Pediatric Illness Anxiety Disorder (Formerly Hypochondriasis)

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Hippocrates used the term hypochondrium in the 4th century BC to refer to the anatomic area below the ribs. Later, the term hypochondriasis emerged to refer to the ill effects upon the psyche and soma of humors or fluids that emanate from the hypochondrium and cause disease.

The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) defines hypochondriasis as the preoccupation with fears of having, or the belief that one has, a serious disease based on misinterpretation of bodily symptoms. In hypochondriasis, this preoccupation lasts at least 6 months and persists despite appropriate medical evaluation and reassurance. Hypochondriasis causes clinically significant distress or impairment in social, occupational, or other areas of functioning. These diagnostic criteria were initially described for adults, and the same basic criteria are applied to children and adolescents.

Because the literature about hypochondriasis in children and adolescents is limited, this review includes adult studies that describe the most recent advances in the subject of hypochondriasis.

United States

Hypochondriasis is rare in childhood and occurs more frequently in adolescence. The precise prevalence in children is unknown because of lack of epidemiologic studies.

As many as 69.2% of children in a psychiatric-based outpatient clinic reported somatic symptoms. More than 12% of adolescents and young adults reportedly have at least one somatoform condition during their lifetime. Somatoform disorder symptoms may begin in early childhood, and the full disorder generally emerges in people aged 8-12 years.

In adults, prevalence rates of hypochondriasis vary according to the population studied and the diagnostic interview used. A prevalence rate of 0.8% was described from a large sample in 15 centers worldwide, and a rate of 3% was described in a primary care adult sample.

Hypochondriasis was found in 7.7% of first-degree relatives of patients with hypochondriasis. These relatives also had a high rate of comorbid anxiety and depressive and other somatoform disorders. The relatives reported substantial physical and psychological impairment, including diminished work performance and disability. In addition, these relatives reported greater use of health care services but less satisfaction with that care. These relatives showed most of the same characteristics found in earlier studies of patients who are hypochondriacal.

International

In adults, prevalence rates of hypochondriasis vary according to the population studied and the diagnostic interview used. A prevalence rate of 0.8% was described from a large sample in 15 centers worldwide.

An epidemiologic German study conducted in 2007 revealed a 0.4 % prevalence rate of DSM IV hypochondriasis. [1]

Hypochondriasis exhibits no racial predilection.

Musculoskeletal pain is associated with depression in both girls and boys. Some data suggest that somatic symptoms are strongly associated with emotional disorders in girls and occur with increased frequency in boys with disruptive behavior disorders. For girls, musculoskeletal pain or the combination of stomachache and headache is associated with anxiety and depressive disorder. For boys, stomachache is associated with oppositional defiant disorder and with attention deficit hyperactivity disorder (ADHD). These data may reflect a degree of referral bias because more boys are referred for psychiatric evaluation for disruptive behavior disorders symptoms than are girls for their more common internalizing symptoms.

Hypochondriasis can begin in people of any age; the most common age at onset is thought to be early adulthood. The clinician should consider a diagnosis of hypochondriasis in older teenagers who have a history of prolonged preoccupation with having a serious illness.

Bleichhardt G, Hiller W. Hypochondriasis and health anxiety in the German population. Br J Health Psychol. 2007 Nov. 12:511-23. [Medline].

Esposito M, Roccella M, Gallai B, Parisi L, Lavano SM, Marotta R, et al. Maternal personality profile of children affected by migraine. Neuropsychiatr Dis Treat. 2013. 9:1351-8. [Medline]. [Full Text].

Walker LS, Garber J, Greene JW. Somatic complaints in pediatric patients: a prospective study of the role of negative life events, child social and academic competence, and parental somatic symptoms. J Consult Clin Psychol. 1994 Dec. 62(6):1213-21. [Medline].

Rask CU, Elberling H, Skovgaard AM, Thomsen PH, Fink P. Parental-reported health anxiety symptoms in 5- to 7-year-old children: the Copenhagen Child Cohort CCC 2000. Psychosomatics. 2012 Jan-Feb. 53(1):58-67. [Medline].

