View Full Version : The most important rules of HA
Hi all,
For some time now I've suffered with pretty extreme health anxiety and I have to advise anybody else with this horrible form of anxiety that there are some important rules which I've discovered....
Firstly and most importantly - get professional help.
Secondly and also very important for peace of mind - do not on any health care investigations mention that you suffer with anxiety or panic.
I know the second rule can be difficult when you're in a state and all sorts off horrible ideas are flowing through your mind but ultimately you will need to fend it off long enough to come away with a diagnosis you're happy with.
In the past months I have seen a cardiologist, a physiotherapist and most recently been to a&e with excruciating lower back spasms...
I was pretty much fobbed off by all the medical professionals I have seen because I mentioned that I suffer with anxiety...even though I wasn't showing myself in a particularly anxious state to them.
On a bright note I have had 3 ecg heart tracings which were all normal...bloods were normal apart from raised bilirubin and I can be happy about that I guess.
I do feel that investigation would have been more thorough on each occasion had I not been so honest as to mention that I do have a certain level of anxiety.
In each case my symptoms and especially pains were very real but as soon as anxiety is mentioned the healthcare professional in each case would simply stop looking for answers and near tell me to go away.
It is an extremely frustrating situation and one in which you can never get a satisfying answer for very real symptoms.
I hope this is helpful to anyone who is about to go for any medical tests or should you consider visiting an emergency room.
Kindest regards
D
Ps. I would also say try not to always think that every ache, pain or symptom is the herald of a most ominous and horrible illness but in the short term that isn't always so easy.
Have to disagree here. If you suffer from anxiety and panic then that is almost always a good indicator of why you're experiencing certain symptoms. If you neglect to tell the health professional about these conditions, it could lead them down the wrong path.
A big part of a doctors weaponry in diagnostics is the patient history, if they don't have a clear history then you could wind up being sent for all kinds of invasive scans and tests. For the health anxiety sufferer, this will do nothing but feed into the anxiety while at the same time pushing the idea that they actually do have something physically wrong with them.
Anxiety and panic are very real medical conditions, and to not tell a doctor about them whilst receiving examination is akin to not telling the doctor you suffer diabetes or something of that nature. It's really not advisable to keep this condition a secret until you get a diagnosis you're "happy with" because at the end of the day, that may very well turn out to be the wrong diagnosis, simply because you've left out a big piece of the puzzle and led the doctor down the garden path.
Yeah I totally agree. I would also say,(and I would only do these if things have been bothering you for a while and no one is doing anything cause they have an obligation to and too many people slip through the net, especially in the UK)
1. If you're at a GP appointment slightly exaggerate your symptoms, but downplay how much they bother you. 'Ive been having really bad stomach pains for 4 weeks now which I'm sure are just IBS or something but I just wanted to know what I can do about them.' Bad doctors deserve reverse psychology in my opinion.
2. Make sure you're clear at what exactly the symptom is and how long you have had it and when it occurs. Doctors hate ambiguity. None of 'oh it feels a bit like...' Or 'im not really sure.'. If you don't know when the symptom started think of the general date you think it did and go back a week- that week is the date of started, you are CERTAIN of it. Same with time it happens. Err on the side of caution of using the words 'on and off' and 'Random'.
3. Don't overwhelm them with symptoms, especially if you have a lot. Think of the think that is most bothering you and make an appointment for that and if there is more than one thing bothering you state symptoms that might be related in a single doctors appointment, are from the same system (ie circulatory or nervous), and at most I would say stick to 3 main symptoms. Make a another doctors appointment with a different doctor to discuss further symptoms and stick to the same rules. I wouldn't go and go back and see the same doctor, especially with a new 'set of symptoms' more than once a month, but even this can be a bit too much for more than 2 months in a row.
4. Don't talk too much, gps don't have time and also arent interested. Let them ask their questions and mentally scan their textbooks.
5. If they mention recent stress contemplate for a second then shake your head and say no like you genuinely cant think of anything. If they mention anxiety or somatoform steer that conversation away like your running from a bear. Somatoform on your file isn't good. If they mention past appointments say you've drastically reduced stress in the past months and this is just something uncomfortable that isn't seemingly going away despite your relaxed stare so you thought you better check. Be cool. Be casual. Act relatively happy and if nothing has come of the appointment politely ask why they don't think further investigation is necessary or when to come back. Be polity passive aggressive is its the end of the appointment and nothing has come of it. If they get a bit peeved with you just give up and get another doctor. A lot of them are jdiots but some are genuinely intelligent and wonderful professionals, you just have to keep trying.
