in their reality appears. As a result, obsessions acquire the character of overvalued formations (dominant ideas that do not correspond to their true meaning), and sometimes delusions. nine0003

An obsessive feeling of antipathy (as well as obsessive blasphemous and blasphemous thoughts) - unjustified, driven away by the patient from himself antipathy towards a certain, often close person, cynical, unworthy thoughts and ideas in relation to respected people, in religious persons - in relation to saints or ministers churches.

Obsessive acts are acts done against the wishes of the sick, despite efforts made to restrain them. Some of the obsessive actions burden the patients until they are realized, others are not noticed by the patients themselves. Obsessive actions are painful for patients, especially in those cases when they become the object of attention of others. nine0003

Obsessive fears, or phobias, include an obsessive and senseless fear of heights, large streets, open or confined spaces, large crowds of people, the fear of sudden death, the fear of falling ill with one or another incurable disease. Some patients may develop a wide variety of phobias, sometimes acquiring the character of fear of everything (panphobia). And finally, an obsessive fear of the emergence of fears (phobophobia) is possible.

Hypochondriacal phobias (nosophobia) - an obsessive fear of some serious illness. Most often, cardio-, stroke-, syphilo- and AIDS phobias are observed, as well as the fear of the development of malignant tumors. At the peak of anxiety, patients sometimes lose their critical attitude to their condition - they turn to doctors of the appropriate profile, require examination and treatment. The implementation of hypochondriacal phobias occurs both in connection with psycho- and somatogenic (general non-mental illnesses) provocations, and spontaneously. As a rule, hypochondriacal neurosis develops as a result, accompanied by frequent visits to doctors and unreasonable medication. nine0003

Specific (isolated) phobias - obsessive fears limited to a strictly defined situation - fear of heights, nausea, thunderstorms, pets, treatment at the dentist, etc. Since contact with situations that cause fear is accompanied by intense anxiety, the patients tend to avoid them.

Obsessive fears are often accompanied by the development of rituals - actions that have the meaning of "magic" spells that are performed, despite the critical attitude of the patient to obsession, in order to protect against one or another imaginary misfortune: before starting any important business, the patient must perform some that specific action to eliminate the possibility of failure. Rituals can, for example, be expressed in snapping fingers, playing a melody to the patient or repeating certain phrases, etc. In these cases, even relatives are not aware of the existence of such disorders. Rituals, combined with obsessions, are a fairly stable system that usually exists for many years and even decades. nine0003

Obsessions of affectively neutral content - obsessive sophistication, obsessive counting, recalling neutral events, terms, formulations, etc. Despite their neutral content, they burden the patient, interfere with his intellectual activity.

Contrasting obsessions ("aggressive obsessions") - blasphemous, blasphemous thoughts, fear of harming oneself and others. Psychopathological formations of this group refer mainly to figurative obsessions with pronounced affective saturation and ideas that take possession of the consciousness of patients. They are distinguished by a sense of alienation, the absolute lack of motivation of the content, as well as a close combination with obsessive drives and actions. Patients with contrasting obsessions and complain of an irresistible desire to add endings to the replicas they have just heard, giving an unpleasant or threatening meaning to what has been said, to repeat after those around them, but with a touch of irony or malice, phrases of religious content, to shout out cynical words that contradict their own attitudes and generally accepted morality. , they may experience fear of losing control of themselves and possibly committing dangerous or ridiculous actions, injuring themselves or their loved ones. In the latter cases, obsessions are often combined with object phobias (fear of sharp objects - knives, forks, axes, etc. ). The contrasting group also partially includes obsessions of sexual content (obsessions of the type of forbidden ideas about perverted sexual acts, the objects of which are children, representatives of the same sex, animals). nine0003

