hypochondriasis vs OCD

[WiseOne]

I'm having a hard time distinguishing these two. It seems like they are one and the same and that hypochondriasis is a specific manifestation of OCD rather than a separate disorder (ie. the only difference is the content not the actual cognitive pattern behind the disorders). Please comment on my appraisal of this. Thank you.

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[thoffen]

There's a reason it got changed to illness anxiety disorder. But I don't really know enough/have enough clinical experience to comment on your observation except it sounds reasonable to me. But if literature bases develop independently, it's hard to lump illnesses back together.

 

[WisNeuro]

Generally, the focus and specificity of the complaints differentiate the two. Those with OCD tend to have more than simple contamination fears, although those are some of the more common ones. Also, OCD will have very specific contamination fears and the compulsions to lessen the anxiety. Those with hypochondriasis tend to be very preoccupied with bodily sensations in a vague way and perhaps just contamination in general. When you've seen plenty of people with OCD and some with hypochondriasis/health anxiety, you see a huge difference.

 

[Armadillos]

On topic of hypochondriasis, I was surprised to see a recent green journal study showing Prozac treats it just as well (and possibly better in some regards) than CBT. Obviously Prozac+CBT was better, but not as big difference as I would have guessed.

This was surprising to me because my general feeling had always been that hypochondriasis was primarily going to benefit from therapy. Although the more disappointing part is neither worked all that well overall.

 

[smalltownpsych]

I'm having a hard time distinguishing these two. It seems like they are one and the same and that hypochondriasis is a specific manifestation of OCD rather than a separate disorder (ie. the only difference is the content not the actual cognitive pattern behind the disorders). Please comment on my appraisal of this. Thank you.

Another way of looking at it: someone with OCD is afraid they will get sick, the person with hypochondriasis thinks they already are sick.

On topic of hypochondriasis, I was surprised to see a recent green journal study showing Prozac treats it just as well (and possibly better in some regards) than CBT. Obviously Prozac+CBT was better, but not as big difference as I would have guessed.

This was surprising to me because my general feeling had always been that hypochondriasis was primarily going to benefit from therapy.

Not too surprising for me as a psychotherapist. Psychotherapy with someone with strong tendency to somaticize can be very difficult and often limited in it's efficacy. At the same time, physical complaints and depressed mood are interrelated. Prozac can alleviate depressed mood thereby alleviating physical complaints. Work with chronic pain patients and one sees this dynamic play out very clearly.

 

[nitemagi]

Hypochondriasis definitely overlaps with OCD. One of the few papers I've written gets into this. There's still anxiety and checking behavior, just that the checking involves reassurance seeking/testing from doctors often.

 

[birchswing]

Hypochondriasis definitely overlaps with OCD. One of the few papers I've written gets into this. There's still anxiety and checking behavior, just that the checking involves reassurance seeking/testing from doctors often.

I've read about this and seeking out a doctor is not necessarily bad in illness anxiety disorder when it's with a single primary care doctor (versus ER/urgent care). It's actually one modality of treatment.

 

[randomdoc1]

I've read about this and seeking out a doctor is not necessarily bad in illness anxiety disorder when it's with a single primary care doctor (versus ER/urgent care). It's actually one modality of treatment.

That's so weird, especially when you treat OCD, one modality is ERP and the aim is to NOT check excessively. I would think that encouraging frequent follow-up with the PCP would only enforce the checking tendencies, but I do remember being told that a good rapport with the PCP and follow up can be of benefit. .

 

[nitemagi]

I've read about this and seeking out a doctor is not necessarily bad in illness anxiety disorder when it's with a single primary care doctor (versus ER/urgent care). It's actually one modality of treatment.

No, you do not encourage the seeking it out, and just like in OCD do not delude yourself that reassuring the patient or doing more tests solves it. The classic teaching is to schedule regular appointments to interrupt the reinforcement cycle. Their visiting the doctor, even PCPs, is definitely not the treatment for this.

 

[splik]

Yes hypochondriasis is a form of OCD. There was a lot of debate about whether to include illness anxiety disorder in the OC-spectrum disorder category in DSM, but instead it went in the somatic symptom and related disorders category even though it has no relation to somatization or conversion. Part of the problem was the new system cuts hypochondriasis into illness anxiety disorder and somatic symptom disorder depending on the presentation. This is by far the worst category in DSM and I refuse to use these stupid and invalid concepts like "somatic symptom disorder". somatization was a perfectly useful construct and the treat is quite different from health anxiety (which responds well to OCD type treatment - i.e. SRIs and ERP). Incidentally they moved body dysmorphic disorder out of the somatoform disorders and into the OC-spectrum category, but left "illness anxiety" and "somatic symptom" nonsense. Not to go off on a tangent, but the main problem with "somatic symptom disorder" is that it is wastebasket for anything from people with hypochondriasis, to people who has a somatic idiom of distress, to people with medical illnesses that they are obsessively preoccupied about, to people with genuine physical symptoms who are naturally distressed about it.