Everyone deserves to be thoroughly checked and listened to.
You have to be reasonable with yourself though too hear. If you obviously suffer from health anxiety then have a conversation with yourself to really discern what's going on. If something is genuinely on/off and only occurs when you haven't drunk enough water logic points to nothing. Ask a friend if they've ever experienced it. But if stomach pains have been plaguing you, randomly but almost every day for weeks and weeks you NEED a doctor who isn't a moron and will listen.
It's true but if you are being referred for further investgations then the referral is usually written by your regular GP. So it's more than likely that he or she already knows about your anxiety. I have actually asked a couple of specialists if my GP wrote anything about anxiety in the referral letter. On at least two occasions the answer has been yes, Still the fact that my GP was willing to refer me in the first place shows that he didn't just discount my complaints as anxiety.
MyNameIsTerry
30-04-15, 09:20
Have to disagree here. If you suffer from anxiety and panic then that is almost always a good indicator of why you're experiencing certain symptoms. If you neglect to tell the health professional about these conditions, it could lead them down the wrong path.
A big part of a doctors weaponry in diagnostics is the patient history, if they don't have a clear history then you could wind up being sent for all kinds of invasive scans and tests. For the health anxiety sufferer, this will do nothing but feed into the anxiety while at the same time pushing the idea that they actually do have something physically wrong with them.
Anxiety and panic are very real medical conditions, and to not tell a doctor about them whilst receiving examination is akin to not telling the doctor you suffer diabetes or something of that nature. It's really not advisable to keep this condition a secret until you get a diagnosis you're "happy with" because at the end of the day, that may very well turn out to be the wrong diagnosis, simply because you've left out a big piece of the puzzle and led the doctor down the garden path.
I agree with telling doctors what they need to know but I also believe in "steering" a GP away from a lazy diagnosis. Make them work for their money and be assertive.
Some people have excellent GP's some people have poor ones. So, you are right when it comes to the excellent ones but Daniele may be right when it comes to the poor ones, the caveat being if they are prone to lazy diagnosis and blaming it on anxiety disorders.
The part bolded I wouldn't agree with. Anxiety symptoms overlap with a lot of other conditions and side effects of medications so they have to be diagnosed and part of that is ruling things out. Otherwise its all assumptions & generalisations.
I would also question how they could come to an incorrect diagnosis. I guess if they are working through a process of ruling things out and you stated "no" when asked about anxiety?
Say you don't tell your doctor that you suffer panic attacks, yet you go in complaining of dizziness. You'll most likely be referred to an ENT doctor, who then finds nothing. They then may refer you to a neurologist who can't find anything on examination so decides an MRI scan is needed. This can take months, and all the while your anxiety is cranking up to fever pitch as all these experts can't find an answer. What does the mind of a health anxiety sufferer do at this point? It tells you that you're seriously ill.
It may even get to a point where a clear MRI can't be accepted as you've now convinced yourself so much that you have a horrible illness, that's when the anxiety sufferer starts to think something has been missed etc. All the while this mystery symptom is being caused by anxiety and could have been diagnosed and treated in one GP visit.
I'm sorry, but you're both almost at the point of advocating lying to your doctor here, which is unfair on both you and the doctor.
MyNameIsTerry
30-04-15, 09:31
Given the timestamp I'm assuming you are aiming that at Danielle & Alice, Gary?
The reality is that when you go to your doctor, they will already know you have anxiety so your scenario won't ba happening anyway. That could only happen if you see a GP at a surgery for the first time because once you have a diagnosis of an anxiety disorder, its on your notes and if you move practice, they will have it too. In the case of someone with no recorded diagnosis of anxiety, I would agree and your example would be a good outline of the mess that would ensue.
Yes it is Terry, I only just read your response and it's a fair few points. Any doctor worth their salt should always seek to rule out serious medical ailments. Most of this can be done by simple blood tests and physical examination in the surgery. If a doctor is just saying "it's anxiety" without so much as laying a finger on you, then yes, that's poor form and I personally would be seeking another doctor in that instance. I accept some GP's are lazy, but I have to assume that for the most part they carry out their duties as they should and if not, tell them as much and ask pertinent questions such as "how are you so sure" and things like that.