Obsessions of pollution (mysophobia). This group of obsessions includes both the fear of pollution (earth, dust, urine, feces and other impurities), as well as the fear of penetration into the body of harmful and toxic substances (cement, fertilizers, toxic waste), small objects (glass fragments, needles, specific types of dust), microorganisms. In some cases, the fear of contamination can be limited, remain at the preclinical level for many years, manifesting itself only in some features of personal hygiene (frequent change of linen, repeated washing of hands) or in housekeeping (thorough handling of food, daily washing of floors). , "taboo" on pets). This kind of monophobia does not significantly affect the quality of life and is evaluated by others as habits (exaggerated cleanliness, excessive disgust). Clinically manifested variants of mysophobia belong to the group of severe obsessions. In these cases, gradually becoming more complex protective rituals come to the fore: avoiding sources of pollution and touching "unclean" objects, processing things that could get dirty, a certain sequence in the use of detergents and towels, which allows you to maintain "sterility" in the bathroom. Stay outside the apartment is also furnished with a series of protective measures: going out into the street in special clothing that covers the body as much as possible, special processing of wearable items upon returning home. In the later stages of the disease, patients, avoiding pollution, not only do not go out, but do not even leave their own room. In order to avoid contacts and contacts that are dangerous in terms of contamination, patients do not allow even their closest relatives to come near them. Mysophobia is also related to the fear of contracting a disease, which does not belong to the categories of hypochondriacal phobias, since it is not determined by fears that a person suffering from OCD has a particular disease. In the foreground is the fear of a threat from the outside: the fear of pathogenic bacteria entering the body. Hence the development of appropriate protective actions. nine0003

A special place in the series of obsessions is occupied by obsessive actions in the form of isolated, monosymptomatic movement disorders. Among them, especially in childhood, tics predominate, which, unlike organically conditioned involuntary movements, are much more complex motor acts that have lost their original meaning. Tics sometimes give the impression of exaggerated physiological movements. This is a kind of caricature of certain motor acts, natural gestures. Patients suffering from tics can shake their heads (as if checking whether the hat fits well), make hand movements (as if discarding interfering hair), blink their eyes (as if getting rid of a mote). Along with obsessive tics, pathological habitual actions (lip biting, gnashing of teeth, spitting, etc.) are often observed, which differ from obsessive actions proper in the absence of a subjectively painful sense of persistence and experience them as alien, painful. Neurotic states characterized only by obsessive tics usually have a favorable prognosis. Appearing most often in preschool and primary school age, tics usually subside by the end of puberty. However, such disorders can also be more persistent, persist for many years and only partially change in manifestations. nine0003

The course of obsessive-compulsive disorder.

Unfortunately, chronization must be indicated as the most characteristic trend in the OCD dynamics. Cases of episodic manifestations of the disease and complete recovery are relatively rare. However, in many patients, especially with the development and preservation of one type of manifestation (agoraphobia, obsessive counting, ritual handwashing, etc.), a long-term stabilization of the condition is possible. In these cases, there is a gradual (usually in the second half of life) mitigation of psychopathological symptoms and social readaptation. For example, patients who experienced fear of traveling on certain types of transport, or public speaking, cease to feel flawed and work along with healthy people. In mild forms of OCD, the disease usually proceeds favorably (on an outpatient basis). The reverse development of symptoms occurs after 1 year - 5 years from the moment of manifestation. nine0003

More severe and complex OCDs such as phobias of infection, pollution, sharp objects, contrasting performances, multiple rituals, on the other hand, may become persistent, resistant to treatment, or show a tendency to recur with disorders that persist despite active therapy. Further negative dynamics of these conditions indicates a gradual complication of the clinical picture of the disease as a whole.

