Previous Experiences With Illness and Traumatic Experiences: A Specific Risk Factor For Hypochondriasis?

Weck, Florian; Neng, Julia M.B.; Göller, Kathrin; Müller-Marbach, Alexis

doi:10.1016/j.psym.2013.10.005

Cited by 25 publications

(19 citation statements)

References 38 publications

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“…1Health anxiety has a prevalence between 0.8 and 4.5% in primary care (21,22). Recognised risk factors include increasing age(23), previous illness, and traumatic childhood experiences, (24) and it is often co-existent with other mental disorders, particularly anxiety disorders. (20) In our review, patients with BFS who developed health anxiety symptoms did so at a younger age compared to the age of onset normally seen in health anxiety.…”

Section: Discussionmentioning

confidence: 99%

The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature

et al. 2019

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Background Benign fasciculation syndrome (BFS) is characterised by persistent spontaneous contractions of muscle fibres in the absence of a pathological cause. Patients with BFS often have concerns around having motor neuron disease (MND), in some cases fulfilling the criteria for health anxiety disorder. Research on how BFS and health anxiety relate to one another and how they should be optimally managed together is sparse. Objective We report two cases of BFS associated with health anxiety. We also review the existing literature on the association between BFS associated with health anxiety. Methods We systematically reviewed the literature using MEDLINE, Embase, PsychInfo, and OpenGrey for studies investigating benign fasciculation and anxiety symptoms up to August 2018. Results Both cases were successfully treated for health anxiety disorder with cognitive behavioural therapy and antidepressant medication. We identified eight studies that met inclusion criteria describing a total of 384 patients. The majority of studies were of moderate quality. Patients with BFS tended to be male and in their 30s or 40s. There was an over-representation of clinicians. Anxiety symptoms were common and frequently coexisted alongside fasciculation symptoms. Health anxiety was overwhelmingly focused around MND. Conclusion A proportion of individuals with BFS experience anxiety around having MND-to the point of developing health anxiety disorder. A bidirectional relationship may exist between BFS and health anxiety. Clinicians should be alert to the possibility of health anxiety in patients with BFS and have a low threshold to refer for psychiatric assessment. There is support for the role of psychological therapy, especially CBT, as well as pharmacotherapy, in the form of antidepressant medication. Furthermore, in severe or treatment-refractive cases, combined treatment may be indicated.

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Section: Discussionmentioning

confidence: 99%

The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature

et al. 2019

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“…nervousness or excitement). Based on the work by Weck, Neng, Göller and Müller-Marbach (2014), we further segmented illnesses into the categories mild, moderate and severe depending on the severity of the illness. Illnesses without lasting impairment were categorized as mild (e.g.…”

Section: Methodsmentioning

confidence: 99%

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

Schwind

Neng

Weck

2016

Behav. Cogn. Psychother.

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“…Illness anxiety is common, with studies reporting lifetime prevalence of 2–13% in the general population, and 5–30% in patients with comorbid medical conditions (1, 2). Previous experiences with illness, especially those associated with strongly negative emotions can contribute to anxiety disorders including IAD (3, 4). Severe IAD often results in high healthcare utilization and is unlikely to resolve sporadically (5).…”

Section: Introductionmentioning

confidence: 99%

Severe Illness Anxiety Treated by Integrating Inpatient Psychotherapy With Medical Care and Minimizing Reassurance

et al. 2019

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Illness anxiety disorder (IAD, formerly hypochondriasis) is characterized by preoccupation with fear of serious illness despite medical reassurance. IAD is common, debilitating, challenging to treat, and results in high healthcare utilization. Outpatient management of IAD is challenging because patients can compulsively seek reassurance from numerous providers, which interferes with learning more productive coping skills. We present the case of a woman with severe IAD who presented to the emergency room with increasing frequency over several months, despite regular outpatient medical visits and escalating psychiatric care. We made the unusual decision to hospitalize her for IAD for 1 month, in the absence of typical hospitalization criteria. This hospitalization allowed us to consolidate all medical and psychiatric care into a single provider team and train all staff and family to communicate with her in a consistent manner. We successfully treated her by integrating a general cognitive-behavioral therapy (CBT) protocol into medical care and decision-making. In response to her numerous health concerns, we minimized medical work-up, reassurance, and reactive medication changes, and instead used the concerns as opportunities to reinforce the psychotherapy. This approach allowed us to simplify her medication regimen and manage her co-morbid hypertension and vitamin deficiencies. Though inpatient hospitalization is likely infeasible in most cases of IAD, outpatient providers may create similar treatment plans based on the example of our case report, without needing highly specialized expertise. Such a plan would require a straightforward understanding of IAD psychology, which we review here, combined with readily accessible tools including a universal CBT protocol, online CBT courses, and clinical symptom scales. We discuss our approach for responding to health concerns, maintaining therapeutic alliance, integrating CBT principles into patient interactions, and managing medications. Since patients with IAD share health concerns with all providers, staff, and family, we also include our own IAD communication guide, appropriate for a general audience, that demonstrates how to respond in these conversations.

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Previous Experiences With Illness and Traumatic Experiences: A Specific Risk Factor For Hypochondriasis?

Cited by 25 publications

References 38 publications

The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature

The Association Between Benign Fasciculations and Health Anxiety: A Report of Two Cases and a Systematic Review of the Literature

Changes in Free Symptom Attributions in Hypochondriasis after Cognitive Therapy and Exposure Therapy

Severe Illness Anxiety Treated by Integrating Inpatient Psychotherapy With Medical Care and Minimizing Reassurance

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