Schwenzer M, Mathiak K. Hypochondriacal attitudes may reflect a general cognitive bias that is not limited to illness-related thoughts. Psychol Health. 2011 Aug. 26(8):965-73. [Medline].

Rask CU. Functional somatic symptoms in 5-7 year old children: assessment, prevalence and co-occurrence. Dan Med J. 2012 Nov. 59(11):B4537. [Medline].

Bailer J, Witthöft M, Wagner H, Mier D, Diener C, Rist F. Childhood maltreatment is associated with depression but not with hypochondriasis in later life. J Psychosom Res. 2014 Aug. 77(2):104-8. [Medline].

Noyes R Jr, Stuart S, Langbehn DR, et al. Childhood antecedents of hypochondriasis. Psychosomatics. 2002 Jul-Aug. 43(4):282-9. [Medline].

Abramowitz JS, Moore EL. An experimental analysis of hypochondriasis. Behav Res Ther. 2007 Mar. 45(3):413-24. [Medline].

Torres AR, Ferrão YA, Shavitt RG, Diniz JB, Costa DL, do Rosário MC, et al. Panic Disorder and Agoraphobia in OCD patients: clinical profile and possible treatment implications. Compr Psychiatry. 2014 Apr. 55(3):588-97. [Medline].

Weck F, Neng JM, Richtberg S, Stangier U. The restrictive concept of good health in patients with hypochondriasis. J Anxiety Disord. 2012 Dec. 26(8):792-8. [Medline].

Bailer J, Witthöft M, Erkic M, Mier D. Emotion dysregulation in hypochondriasis and depression. Clin Psychol Psychother. 2017 Nov. 24 (6):1254-1262. [Medline]. [Full Text].

Muse K, McManus F, Leung C, Meghreblian B, Williams JM. Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. J Anxiety Disord. 2012 Jan. 26(1):189-96. [Medline].

Sakai R, Nestoriuc Y, Nolido NV, Barsky AJ. The prevalence of personality disorders in hypochondriasis. J Clin Psychiatry. 2010 Jan. 71(1):41-7. [Medline].

Cooper K, Gregory JD, Walker I, Lambe S, Salkovskis PM. Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis. Behav Cogn Psychother. 2017 Mar. 45 (2):110-123. [Medline].

Greeven A. van Balkom AJ. Visser S. Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a control randomized trial. American Journal of Psychiatry. 2007 jan. 164(1):91-9. [Medline].

Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database Syst Rev. 2007 Oct 17. CD006520. [Medline].

Olthuis JV, Watt MC, Bailey K, Hayden JA, Stewart SH. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev. 2016 Mar 12. 3:CD011565. [Medline]. [Full Text].

Eilenberg T, Kronstrand L, Fink P, Frostholm L. Acceptance and commitment group therapy for health anxiety – Results from a pilot study. J Anxiety Disord. 2013 Jun. 27(5):461-8. [Medline].

Sorensen P, Birket-Smith M, Wattar U, Buemann I, Salkovskis P. A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychol Med. 2011 Feb. 41(2):431-41. [Medline].

Warwick HM, Clark DM, Cobb AM, Salkovskis PM. A controlled trial of cognitive-behavioural treatment of hypochondriasis. Br J Psychiatry. 1996 Aug. 169(2):189-95. [Medline].

Weck F. Treatment of Mental Hypochondriasis: A Case Report. Psychiatr Q. 2013 Aug 10. [Medline].

Schweitzer PJ, Zafar U, Pavlicova M, Fallon BA. Long-term follow-up of hypochondriasis after selective serotonin reuptake inhibitor treatment. J Clin Psychopharmacol. 2011 Jun. 31(3):365-8. [Medline].

Undefined.

Abramowitz JS, Deacon BJ. Severe health anxiety: why it persists and how to treat it. Compr Ther. 2004 Spring. 30(1):44-9. [Medline].

Albrecht S, Naugle AE. Psychological assessment and treatment of somatization: adolescents with medically unexplained neurologic symptoms. Adolesc Med. 2002 Oct. 13(3):625-41. [Medline].

Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA. 2004 Mar 24. 291(12):1464-70. [Medline].

Barsky AJ, Coeytaux RR, Sarnie MK, Cleary PD. Hypochondriacal patients’ beliefs about good health. Am J Psychiatry. 1993 Jul. 150(7):1085-9. [Medline].

Bouman TK, Visser S. Cognitive and behavioural treatment of hypochondriasis. Psychother Psychosom. 1998 Jul-Oct. 67(4-5):214-21. [Medline].

Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ. Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry. 1999 Sep. 38(9):1093-101. [Medline].

Campo JV, Reich MD. Somatoform disorders. Netherton S, Walker CE, Holmes D, eds. Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York, NY: Oxford Univ Press; 1999. 320-43.

Lewis M, ed. Child and Adolescent Psychiatry? A Comprehensive Textbook. Williams & Wilkins; 1996.

Egger HL, Costello EJ, Erkanli A, Angold A. Somatic complaints and psychopathology in children and adolescents: stomach aches, musculoskeletal pains, and headaches. J Am Acad Child Adolesc Psychiatry. 1999 Jul. 38(7):852-60. [Medline].

Escobar JI, Gara M, Waitzkin H, et al. DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry. 1998 May. 20(3):155-9. [Medline].

Fallon BA, Schneier FR, Marshall R, et al. The pharmacotherapy of hypochondriasis. Psychopharmacol Bull. 1996. 32(4):607-11. [Medline].

Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10):1329-38. [Medline].

Haugaard JJ. Recognizing and treating uncommon behavioral and emotional disorders in children and adolescents who have been severely maltreated:somatization and other somatoform disorders. Child Maltreat. 2004. May 9(2):169-76. [Medline].

Hiller W, Leibbrand R, Rief W, Fichter MM. Differentiating hypochondriasis from panic disorder. J Anxiety Disord. 2005. 19(1):29-49. [Medline].

Hitchcock PB, Mathews A. Interpretation of bodily symptoms in hypochondriasis. Behav Res Ther. 1992 May. 30(3):223-34. [Medline].

Kellner R. Somatization and Hypochondriasis. New York, NY: Praeger-Greenwood; 1986.

Lieb R, Pfister H, Mastaler M, Wittchen HU. Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: prevalence, comorbidity and impairments. Acta Psychiatr Scand. 2000 Mar. 101(3):194-208. [Medline].

Livingston R, Witt A, Smith GR. Families who somatize. J Dev Behav Pediatr. 1995 Feb. 16(1):42-6. [Medline].

Longley SL, Watson D, Noyes R Jr. Assessment of the hypochondriasis domain: the multidimentional inventory of hypochondriacal traits (MIHT). Psychol Assess. 2005. Mar 17(1):3-14. [Medline].

Noyes R Jr, Happel RL, Yagla SJ. Correlates of hypochondriasis in a nonclinical population. Psychosomatics. 1999 Nov-Dec. 40(6):461-9. [Medline].

Maria Sandra Cely-Serrano, MD Developmental and Behavioral Pediatrician, Center for Child Development, Florida Hospital

Maria Sandra Cely-Serrano, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Angelo P Giardino, MD, MPH, PhD Professor and Section Head, Academic General Pediatrics, Baylor College of Medicine; Senior Vice President and Chief Quality Officer, Texas Children’s Hospital

Angelo P Giardino, MD, MPH, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, International Society for the Prevention of Child Abuse and Neglect, Ray E Helfer Society

Disclosure: Nothing to disclose.

Anna Maria Wilms Floet, MD Assistant Professor, Assistant Professor of Pediatrics, Department of Pediatrics, Behavior and Developmental, University of Maryland School of Medicine

Anna Maria Wilms Floet, MD is a member of the following medical societies: American Academy of Pediatrics and Society for Developmental and Behavioral Pediatrics

Disclosure: Nothing to disclose.

Pediatric Illness Anxiety Disorder (Formerly Hypochondriasis)

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