DIFFERENTIAL DIAGNOSIS

It is important to distinguish OCD from other disorders that involve compulsions and rituals. In some cases, obsessive-compulsive disorder must be differentiated from schizophrenia, especially when the obsessive thoughts are unusual in content (eg, mixed sexual and blasphemous themes) or the rituals are exceptionally eccentric. The development of a sluggish schizophrenic process cannot be ruled out with the growth of ritual formations, their persistence, the emergence of antagonistic tendencies in mental activity (inconsistency of thinking and actions), and the uniformity of emotional manifestations. Prolonged obsessional states of a complex structure must be distinguished from the manifestations of paroxysmal schizophrenia. Unlike neurotic obsessive states, they are usually accompanied by a sharply increasing anxiety, a significant expansion and systematization of the circle of obsessive associations, which acquire the character of obsessions of "special significance": previously indifferent objects, events, random remarks of others remind patients of the content of phobias, offensive thoughts and thereby acquire in their view a special, menacing significance. In such cases, it is necessary to consult a psychiatrist in order to exclude schizophrenia. It can also be difficult to differentiate between OCD and conditions with a predominance of generalized disorders, known as Gilles de la Tourette's syndrome. Tics in such cases are localized in the face, neck, upper and lower extremities and are accompanied by grimaces, opening the mouth, sticking out the tongue, and intense gesticulation. In these cases, this syndrome can be excluded by the coarseness of movement disorders characteristic of it and more complex in structure and more severe mental disorders. nine0003

Genetic factors

Speaking about hereditary predisposition to OCD, it should be noted that obsessive-compulsive disorders are found in approximately 5-7% of parents of patients with such disorders. Although this figure is low, it is higher than in the general population. While the evidence for a hereditary predisposition to OCD is still uncertain, psychasthenic personality traits can be largely explained by genetic factors.

FORECAST

Approximately two-thirds of OCD patients improve within a year, more often by the end of this period. If the disease lasts more than a year, fluctuations are observed during its course - periods of exacerbations are interspersed with periods of improvement in health, lasting from several months to several years. The prognosis is worse if we are talking about a psychasthenic personality with severe symptoms of the disease, or if there are continuous stressful events in the patient's life. Severe cases can be extremely persistent; for example, a study of hospitalized patients with OCD found that three-quarters of them remained symptom-free 13 to 20 years later. nine0003

TREATMENT: BASIC METHODS AND APPROACHES

Despite the fact that OCD is a complex group of symptom complexes, the principles of treatment for them are the same. The most reliable and effective method of treating OCD is considered to be drug therapy, during which a strictly individual approach to each patient should be manifested, taking into account the characteristics of the manifestation of OCD, age, gender, and the presence of other diseases. In this regard, we must warn patients and their relatives against self-treatment. If any disorders similar to mental ones appear, it is necessary, first of all, to contact the specialists of the psycho-neurological dispensary at the place of residence or other psychiatric medical institutions to establish the correct diagnosis and prescribe competent adequate treatment. At the same time, it should be remembered that at present a visit to a psychiatrist does not threaten with any negative consequences - the infamous "accounting" was canceled more than 10 years ago and replaced by the concepts of consultative and medical care and dispensary observation. nine0003

When treating, it must be borne in mind that obsessive-compulsive disorders often have a fluctuating course with long periods of remission (improvement). The apparent suffering of the patient often seems to call for vigorous effective treatment, but the natural course of the condition must be kept in mind in order to avoid the typical error of over-intensive therapy. It is also important to consider that OCD is often accompanied by depression, the effective treatment of which often leads to an alleviation of obsessional symptoms. nine0003

The treatment of OCD begins with an explanation of the symptoms to the patient and, if necessary, with reassurance that they are the initial manifestation of insanity (a common concern for patients with obsessions). Those suffering from certain obsessions often involve other family members in their rituals, so relatives need to treat the patient firmly, but sympathetically, mitigating the symptoms as much as possible, and not aggravating it by excessive indulgence in the sick fantasies of patients. nine0003

