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Hypochondriasis (Health Anxiety) Reformulated: Similarities With Generalized Anxiety Disorder in A Routine Setting Single Case

25 July 2011


Despite its long documented history, Hypochondriasis remains a ubiquitous enigma to virtually all health care disciplines and providers. Because such highly health anxious patients are not commonly open to psychological (i.e., non-medical) interpretations of their physiological symptoms, sufferers ironically often become fixed on a pathological quest for physical and/or medical explanations for their problems. This pervasive worry and worry-based behavioral pattern perpetuates and reifies the belief that one has- or will develop- a serious medical condition, and, due to its inappropriate fixity on perceived organic (versus psychic) etiology, leaves such excessive doubt largely untreated. Therefore, continual high medical utilization and costs persist, and profound human suffering goes largely unchecked and unmanaged. Collectively, this sad, but very real condition and circumstance is unacceptable. Fortunately, this oft recalcitrant and thorny phenomenon has recently been construed as perhaps being similar to another such condition, namely Generalized Anxiety Disorder. If this resemblance is more than a surface relationship, and the two phenomena are indeed related on a process level (i.e., the two share a common pathological core), then Hypochondriasis should be treatable via a specifically tailored treatment for Generalized Anxiety Disorder. Since Generalized Anxiety Disorder has been far more responsive to intervention than Hypochondriasis, as its central mechanism of pathology is now well understood (i.e., intolerance for uncertainty), it would be conceivable that Hypochondriasis is in actuality far more treatable than its current riddle-status would otherwise suggest. Indeed, if the two prove to be quite similar, if not outright forms of one another, then there would be far more hope that patients who suffer with this can be helped. This stirring hypothesis was tested by treating a particularly refractory, chronic and severe case of Hypochondriasis with a specialized Generalized Anxiety Disorder treatment package. “Joe” responded quite favorably to treatment, and obtained meaningful change according to Jacobson and Truax’s (1991) method for determining clinically significant- and reliable- change. In fact, according to their most restrictive standard, Joe could be labeled “Recovered” at the end of treatment, and at all 18-month follow-up points. His response, caveated around single case generalizability limitations, suggested that perhaps Hypochondriasis does indeed share a common etiological source, namely intolerance for uncertainty, with Generalized Anxiety Disorder; if so, then that would be highly explanative of the strong results. Recommendations are given for conceptualizing pathological forms of health-related fears as just that, a concrete form of an anxiety disorder rather than a Somatoform condition. Suggestions for future research direction are provided.


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