Health anxiety, somatisation + unexplained symptoms

Question 1

What is health anxiety?

Answer 1

Excessive health-related concerns (e.g. ruminations on having an illness, suggestibility if one reads or hears about a disease, unrealistic fear of infection)
somatic perceptions (eg preoccupation with bodily sensations or functioning)
behaviours (eg repeated reassurance seeking, avoidance of medications or medical personnel)

Question 2

What is somatisation?

Answer 2

“psychological distress is expressed through physical symptoms and subsequent medical help-seeking”

It is sometimes also known as Medically Unexplained Symptoms.

Question 3

Which diagnoses in the ICD-10 is health anxiety related to?

Answer 3

Hypochondriasis or hypochondriacal disorder (concerns about having a serious illness persists for at least six months despite medical assurance and these concerns cause clinically significant impairment or distress)
Health anxiety can also be part of somatisation disorder, obsessive-compulsive disorder (OCD), body dysmorphic disorder, panic disorder and delusional disorder

Question 4

What is somatisation disorder?

Answer 4

History of at least 2 years complaints of multiple and variable physical symptoms that cannot be explained by any detectable physical disorder
Preoccupation with symptoms causes persistent distress and leads the patient to seek repeated consultations
persistent refusal to accept medical reassurance that there is no adequate physical cause for the physical symptoms
must be a number of symptoms from at least two separate groups

Question 5

What are the physical symptoms that someone needs to have to be diagnosed with somatisation disorder (2 from separate groups)?

Answer 5

GI Symptoms: Abdominal pain, nausea, feeling bloated, bad taste in mouth, complaints of vomiting, complaints of frequent loose bowel motions
Cardiovascular: breathlessness without exertion, chest pains
GU symptoms: dysuria, unpleasant sensation around the genitals, complaints of unusual or copious vaginal discharge
Skin and pain complaints: blotchiness, discoloration, pain in limbs, unpleasant numbness or tingling sensation

Question 6

What is hypochondriacal disorder?

Answer 6

persistent belief, of at least 6 months, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient)
persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder)
persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigation
Persistent refusal to accept medical reassurance that there is no physical cause for the symptoms or physical abnormality

Question 7

What is factitious disorder? (Munchausen’s)

Answer 7

Patient feigns or exaggerates symptoms for no obvious reason
Patient may even inflict self-harm in order to produce symptoms or signs
Internal motivation with aim of adopting the sick role
Munchausen syndrome by proxy - the patient imposes symptoms to other individuals (e.g. a child)

Question 8

What is malingering?

Answer 8

Conscious manufacturing or exaggerating of symptoms for a secondary gain e.g. benefits, housing, other than assuming the sick role

Question 9

What are the differential diagnoses for hypochondriasis, somatisation and medically unexplained symptoms?

Answer 9

Depression and anxiety 
Personality disorder 
Organic conditions 
Dissociative (conversion) disorders (the presence unconsciously produced symptoms that affect voluntary sensory or motor functions, suggesting a medical or neurological disorder)
Psychosis

Question 10

What is dissociative (conversion) disorder?

Answer 10

Classically a traumatic event leads to a disruption of the usually integrated functions of consciousness, memory, identity or perception
show a lack of concern for the disability (la belle indifference)
amnesia
fugue (sudden, unexpected journey that may last a few months, together with memory loss, confusion about personal identity)
stupor
trance or possession disorders
motor disorders (paralysis of limbs)
anaesthesia/sensory loss
convulsions (“pseudo-seizures” or “psychogenic non-epileptic seizure”)

Question 11

What is the management for health anxiety/somatisation?

Answer 11

antidepressants (SSRI, SNRI) may be useful
in the case of hypochondriacal delusion, antipsychotic may also be indicated
avoid routine benzodiazepine use
CBT
Psychoeducation
Encourage normal function and activities
Involve social network to improve emotional support