Drug therapy

The following therapeutic approaches exist for the currently identified types of OCD. Of the pharmacological drugs for OCD, serotonergic antidepressants, anxiolytics (mainly benzodiazepine), beta-blockers (to stop autonomic manifestations), MAO inhibitors (reversible) and triazole benzodiazepines (alprazolam) are most often used. Anxiolytic drugs provide some short-term relief of symptoms, but should not be given for more than a few weeks at a time. If anxiolytic treatment is required for more than one to two months, small doses of tricyclic antidepressants or small antipsychotics sometimes help. The main link in the treatment regimen for OCD, overlapping with negative symptoms or ritualized obsessions, are atypical antipsychotics - risperidone, olanzapine, quetiapine, in combination with either SSRI antidepressants or other antidepressants - moclobemide, tianeptine, or with high-potency benzodiazepine derivatives ( alprazolam, clonazepam, bromazepam). nine0003

Any comorbid depressive disorder is treated with antidepressants at an adequate dose. There is evidence that one of the tricyclic antidepressants, clomipramine, has a specific effect on obsessive symptoms, but the results of a controlled clinical trial showed that the effect of this drug is insignificant and occurs only in patients with distinct depressive symptoms.

In cases where obsessive-phobic symptoms are observed within the framework of schizophrenia, intensive psychopharmacotherapy with proportional use of high doses of serotonergic antidepressants (fluoxetine, fluvoxamine, sertraline, paroxetine, citalopram) has the greatest effect. In some cases, it is advisable to connect traditional antipsychotics (small doses of haloperidol, trifluoperazine, fluanxol) and parenteral administration of benzodiazepine derivatives. nine0003

Psychotherapy

Behavioral psychotherapy

One of the main tasks of the specialist in the treatment of OCD is to establish fruitful cooperation with the patient. It is necessary to instill in the patient faith in the possibility of recovery, to overcome his prejudice against the "harm" caused by psychotropic drugs, to convey his conviction in the effectiveness of treatment, subject to the systematic observance of the prescribed prescriptions. The patient's faith in the possibility of healing must be supported in every possible way by the relatives of the OCD sufferer. If the patient has rituals, it must be remembered that improvement usually occurs when using a combination of the method of preventing a reaction with placing the patient in conditions that aggravate these rituals. Significant but not complete improvement can be expected in about two-thirds of patients with moderately heavy rituals. If, as a result of such treatment, the severity of rituals decreases, then, as a rule, the accompanying obsessive thoughts also recede. In panphobia, predominantly behavioral techniques are used to reduce sensitivity to phobic stimuli, supplemented by elements of emotionally supportive psychotherapy. In cases where ritualized phobias predominate, along with desensitization, behavioral training is actively used to help overcome avoidant behavior. Behavioral therapy is significantly less effective for obsessive thoughts that are not accompanied by rituals. Thought-stopping has been used by some experts for many years, but its specific effect has not been convincingly proven. nine0003

Social rehabilitation

We have already noted that obsessive-compulsive disorder has a fluctuating (fluctuating) course and over time the patient's condition may improve regardless of which particular methods of treatment were used. Until recovery, patients can benefit from supportive conversations that provide continued hope for recovery. Psychotherapy in the complex of treatment and rehabilitation measures for patients with OCD is aimed at both correcting avoidant behavior and reducing sensitivity to phobic situations (behavioral therapy), as well as family psychotherapy to correct behavioral disorders and improve family relationships. If marital problems aggravate the symptoms, joint interviews with the spouse are indicated. Patients with panphobia (at the stage of the active course of the disease), due to the intensity and pathological persistence of symptoms, need both medical and social and labor rehabilitation. In this regard, it is important to determine adequate terms of treatment - long-term (at least 2 months) therapy in a hospital with subsequent continuation of the course on an outpatient basis, as well as taking measures to restore social ties, professional skills, family relationships. Social rehabilitation is a set of programs for teaching OCD patients how to behave rationally both at home and in a hospital setting. Rehabilitation is aimed at teaching social skills to properly interact with other people, vocational training, as well as skills necessary in everyday life. Psychotherapy helps patients, especially those who experience a sense of their own inferiority, treat themselves better and correctly, master ways to solve everyday problems, and gain confidence in their strength. nine0003

