Hypochondriasis, also known as hypochondriac neurosis, is a condition in which the patient fears or believes that he or she is suffering from one or more serious physical illnesses, complains of physical symptoms, repeatedly seeks medical attention, and is often accompanied by anxiety or depression, despite repeated negative medical tests and medical explanations from doctors that there is no corresponding illness. The disease mostly develops before the age of 50, is a chronic fluctuating course, and can occur in both men and women. Etiology 1. Personality basis The personality characteristics of being withdrawn, stubborn, introverted, overly concerned with oneself, sensitive, egocentric, narcissistic, narrow interests, timid, vulnerable, and suggestive can be the basis for the development of hypochondria. 2. Social environment factors When one learns that one’s relatives or friends have died of a serious disease, one may suspect that one will follow suit. If you see someone else has liver cancer, you will feel discomfort in the liver area. Inappropriate remarks of doctors, excessive medical instruments, unnecessary and excessive treatment, unnecessary surgery, etc. may all contribute to the generation of suspicion. Somatic factors People in adolescence or menopause are prone to some somatic sensory changes and autonomic instability symptoms, such as palpitations, hot flashes, development or atrophy of reproductive organs, etc. Unreasonable perception of such physiological phenomena may contribute to the generation of the concept of hypochondriasis. 4, psychological factors Some people believe that the disease is caused by perceptual and cognitive abnormalities. The patient’s cognitive system may make inappropriate interpretations of some somatic sensations and changes, leading to hypochondriacal concepts. The basic feature of the disease is the persistence of the preoccupation concept that one is suffering from one or more serious progressive diseases or currently unrecognized physical diseases. Patients show excessive concern for their health and any slight changes in their body, and make hypochondriacal explanations that do not correspond to their actual health status. Suspicious symptoms can be general discomfort, pain or dysfunction in a particular area, or even a specific illness. Symptoms are varied, ranging from well-localized and clearly described sensations such as a swollen liver, the experience of gastrointestinal torsion, a feeling of head congestion, and a blocked throat, to discomfort that is poorly localized and vague in nature. Pain is the most common symptom, and in terms of location, the head, neck, back, and chest are predominant. Somatic discomfort symptoms can involve different organs, such as nausea, acid reflux, diarrhea, palpitations, chest pain, and dyspnea. Some patients are suspected to have irregularities of the five senses, especially the nose, ears and breasts, and also complain of body odor or sweating. This is often accompanied by anxiety, apprehension, fear and symptoms of vegetative dysfunction. Patients cannot believe and accept the negative test results and doctors’ explanations, but still insist on their suspicion and continue to go to various hospitals repeatedly for examination and treatment. Since most or all of the patient’s attention is focused on health problems, so much so that it obviously affects daily study, work, life and interpersonal communication. Diagnosis 1.Meets the diagnostic criteria of neurosis. 2.Suspicious symptoms as the main clinical signs, manifested as at least one of the following. (1) Excessive worry about physical health or illness, the severity of which is clearly disproportionate to the actual situation. (2) Hypochondriacal explanation of the usual physical phenomena and abnormal sensations. (3) A firm suspicion of illness that lacks sufficient basis, but is not delusional. (3) Repeated visits to the doctor or repeated requests for medical examination, but negative test results or reasonable explanations from the doctor do not dispel the concern. 4.Excluding the diagnosis of obsessive-compulsive disorder, depression, and paranoid psychosis, the symptoms of hypochondriasis are not limited to panic attacks. Differential diagnosis Organic diseases Some systemic systemic diseases such as multiple sclerosis, systemic lupus erythematosus, thyroid disease, etc. Therefore, a thorough examination is required to rule out relevant somatic disorders before diagnosing hypochondriasis. Depression is most often associated with symptoms of hypochondriasis. Patients with major depression often have some biological symptoms, such as early awakening, morning-heavy circadian rhythm changes, weight loss and psychomotor retardation, and self-condemnation, which can be distinguished. Occult depression should be distinguished from hypochondriasis. Occult depression conceals the nature of depression with somatic symptoms, but often achieves significant results with antidepressant treatment, whereas hypochondriasis is more difficult. Somatization disorders Patients with hypochondriasis focus on the disorder itself and its future consequences, and their preoccupation involves only one or two somatic disorders. Patients with somatization disorders, on the other hand, are more concerned with specific somatic complaints and their complaints often change and involve a wider range of systems. Anxiety and panic disorders Somatic symptoms during anxiety are sometimes interpreted by patients as signs of a serious somatic illness, but patients with these disorders are usually able to accept the medical explanations given by their physicians and feel reassured, and are not convinced that they have a particular somatic illness. Schizophrenia Early symptoms of hypochondria, but their content is mostly bizarre and variable, often with thought disorders and perceptual disturbances, and the patient does not actively seek treatment, can be identified. Treatment After somatic diseases are excluded and the diagnosis is clear, patients should be advised to stop all kinds of unnecessary tests. Treatment of hypochondria is generally based on psychotherapy, supplemented by medication. Psychotherapy The main treatment is supportive psychotherapy, which starts by listening to the patient patiently and carefully, allowing them to present the results of various tests, and holding a sympathetic and caring attitude. Establish a good relationship with the patient, and guide the patient to realize that the nature of his disease is not a physical disease but a psychological disorder on the basis of his trust in the doctor. Based on the recognition and acceptance that the patient does have significant somatic discomfort, provide a scientific and reasonable explanation of the nature of the disease and avoid dwelling on the discussion of the symptoms themselves. In addition, environmental shifts, lifestyle changes, and participation in various social activities can divert the patient’s attention and lead him or her to do another interesting thing, which can also lead to some improvement. Morita therapy can be useful in eliminating hypochondria. Cognitive-behavioral therapy techniques can provide new information to help patients change their perception of their symptoms, from enabling them to recognize the real cause of these somatic symptoms. Medication Medication is mainly aimed at depression, anxiety and other emotional symptoms of the patient, and can be used anti-anxiety and antidepressants such as selective 5-hydroxytryptamine reuptake inhibitors, benzodiazepines and so on. For cases that are really difficult to treat, small doses of atypical antipsychotics, such as quetiapine and risperidone, can be used to improve the efficacy. Recently, we often encounter patients who feel some physical discomfort, such as numbness, tingling, burning sensation, pain, hiccups, nausea, and discomfort in the precordial area, and others who feel some serious illness when they feel uncomfortable. Although repeated laboratory tests, CT, MRI and other tests do not show any abnormality, the doctor repeatedly explains that there is no problem, but also cannot dispel the patient’s concern, and even complains that the doctor’s attitude is bad or the level is too poor. These patients usually go to general hospitals such as medical universities and city hospitals, and do not think that they have psychological problems, and finally they are referred to our psychological hospital for treatment. This not only delays the treatment, and the patient is not treated for a long time, causing suffering.