Real Therapy Eases Imagined Illnesses

Cognitive behavior program helps break cycle of hypochondria

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HealthDay Reporter

TUESDAY, March 23, 2004 (HealthDayNews) -- An intense course of behavioral therapy can rid many people of the persistent, distressing and false belief that they suffer from a serious disease, new research finds.

The study is a notable advance about hypochondria, a problem that affects a surprising large number of Americans but one that rarely gets the treatment it needs, says Dr. Arthur J. Barsky, director of psychiatric research at Brigham and Women's Hospital in Boston. He is the lead author of a report on the study in the March 24/31 issue of the Journal of the American Medical Association.

"It's a big problem because, first, it is quite prevalent," Barsky says. "From 4 to 6 percent of patients seen in a primary-care clinic have severe hypochondria."

"And second, we don't do a good job in treating it. The doctors who see these patients don't know what to do with them," he adds. "They feel that there is no reason for the patients to have these symptoms, and therefore they should go away. But the patients aren't able to feel better, so the problem is chronic."

It's also expensive, for individuals and the health-care system, Barsky says. People with hypochondria "are extraordinarily expensive to take care of. They get a lot of tests, more than twice as many as other people, and they make twice the number of visits to primary-care physicians."

The regimen described by Barsky is designed to break a vicious cycle in which people worry so much about being sick that they are acutely sensitive to even minor symptoms that make them worry more about being sick.

The idea of using cognitive behavior therapy to break that cycle isn't new, he says. However, only one other study about the treatment has been published until now and the treatment is not widely accepted.

The study included patients referred by their primary-care doctors and people who volunteered after hearing public service announcements. None had a major medical problem, but all scored high enough on a self-report questionnaire to meet the formal psychiatric definition of hypochondria.

One-hundred-two of the patients had 90-minute sessions for six weeks in which a psychiatrist went through six factors involved in exaggerating their fears of illness -- hypervigilance to any minor problem, mistaken beliefs about what was causing those problems, their response to the symptoms, and so on. The other 85 people had their usual medical care, with no psychiatric intervention.

One year later, the people who had the behavioral therapy "had significantly lower levels of hypochondriacal symptoms, beliefs and attitudes and health-related anxiety," the report says. "They also had significantly less impairment of social role functioning and intermediate activities of daily living."

The hope is that people beset with false medical worries and their doctors will learn from the report that help is available, Barsky says. But he acknowledges that a lot of education is needed for the public and the medical profession.

"It's true that word about the treatment has not been disseminated," Barsky says. "Not many people will be referred for psychiatric care for hypochondria."

However, there are models of care for similar problems, such as chronic fatigue and chronic low back pain, in which feelings interact with symptoms. The psychiatric treatments used for those conditions can be applied to hypochondria, Barsky says.

It's significant that the study is being published in a journal that reaches many family doctors, says Dr. Russell Noyes Jr., professor emeritus of psychiatry at the University of Iowa who has researched hypochondria.

"Quite often people with this sort of disturbance go to a general practitioner feeling that they have a lot of symptoms and worried that they might have cancer or some other serious condition," Noyes says. "The doctor can't find anything, and the person is told that the problem is in the head, which only adds to distress."

The Barsky report is "an exciting indication that treatments are coming forward in this area," Noyes says.

More information

Get a rundown on hypochondria from the National Library of Medicine. You can test yourself for the illness by going to Norway's University of Bergen.

SOURCES: Arthur J. Barsky, M.D., director, psychiatric research, Brigham and Women's Hospital, Boston; Russell Noyes Jr., professor emeritus, psychiatry, University of Iowa, Iowa City; March 24/31, 2004, Journal of the American Medical Association

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