All of these methods, when used judiciously, can increase the effectiveness of drug therapy, but are not capable of completely replacing drugs. It should be noted that explanatory psychotherapy does not always help, and some patients with OCD even worsen because such procedures encourage them to think painfully and unproductively about the subjects discussed in the course of treatment. Unfortunately, science still does not know how to cure mental illness once and for all. OCD often has a tendency to recur, which requires long-term prophylactic medication. nine0003

Hypochondriacal disorder - symptoms, causes, stages

There is a common stereotype that people with hypochondria intentionally pretend and fake the disease to achieve personal goals. For example, release from work or attracting everyone's attention.

However, hypochondriacal personality disorder is recognized by modern medicine as a mental illness related to somatization disorders. The fear of getting sick or dying from an incurable disease in hypochondriacs is the most real and painful, and often complicates their daily life. nine0003

Disease definition

Hypochondriacal disorder (ICD-10 code F 45.2) is a mental health condition in which the patient firmly believes that he has (or will soon develop) a serious and life-threatening illness. At the same time, the symptoms of a "terrible" disease are actually absent or mildly expressed. However, the feeling of fear and concern for one's health persists even when the examinations performed show that the person is absolutely healthy. nine0003

Somatoform hypochondriacal disorder refers to psychogenic diseases, which are based on physical symptoms that resemble any bodily disease. However, no specific disorders of organs and systems can be detected.

Sometimes hypochondriacs can develop senesto-hypochondriac syndrome. It represents pathological sensations (tingling, bursting, pressure, etc.) in various parts of the body, which are taken by the patient as symptoms of a terrible disease. nine0003

Senesto-hypochondriac disorder is often accompanied by vegetative crises (panic attacks), during which bodily sensations intensify. There is tachycardia (rapid pulse), extrasystoles (extraordinary heart contractions), tingling in the chest, dizziness and many other "bodily" manifestations. At these moments, the hypochondriacal ideas of the patient reach the level of dominant and overvalued. And negative thoughts and attitudes are even more fixed in the head.

Signs of hypochondria

The symptoms of hypochondriacal disorder are primarily centered around the perceived possibility of having a serious illness (in the absence of serious physical complaints) or the fear of getting sick in the future.

Common symptoms of anxiety-hypochondriacal disorder include:

Avoiding public places and contact with people for fear of infection.
Constant search on the Internet for information about the symptoms of various diseases and finding them in oneself. nine0168
Reading professional medical literature.
A distinct fear that various physical sensations in the body (such as tingling or palpitations) are caused by a terminal illness. Most often, patients are worried that they have cancer or HIV infection.
Frequent conversations with other people (friends, colleagues, family members) about health problems, complications of diseases.
Constant feeling of nervousness and obsession with frequent health checks. nine0168
Doubts about the competence of the attending physician and the results of the tests.
Increased awareness of minor bodily symptoms of illness, such as headache, joint pain, or sweating.
Making regular appointments with your doctor to check for “mild” symptoms of disease (or normal bodily functions).
Excessive spending on unnecessary medical tests and specialist consultations.
Carrying out various diagnostic and instrumental studies without indications and appointment of the attending physician. nine0168
Significant emotional stress due to the perceived possibility of getting sick.
Increased anxiety, nervousness, restlessness.

Sometimes patients may present with somatic manifestations of the disorder:

Rapid heartbeat, high blood pressure.
Tingling in the chest, difficult breathing.
Increased sweating.
Headache, dizziness. nine0168
Nausea and pain in the gastrointestinal tract.

However, all these symptoms are not associated with the presence of any serious physical illness, but are the result of the patient's worries about his health, increased anxiety.

Feelings of anxiety may decrease for a short time after seeing a doctor and undergoing examinations, but they return very quickly.

