The OC spectrum: a closer look at the arguments and the data.
Concepts and controversies in obsessive-compulsive disorder. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. Arthur J.
Hypochondriasis remains controversial, despite its year history. Although it is considered a mental disorder, hypochondriasis is often regarded as a defense mechanism, peculiar cognitive/ perceptual. Hypochondriasis: Modern Perspectives on an Ancient Malady Edited by Vladan Starcevic and Don R. Lipsitt Oxford University Press, New York, ,
Barsky , David K. A contemporary conceptual model of hypochondriasis. Jonathan Stuart Abramowitz , Stefanie A.
Schwartz , Stephen P H Whiteside. Pharmacologic strategies for hypochondriasis. A trusting doctor-patient relationship enhances outcome. Skip to main content. Evidence-Based Reviews.
Current Psychiatry. Author and Disclosure Information Suzanne B. Related resources Fallon BA. Hypochondriasis: clinical, theoretical, and therapeutic aspects. In: Oldham J ed.
Review of psychiatry vol. Individual, planned contrasts were calculated for each outcome measure comparing baseline and 6-month, and baseline and month assessments, respectively.
Effect sizes and threshold values for clinical significance were also derived for each analysis. Statistical analyses were performed using SPSS, release The study was conducted between September and November A total of individuals completed the screening questionnaire, of whom Two hundred nineteen individuals declined to participate, proved to be ineligible, and could not be reached subsequently, resulting in a total of subjects The nonparticipants were older Of the patients in the treatment arm, 63 Six-month follow-up was obtained for 85 Twelve-month follow-up was obtained for 92 These attrition rates do not differ significantly between groups.
Twelve-month follow-up was obtained for The sociodemographic characteristics of the 2 treatment groups did not differ significantly Table 1. They were predominantly women, middle-aged, and reported a history of hypochondriasis for approximately 11 years. Educational level and generalized psychiatric distress did not differ significantly in the 2 groups at baseline but were used as covariates in the analyses because of their established relationships to the outcome variables of interest.
The treatment and control groups did not differ significantly in aggregate medical morbidity at baseline. Eighty patients were recruited from primary care practices and were volunteers. Repeated measures of ANCOVA were performed on the Whiteley Index modeled as a function of participant status patients vs volunteers , treatment CBT vs usual care and assessment point baseline, 6 months, and 12 months , and all 2- and 3-way interaction terms.
mytoolsguy.com/wp-content/139.php Consequently, participant status patient or volunteer also was included as a covariate in the models. There was a statistically significant interaction effect for group treatment vs control by assessment time baseline, 6-month, and month follow-up. The secondary outcome measures of hypochondriacal symptoms were analyzed in the same manner as the Whiteley Index.
For hypochondriacal thought frequency, health anxiety, and somatosensory amplification, the interactions between group and assessment were statistically significant, indicating a significant treatment effect on these measures see Table 2. Hypochondriacal somatic symptoms were not significantly improved by treatment. The 2 treatment groups were compared on measures of functional status using MANCOVA as the omnibus test, with intermediate and social activities combined as dependent measures, again including baseline educational level, psychiatric comorbidity, and participant status as covariates.
No therapist effect was found, ie, when the patients treated by each of the therapists were compared, no significant differences were found for any of the outcome measures. Although the intervention did not include treatment for comorbid psychiatric disorder, subjects were free to obtain such treatment as they or their physicians saw fit. At 6-month follow-up, 20 CBT patients At 12 months, 6 CBT patients 5. These rates do not differ significantly between groups. This 6-session CBT, specifically targeting the cognitive and perceptual mechanisms thought to underlie hypochondriasis, appears to significantly improve a range of hypochondriacal symptoms, beliefs, and attitudes.
These effects are evident at 6-month follow-up and persist at 12 months. The effects on role functioning are not consistently significant at 6 months but emerge at 12 months, the primary end point. These treatment effects are seen using an intent-to-treat analysis, after adjusting for psychiatric comorbidity, sociodemographic characteristics, and participant status patient vs volunteer at baseline.