 

[Liquid8]

I find that clinically they present very differently.

Hypochondriacs are usually resistant to seeing psychiatrists, because they are convinced they have a physical disorder and “not crazy”. They often think what they are doing in seeing multiple healthcare providers makes perfect sense – i.e. their thoughts are ego syntonic, not unlike patients with anorexia nervosa who restrict their food intake because they believe this is healthy.

With OCD, it is the opposite and there is often a recognition that what they are doing doesn’t make any sense at all. They might be very embarrassed to talk about it, but they’re usually willing to see anyone who can help stop what’s going on. Sometimes you get severe situations where the compulsions that originally reduce the anxiety take up so much time that patient with OCD who have obsessions about cleanliness ends up avoiding doing any cleaning due to the amount of time it takes leaving them living in squalor. Really haven’t seen that kind of equivalent in hypochondriasis, but I’d be interested to know from those who do more C/L work what they think.

 

[thoffen]

I find that clinically they present very differently.

Hypochondriacs are usually resistant to seeing psychiatrists, because they are convinced they have a physical disorder and “not crazy”. They often think what they are doing in seeing multiple healthcare providers makes perfect sense – i.e. their thoughts are ego syntonic, not unlike patients with anorexia nervosa who restrict their food intake because they believe this is healthy.

With OCD, it is the opposite and there is often a recognition that what they are doing doesn’t make any sense at all. They might be very embarrassed to talk about it, but they’re usually willing to see anyone who can help stop what’s going on. Sometimes you get severe situations where the compulsions that originally reduce the anxiety take up so much time that patient with OCD who have obsessions about cleanliness ends up avoiding doing any cleaning due to the amount of time it takes leaving them living in squalor. Really haven’t seen that kind of equivalent in hypochondriasis, but I’d be interested to know from those who do more C/L work what they think.

That's a good point, but worth noting that DSM 5 no longer requires that adults have insight into their obsessive beliefs. I have limited experience with illness anxiety disorder, but have seen at least ambivalence about them actually having an illness.

 

[nitemagi]

Yes hypochondriasis is a form of OCD. There was a lot of debate about whether to include illness anxiety disorder in the OC-spectrum disorder category in DSM, but instead it went in the somatic symptom and related disorders category even though it has no relation to somatization or conversion. Part of the problem was the new system cuts hypochondriasis into illness anxiety disorder and somatic symptom disorder depending on the presentation. This is by far the worst category in DSM and I refuse to use these stupid and invalid concepts like "somatic symptom disorder". somatization was a perfectly useful construct and the treat is quite different from health anxiety (which responds well to OCD type treatment - i.e. SRIs and ERP). Incidentally they moved body dysmorphic disorder out of the somatoform disorders and into the OC-spectrum category, but left "illness anxiety" and "somatic symptom" nonsense. Not to go off on a tangent, but the main problem with "somatic symptom disorder" is that it is wastebasket for anything from people with hypochondriasis, to people who has a somatic idiom of distress, to people with medical illnesses that they are obsessively preoccupied about, to people with genuine physical symptoms who are naturally distressed about it.

My research mentor was the chair of somatic sx d/o section for DSM5, and there were a lot of politics playing into the BDD thing. The purpose of many of the changes within somatization is purely for utility. Who sees a majority of these patients? Primary care doctors, specialists. Not psychiatrists. Non-psychiatrists are loathe to make diagnoses that something is "non-organic" or "medically unexplained." Thus the shift was made to the level of distress rather than the cause. The category as a whole, including IAD, was to contain the disorders most seen by non-psychiatrists and make it useful and understandable for those physicians. Now that choice of course has its own problems, but c'est la vie.

 

[WisNeuro]

I think we can all agree that the DSM is more about politics than "carving nature at its joints" when it comes to formulating disorders and placement of such into categories.

 

[Ceke2002]

I find that clinically they present very differently.

Hypochondriacs are usually resistant to seeing psychiatrists, because they are convinced they have a physical disorder and “not crazy”. They often think what they are doing in seeing multiple healthcare providers makes perfect sense – i.e. their thoughts are ego syntonic, not unlike patients with anorexia nervosa who restrict their food intake because they believe this is healthy.

With OCD, it is the opposite and there is often a recognition that what they are doing doesn’t make any sense at all. They might be very embarrassed to talk about it, but they’re usually willing to see anyone who can help stop what’s going on. Sometimes you get severe situations where the compulsions that originally reduce the anxiety take up so much time that patient with OCD who have obsessions about cleanliness ends up avoiding doing any cleaning due to the amount of time it takes leaving them living in squalor. Really haven’t seen that kind of equivalent in hypochondriasis, but I’d be interested to know from those who do more C/L work what they think.

This is really well put, and definitely mirrors my own observations and experiences.