Hypochondriasis

Kids with hypochondriasis have an extreme preoccupation with contracting an illness, and worrying that the headaches, bumps, rashes and random pains experienced in everyday life indicate a serious, undiagnosed illness. Hypochondriasis is not caused by delusions; instead the disorder is caused by actual physical symptoms that have been misinterpreted, causing intense anxiety. The nature of these symptoms makes accepting a diagnosis of hypochondriasis very difficult for many children, and it is equally difficult for children to understand that what they feel is really a disorder. Children with hypochondriasis generally do not understand their symptoms; even if they know there is a possibility that they’re healthy, their anxiety makes it impossible to accept that conclusion.

Kids with hypochondriasis mistake normal aches, pains and other symptoms as indications that they have a serious illness—a headache might mean a brain tumor, or a bruised knee might “guarantee” hemophilia. Some children with hypochondriasis will resist going to see the doctor, either because they are afraid of receiving confirmation or because they believe their illness is already a hopeless case. Others will frequently visit the doctor and the nurse’s office at school, and may even engage in “doctor shopping” when their physician won’t diagnose their supposed illness. These kids may have unnecessary medical procedures, spend time researching diseases on the Internet, and constantly seek reassurance from their parents. Children with the disorder are not faking their fear. Hypochondriasis causes acute anxiety, and interferes with a child’s performance in school, as well as relationships with family and friends.

The exact causes of hypochondriasis are unknown. There may be a biological predisposition, and the disorder can also be learned behavior. Children who already have an anxiety disorder may be more susceptible; others at risk include those who have family members who are ill and children who have recently lost a family member or friend. Males and females are equally likely to have hypochondriasis.

To be diagnosed with hypochondriasis your child must experience a severe preoccupation with having a physical illness that interferes with school, home life, and social development, causing significant distress. Before concluding that it’s hypochondriasis, of course, your doctor will do a physical examination and appropriate laboratory work to make sure that your child is not actually ill.

Psychotherapeutic: Therapists frequently employ cognitive behavioral therapy (CBT) to help children identify the thoughts that fuel their anxiety reactions, with the goal of stopping behaviors that worsen their fear. Through CBT kids with hypochondriasis can learn to accept that their thoughts are just thoughts, and not proof of any physical illness.

 

After a child has some success with CBT, she may undergo exposure and response prevention therapy, which exposes kids to feared thoughts and situations in a therapeutic setting, to gradually diminish their power and train the child not to react. For example, a boy who frequently monitors his vital statistics might be asked to refrain from checking his pulse for a set period of time. A child afraid of going to the doctor might be helped to call the doctor’s office and make an appointment. Similarly, parents can be trained to be less reactive through exposure therapy. The therapist can also help families establish guidelines about when to call the pediatrician.

 

Pharmacological: Antidepressant medications such as SSRIs are sometimes prescribed to help relieve symptoms of anxiety.

What if my child is actually sick?
The doctor will check your child’s symptoms and establish whether she is physically ill or not. Physical exams and appropriate laboratory work are always the first step in any hypochondriasis evaluation.
What happens when my child with hypochondriasis actually becomes sick?
It’s important not to skip routine checkups or begin ignoring your child’s symptoms. Focus on finding a good family doctor who is supportive of your child and understands her condition. Work with your doctor and develop a plan to monitor your child’s medical condition while behavioral therapy helps your child learn ways to recognize things that trigger anxiety and to avoid responding compulsively.
Does medication help?
Antidepressant medications such as SSRIs may be helpful in treating anxiety symptoms that affect children with hypochondriasis. However, if your child experiences any side effects from the medication, she could mistake the side effects as indicators of an illness, exacerbating her anxiety.