The hypochondria is very frequent in the population. It is characterized by the feeling and/or the idea of being sick, without however having valid or justifiable basis of reality.
The concerns relating to your body can be present differently. Sometimes fears are manifested in certain conditions, in certain moments of life, or in the face of certain events or certain news (for example, the disease of a peer). Other times the fears are more structured, in personalities with particular traits (for example in obsessive personalities), up to more frankly pathological forms.
Transitional hypochondriache reactions They can manifest themselves following serious stress, more commonly after death or a serious illness of an important person for the patient himself.
The hypochondriac tends to interpret trivial alterations, such as a headache, a cardiac functional disorder or a viral respiratory infection as evidence of the presence of a serious illness.
It happens frequently that fears concentrate on a single organ, whose operation becomes the patient source of extreme concern for the patient.
The general practitioner and the hypochondriac patient
The therapeutic figure who is initially asked more often by the hypochondriac patient is the General practitioner (or general practitioner). In fact, he is the first to face the problems of these subjects. Excessively worried about their state of health, they complain insistently for numerous somatic disorders. However, they are not reflected in the various laboratory or radiological analyzes, the outcome of which is invariably negative.
What the doctor can easily detect, in these cases, is both the disproportion between the extent of the disorder and the degree of apprehension with which the patient reports him. The latter does not accept the reassurance which receives from the careful, but, on the contrary, it can react with anger or disbelief, rather than with relief. Especially when he is communicated to him that his symptoms, in light of the negative findings of the various tests made, are not attributable to any organic disease.
It is also not uncommon for the patient to interpret the request for diagnostic investigations carried out by the doctor exactly as confirms that his suspicion of being affected by a serious illness is well founded. The very lack of any response of organic disease leaves him equally worried about the feeling that some pathology could still have escaped the diagnostic investigations.
Therefore these patients, disappointed by the responses that can provide their doctor in the face of their ailments, begin to consult various specialists. They transfer their hypochondriache to multiple areas of medicine, such as cardiology, dermatology, otolaryngology, infectivology, gastroenterology, gynecology, oncology.
The relationship with the hypochondriac patient
Correct management of the therapeutic relationship After all, the doctor cannot be careful from considering any new symptom reported by hypochondriac subjects carefully. In fact, it is obvious that these patients can, during their lives, meet organic pathologies. Precisely in these cases the risk of underestimating the disorders is higher, with obvious consequences also of the medical medical order.
In this sense, they believe they are useful anyway periodic medical checksplanning visits to fixed and regular deadlines. This serves to reassure patients on the fact that they are not neglected and that, on the other hand, their complaints are kept in adequate consideration. In order to avoid the risk of strengthening hypochondriac cyclic behavior, the treating should involve the patient, as far as possible, in the decision -making process. However, it must be avoided, at the same time, that an excess of food reassurance an unaware circuit of research of comfort for itself.
It is clear that the presence of these dynamics makes theHypochondria Among the most difficult and complex pathologies to be treated in the field of general medicine. Soon the doctor realizes that the symptoms complained by these patients are refractory to all standard medical therapies. In particular, it is the very nature of the medical-patient relationship that is problematic, since it is often critical patients. They tend to devalue the work of their doctor, despite being assiduous visitors of the clinic often in possession of a certain medical culture (albeit confused and approximate). They can arouse negative “countertransfeter” feelings, evoking in the caregiver an attitude of rejection or in any case of little consideration towards them.
Work on the relationship instead of on the symptom
To adequate these dynamics adequately, the doctor should change his concept of care. Moving the goal from the attempt to intervene directly on the symptoms to a work focused on Improvement of the therapeutic relationship. This has also lived by the patient as a fundamental channel to convey his experience of suffering and therefore as important as the symptom itself.
These patients are inclined to irritate when they are told that they “have nothing”, that is, that their ailments do not have an identifiable cause. This is because this contradicts their bodily and subjective experience. It does not help try to empty the symptom of its pathological meaning, risking to cause oppositional feelings by the patient, who feels his physical experience trivial and misunderstood. On the contrary, the doctor should suggest the possibility that the disorders perceived are mediated and amplified by a specific anxious reactivity that the extent of body perceptions can distort in the worst sense.
This methodology of approach also aims to underline the importance of the psychological dimension In the genesis of somatic sensations and therefore to propose a therapeutic relationship style that takes into account this element.
Sending the hypochondriac patient to psychological treatment
In the clinical practice of general medicine, however, a certain degree of resistance by the Hypochondriac patients to undertake psychological or psychiatric treatments. They are relied on reluctantly, sometimes even with the suspicion that it is a stratagem of your trusted doctor aimed at avoiding dealing with them.
The main obstacle in this sense is precisely the difficulty in making these problems consider according to an exclusively somatic perspective. It is complex to make these patients aware of being carriers essentially of an anxiety disorder, focused on the fear of being affected by a serious physical disease.
Many patients are reluctant to admit depressive area symptoms, while it is frequent that depressive symptoms are expressed in somatic form (see masked depression). This happens above all in the context of the elderly population, as an adaptive response to social and family problems.
Psychotherapy and psychotropic drugs
Good results can be obtained through short -term psychotherapeutic interventions cognitive-behavioral type. They are based on the clarification of the meaning of symptoms, on body relaxation techniques, on the modification of dysfunctional thought styles and the behavior of maintaining the problem.
Any decision to propose a psychotropic drug must be taken after an adequate preparatory work aimed at establishing a correct therapeutic alliance. A premature prescription could damage the relationship with the patient. In fact, it should be considered that the organic side effects of these drugs often risk feeding concerns about their health. The administration of drugs must therefore be cautious and in a context that does not food the search for non -existent miraculous therapies, where possible always supported by psychotherapeutic support.
