7 Best Ways to Deal With a Hypochondriac Patient

Debra A. Shute

Disclosures

September 03, 2019

Is it hypochondriasis or "illness anxiety disorder"?

Most physicians have some experience with attempting to care for people who are seemingly never satisfied that their health is sound.

These patients can be draining to treat because they tend to visit, email, and call their doctor's office frequently with new symptoms and concerns. Such patients may also request excessive or unnecessary tests to assuage their often unrealistic fears.

Physicians may regard all patients with such anxiety in the same manner as those with true hypochondriasis. Actual hypochondriasis is a mental disorder in which people experience extreme fear that they're suffering from a serious illness despite medical evidence to the contrary, says Jeffrey P. Staab, MD, a psychiatrist at the Mayo Clinic in Rochester, Minnesota. "The idea was that a hypochondriac was worried about something he or she doesn't have," he says, "as opposed to being worried about the illnesses that they might have."

Hypochondriasis is no longer used as a psychiatric diagnosis in the United States. It was replaced by illness anxiety disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. The updated term carries an important distinction from hypochondria in that it doesn't suggest all medical causes of a person's symptoms must be ruled out, notes Staab.

"One can have illness anxiety disorder with or without another medical condition," he says. "The diagnosis of illness anxiety disorder is based on the presence of excessive worry about illness and its associated behaviors, such as excessive checking of symptoms or requests for frequent tests. It is not based on the absence of medical illness."

Staab estimates that about 10%-15% of people have this form of illness anxiety disorder, also referred to as "health anxiety" in the DSM-5. As a psychiatrist and professor, he works to promote effective ways to help these patients feel more at ease with their health.

As for the difficulty that physicians may have in spending the time to carry out these discussions, Staab notes that it's probably more time-consuming to continually remind the patient that all of his or her test results have been normal.

Here are seven strategies to effectively treat patients who may be experiencing illness anxiety disorder.

1. Don't Order Unnecessary Tests

It can be tempting for physicians to order extra tests in an attempt to reassure an anxious patient, but there are numerous downsides to that approach. In addition to perpetuating the cycle of anxiety, unnecessary care is wasteful and invites the potential for false-positive results that only exacerbate the patient's worries.

If the results are normal, on the other hand, the patient still may not be satisfied, Staab notes. "Then you're at odds with the patient."

A better alternative is to address the patient's anxiety and recommend an evaluation with a behavioral health professional. "Even if there aren't great mental health resources available or the patient doesn't have good insurance coverage for mental health—whatever the barrier is—it's still worthwhile knowing that this is a person who's more uneasy than average about their health," Staab says.

"Just acknowledging it up front and saying, 'These are the necessary tests. This is what we have to do, and we'll go over the results,' begins to put some limits around how far you're willing to go, and in a comfortable way," he says.

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