Causes of hypochondriacal disorder

The exact causes of hypochondriacal disorder are unknown. It is believed that a number of factors may play a role in the development of this condition:

psychosocial factors. Childhood trauma, episodes of abuse or violence.
Presence of other psychiatric disorders. For example, anxiety, panic, obsessive-compulsive or depressive disorder.
A certain type of personality. Easily excitable, quickly fatigued people with an anxious and suspicious personality type and a melancholic temperament are prone to hypochondriacal disorder. They often "listen" to themselves and their feelings, have increased sensitivity and nervous excitability. nine0168
The presence of a serious physical illness or a life-threatening condition in the past, which provoked a subconscious fear of getting sick with it again.
The influence of society. Close people diagnosed with hypochondria can “pass on” their condition to other family members, including children. This is facilitated by daily discussions of diseases and symptoms.

The pathogenesis of hypochondriacal disorder is not fully understood.

During the research, scientists found that patients with hypochondria suffer from subcortical structures of the brain (limbic system, hypothalamus, pituitary gland), as well as mesolimbic and mesocortical systems of the brain. nine0003

In addition, the appearance of this disease is associated with a change in the synaptic activity of brain neurotransmitters (serotonin, dopamine, norepinephrine, adrenaline).

Some psychiatrists also believe that hypochondria arises as a result of the perception by the central nervous system of certain signals from the internal organs, which are normally suppressed and do not "reach" the person.

From the point of view of psychology, hypochondriacal disorder is considered as one of the mechanisms of secondary neurotic defense of the individual. Its meaning lies in the fact that the search for recognition of the disease and treatment alleviates the primary pointless fear and anxiety caused by unconscious internal conflict. With the help of this disease, people subconsciously strive to get more attention and "return" to childhood. nine0003

Classification of hypochondria

According to the International Classification of Diseases of the 10th revision, it is customary to distinguish several types of hypochondriacal disorder:

Hypochondria (hypochondriac syndrome). It manifests itself in the form of an excessive concern of a person with his own health and fears about diseases. Neurotic symptoms are mild, there are no delusional ideas of the disease.
Hypochondriacal neurosis. The disease is accompanied by more pronounced anxiety and obsessive thoughts, fears, increased sensitivity and fatigue. However, this type of hypochondriacal disorder, like all neuroses, is exclusively functional. The personality of a person is preserved: there is criticism, there is no violation of thinking and perception. The patient is fully aware of his problem. <
Nosophobia. Hypochondriacal phobia with signs of obsessive thoughts, images. Nosophobia differs significantly from hypochondria in that it involves the fear of developing a particular disease (for example, heart disease). May be accompanied by panic attacks, agoraphobia.
Body dysmorphic disorder (dysmorphophobia). It is a mental disorder in which a person is overly concerned about a minor defect or feature of their body, and suggests the presence of a severe progressive disease associated with it. At the same time, persistent false beliefs (crazy ideas) can be formed. For example, about the wrong structure or deformation of any parts of the body. nine0168

Complications of hypochondria

As it develops, hypochondriacal disorder leads to various complications.

Restrictive behavior is formed, avoiding potentially dangerous places, narrowing the circle of communication only to family members and people who share the thoughts and fears of a hypochondriac. There is a social disadaptation of a person. Fear for one's health can prevent the patient from leaving the house, meeting friends, going to work.

It often comes to the point that the patient, against the background of stress, has panic attacks, phobic disorders (most often agoraphobia).

To alleviate their condition and relieve tension, a hypochondriac may begin to abuse alcohol or drugs.

In severe cases, other mental disorders join:

hypochondriacal depressive disorder or depression;
bipolar disorder;
obsessive-compulsive disorder; nine0168
phobias;
panic disorder.

Hypochondria are characterized by a tendency to a protracted course of the disease and resistance to ongoing therapy. In particularly sensitive individuals, hypochondriacal states can last a lifetime.

