Continue drug therapy, when used, for at least 8 weeks, with each dosage maintained for at least 4 weeks. If patients do not respond to lower SSRI dosages, increase to the higher dosages reported to be more effective for OCD (Table 3).14
Except for primary illness phobia, hypochondriasis has not been shown to respond to tricyclics, benzodiazepines, or dopaminergic blockers. In our experience, electroconvulsive therapy—although inadequately studied—may help treat patients with severe, treatment-refractory hypochondriasis with marked somatization.
Psychotherapy. Cognitive-behavioral therapy (CBT)—challenging patients’ irrational fears about illness and teaching them problem-solving tools—is effective in treating hypochondriasis.15 CBT can help patients understand that distorted thoughts lead to their sad or anxious moods.
Instructing patients to keep thought diaries can help them identify irrational fears and use cognitive restructuring to correct their faulty schemas. Tailor your cognitive therapy techniques to target the patient’s level of insight at the time of therapy.
Effective behavioral techniques may include setting limits on doctor visits, checking behaviors, reassurance seeking, etc. Repeated exposure to feared stimuli such as needles, white lab coats, blood pressure cuffs, medical dialogue, or hospital wards can help the patient habituate to the anxiety.
Relaxation techniques, a healthy diet, and exercise are also useful. Relaxation exercises—such as diaphragmatic breathing, progressive muscle relaxation, and visual imagery—may help patients manage anxiety by reducing CNS and autonomic nervous system arousal.
Bottom line
Hypochondriasis’ cognitive dysfunction is treatable, once an accurate diagnosis is made. Using a checklist can help you differentiate hypochondriasis from other medical and psychiatric disorders. A trusting doctor-patient relationship enhances outcome.
Related resources
- Fallon BA., Feinstein SB. Hypochondriasis: clinical, theoretical, and therapeutic aspects. In: Oldham J (ed). Review of psychiatry (vol. 20) Washington, DC: American Psychiatric Press, 2001:27-60.
- Cantor C, Fallon BA. Phantom illness: shattering the myth of hypochondria Boston: Houghton Mifflin Company, 1996.
- Starcevic V, Lipsitt DR (eds). Hypochondriasis: modern perspectives on an ancient malady New York: Oxford University Press, 2001.
Drug brand names
- Fluoxetine • Prozac
- Fluvoxamine • Luvox
- Nefazodone • Serzone
- Paroxetine • Paxil