The findings are compatible with the only other major trial reported to date and expand on it by having a control group available for comparison at long-term follow-up. Though the magnitude of the treatment effect is modest, it is important to remember that hypochondriasis generally has been considered a refractory and chronic disorder the mean duration of illness was 11 years in this study for which there has been no empirically validated treatment.
In addition, this CBT was brief only 6 sessions and included no follow-up "booster" sessions. Finally, patients were not treated in the study for comorbid psychiatric disorder, and the continued presence of these disorders likely moderated the treatment effect.
The study has several limitations. First, many eligible patients did not participate, limiting the generalizability of the findings. Those who did consent to participate might have been more receptive to a psychosocial approach and hence benefited more from it than those who did not consent.
Second, we lacked an "attention" control, ie, a generic psychosocial intervention providing nonspecific attention, support, concern, and positive expectation.
This limits our ability to attribute the treatment effect to the specific cognitive and behavioral strategies of the intervention. However, the fact that the cognitive processes thought to underlie the disorder eg, hypochondriacal cognitions, health beliefs, amplification improved with treatment suggests that the treatment had a specific effect. Third, considerable improvement occurred in the control group.
This was likely due to the inadvertent inclusion of patients with transient hypochondriasis, probably because the 2 screening measures were too close to each other in time approximately 3 weeks. Additionally, regression to the mean and the supportive effect of being enrolled in a longitudinal study contributed to the high rate of spontaneous improvement. A Hawthorne effect may also have occurred whereby control physicians, having learned of the study, made a greater effort to help their hypochondriacal patients.
Finally, study subjects came from 2 different sources. Participant status, however, was included as a covariate in all analyses, and the fact that these 2 groups differed at baseline confers some measure of generalizability on the findings. Hypochondriacal attitudes and concerns improved more than somatic symptoms did. This finding, although it might seem counterintuitive, was actually expected: the treatment was intended to improve coping with symptoms rather than curing them outright "care rather than cure".
This had both an empirical and a conceptual basis. Empirically, clinical experience and intervention trials for a variety of functional somatic syndromes suggest that the patients who do best are those who learn to compensate for, rather than attempting to eliminate, their somatic distress. Conceptually, hypochondriacal somatic symptoms cannot simply be stripped away with symptomatic treatment because they exist for underlying psychological and interpersonal reasons.
This suggests that a realistic goal in treating hypochondriasis is amelioration of distressing fears and beliefs and improved coping, rather than the elimination of somatic symptoms per se. We are unable to partial out the variance in treatment effect between the CBT and the physician consultation letter.
That the latter may have been beneficial is suggested by 2 studies with somatization disorder patients in which a psychiatric consultation letter alone resulted in lower health care costs along with either improved or stable physical functioning. Hypochondriacal individuals are by definition convinced of the medical nature of their condition and therefore psychosocial treatment seems nonsensical to them. Although a major problem, this should not detract from the fact that those patients who did undergo treatment benefited from it.
And since hypochondriasis is a prevalent problem in ambulatory medical practice, 6 , 44 this fraction of hypochondriacal patients still represents a sizeable population.
Classification of somatic syndromes in ICD Anagnostopoulos, Fotios and Botse, Tzesiona This article has been cited by the following publications. General Hospital Psychiatry , 10 , — Given the heterogeneity of hypochondriasis and doubt about the validity and practical utility of the diagnosis, it comes as no surprise that hypochondriasis has also presented treatment dilemmas. Snyder, M.
The treatment must be made more attractive in the future by seamlessly integrating it into the primary care process and conducting it in the medical setting as our treatment was not. The treatment effect could also be strengthened by increasing the number of sessions to 8 and by adding booster sessions.
All Rights Reserved. Table 1. Sociodemographic Characteristics View Large Download. Table 2. Table 3. Somatization and Hypochondriasis. New York, NY: Praeger; One-year follow-up of medical outpatients with hypochondriasis. Arch Gen Psychiatry. Hypochondriasis: Modern Perspectives on an Ancient Malady.