If you begin to notice that your loved one is overly concerned about their health and suspects that they have a serious illness (despite the fact that medical research suggests otherwise), they may be suffering from a psychogenic hypochondriacal disorder. nine0003

In order to speak with confidence about this, it is important, first of all, to exclude the presence of physical ailments, as well as to visit a mental health specialist.

The diagnosis and treatment of hypochondria is done by a psychiatrist. While the disease is not very advanced, it is possible to significantly alleviate the patient's condition and avoid complications through timely treatment.

Diagnosis of hypochondria

Most often, a person suffering from hypochondria does not go to a psychiatrist about his anxiety disorder, because he simply does not know about it. nine0003

In search of a fictitious physical ailment, hypochondriacs knock on the thresholds of various specialists, ranging from therapists to cardiologists, neurologists, and oncologists. Therefore, the process of establishing a diagnosis is usually initiated by general practitioners or subspecialists: if a disorder is suspected, they refer their patient to a psychologist or psychiatrist.

The psychiatrist examines the patient, collects a complete medical history, conducts a clinical interview, assesses his level of anxiety and mental state at the time of admission. nine0003

The criteria for diagnosing hypochondriacal disorder are:

Concern about the presence (or future occurrence) of a serious illness.
Absence or mild severity of somatic symptoms.
High levels of anxiety and concern about your health that interfere with normal functioning.
The disease concern has been present for at least 6 months, but the specific disease that the patient fears may change over this period of time. nine0168

Treatment of hypochondria

The treatment plan for hypochondriacal disorder depends on the severity of the condition and the presence of comorbid psychiatric illnesses.

At the initial stage of the disease, excellent results are obtained by the use of psychotherapy. Cognitive behavioral therapy is the most popular treatment for anxiety disorders.

This type of therapy helps a person learn to manage the anxiety and anxiety they feel about their physical symptoms and the fact that they have a serious illness. During the sessions, the psychotherapist corrects false conclusions, teaches the patient the techniques of muscle relaxation, proper breathing, and stress management. nine0003

If the effectiveness of the method of psychotherapy is unsatisfactory, the patient may be prescribed medications: antidepressants, tranquilizers, or atypical antipsychotics. The most commonly used are selective serotonin reuptake inhibitors (SSRIs), which affect the level of serotonin in the human brain. These include Zoloft, Cipralex, Elicea, Paxil, Prozac and others. In more complex cases, combinations of an antidepressant with a tranquilizer and small antipsychotics are used. nine0003

Suicide attempts and the occurrence of hypochondriacal delusional disorder may require hospitalization in a specialized hospital.

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Disease prevention and advice

The following are important recommendations for hypochondriacal disorder that will help a person to relieve symptoms and control the disease:

Work on changing your thinking patterns. For example, write down your disturbing thoughts in a diary, and next to it - more “healthy”, alternative thoughts. nine0168
Distract yourself when intrusive thoughts appear. Go for a walk or watch an interesting movie.
Practice breathing and relaxation exercises.
Avoid researching medical conditions and symptoms online.
Communicate less with people suffering from the same disorder on the forums and "leave" in the discussion of diseases.
Switch your attention to hobbies and activities that you enjoy.
Move more and spend time outdoors. nine0168
Avoid alcohol and substance abuse.

References:

Ed. N. G. Neznanov, Yu. A. Aleksandrovsky, L. M. Bardenshtein, V. D. Vid, V. N. Krasnov, Yu. V. Popov. Psychiatry / M.: GEOTAR-Media, 2009
Stoimenov Y. A., Stoimenova M. Y., Koeva P. Y. et al. Psychiatric Encyclopedic Dictionary. - K .: "MAUP", 2003.
Begoyan A. N.
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Obsessive-compulsive disorder

Hypochondriacal disorder - symptoms, causes, stages

Disease definition

Signs of hypochondria

Causes of hypochondriacal disorder

Classification of hypochondria

Complications of hypochondria

Diagnosis of hypochondria

Treatment of hypochondria

Disease prevention and advice