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By Catherine Robertson Souter
Hypochondriasis has long been a difficult diagnosis for the medical
and mental health professions. How should you treat someone who
falls under both areas? Should you treat the physical symptoms or
the belief system that lies below them?
In a recent study done at Boston's Brigham and Women's Hospital,
researchers have found promising evidence that hypochondriasis can
be treated with mental health intervention.
In the study, patients participated in an experimental, six-session
cognitive behavioral treatment (CBT) program where therapists used
"tightly scripted" intervention. In addition, the patient's primary
care physician received a detailed letter on how to work with that
patient during the clinical study with suggestions for medical management.
Subjects were given an assessment before the treatment and both
6 and 12 months following it.
Compared to a control group who did not receive the CBT program
or the doctor's letter, the study patients showed improvement after
a one-year period. They felt better, reported fewer symptoms and
diminished anxiety about their health and were more comfortable
socially and in day-to-day activities.
"We now have solid data demonstrating that specific, focused treatment
can offer long-term benefits to a population that has been somewhat
lost in our healthcare system and until now often left without accepted
treatment options," says study author Arthur Barsky, M.D., Brigham
and Women's director of psychiatric research and a professor of
psychiatry at Harvard Medical School.
The treatment did not result in a reduction in somatic symptoms,
which the authors said was expected. The treatment, they explain
in the published work, was designed to improve the patient's ability
to cope with the symptoms rather than to cure them. According to
the report, the results suggest that a realistic goal in treating
hypochondriasis would be the amelioration of "fears and beliefs…rather
than the elimination of somatic symptoms per se."
The study, published in the March 24 issue of the Journal of the
American Medical Association, was the first major U.S. trial to
test a specific therapy for hypochondriasis, according to a hospital
spokesperson. Nearly five percent of medical outpatients in the
U.S. are hypochondriacal. With no validated treatment for the condition,
hypochondriasis was often treated with antianxiety drugs to help
the patient deal with their fears.
"This very important study is the latest product of Barsky's research
into hypochondriasis, a prevalent, functionally impairing, and costly
disorder which distresses both its sufferers and their caregivers,"
says Jonathan F. Borus, M.D., chairperson of the department of psychiatry
and professor of psychiatry at Harvard Medical School. "This effective
treatment has the potential to have a major impact on these patients'
lives and also help decrease their use of costly medical care that
in the end does not successfully relieve their symptoms."
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