In the OP's scenario they are suggesting keeping the anxiety a secret, so that would suggest to me that they're talking about a visit to an ER or some other scenario where the doctor doesn't already have a clear history on you.
MyNameIsTerry
30-04-15, 09:50
I agree, Gary.
I think being assertive is important. Its very hard for a lot of people early on and doctors do hold a certain level of authority that can make us feel it is inappropriate to challenge them but when it comes to mental health I guess we have to remember that we are not talking to specialists so should be able to ask them why & how.
An example I have of myself long before joining this place fits this. I had just started the standard dose of Duloxetine and raised a question over why I was experiencing adrenaline rushes upon waking despite never having them before. My GP said it was my anxiety, not the meds. By day 10 it had gone. It doesn't take a genuis to work that one out but my GP wouldn't have it. I wasn't assertive enough though and allowed his status to overrule me. No testing was ever going to be needed, its purely an example of how GP's can make assumptions with anxiety although there are many examples on NMP of GP's who don't do that and follow it up.
Since joining NMP I have learnt tons. I now would have the ammo to go into that situation and be able to win that argument.
The important thing is how you do it. The line of questioning should be like how you challenge anyone effectively by asking some leading questions. If they are wrong, they will trip themselves up somewhere or leave obvious gaps that you can explot with new questions.
Its very hard if you are very anxious though, your heads just not that tactical.
You are definately right about the ER scenario. There is the additional issue of putting someone else at risk in the process.
They were compiling a central database for medical records not long ago. Hopefully all doctors now have access but I seem to recall an opt out option?
I would often find myself saying to my GP "this isn't my anxiety" I even told him a number of times that I was concerned that he would just think my concerns were caused by anxiety. He always assured me that he never did that. I'm not so sure though. If you have a patient turning up an excessive number of times for a long period of time and almost every single one of their "illnesses" have turned out to be "imagined" then even the best doctor would find it hard not to entertain the thought that the latest "illness" was "imagined".
The thing is though, the physical symptoms of anxiety are seldom imagined, they're very real symptoms and they are caused by a bodily reaction to heightened stress. This is where I do agree that GP's fail at times, they don't really explain the mechanism behind the physical sensations, they just tell you it's caused by anxiety and leave it at that.
If, for instance, your GP tells you that your dizziness or rapid heart rate is caused by anxiety, then went on to explain the effects of adrenaline and hyperventilation on your nervous system, that would of course make more sense. It's very counter intuative to the layperson to think a mental issue can cause physical sensations, so I do wholeheartedly agree that doctors as a whole must put more effort into explaining the how and why, rather than just pointing to a diagnosis and expecting you to be satisfied.
MyNameIsTerry
30-04-15, 10:09
Well it is a pattern of behaviour so it could introduce an element of bias. I guess it comes down to the doctor remaining objective at all times. Its hard though.
Something I have found is that a young fresh doctor is less likely to make assumptions. Its true that as you gain experience you find yourself getting to conclusions more efficiently but this can bite you sometimes when you don't think everything through. I would hope doctors are more careful though.
Then you get the other end of the scale with GP's who just send people for tests "just in case". I know people on here have said there is a legal responsibility but I don't understand this because my impression was always that GP's don't authorise tests unless they think they are needed because the local trusts are on their backs to reduce these referrals. I thought they get penalised or put in some form of monitoring if they are seen to be excessive?
I've seen posts on here where a GP has advised someone to have the test as it will reassure them. Surely this is the worst thing they can do as they are just reinforcing the issue?
It almost feels like GP's need guidance issueing specifically to tackle this so its all done fairly.
Not having HA, I obviously can't see it on your side of the fence and can only comment as a GAD & OCD sufferer but at the same time I think its useful to comment on here about this because I think you need to know thats its not just where HA is present. Its just that you are far more likely to come across the stigma than I would.
countrygirl
30-04-15, 10:09
From my vast experience of health anxiety since a child I have found that with GP's at least then, once I became open about my health worries and had honest conversation with them that this helped enormously whereas when I was trying to hide the fact neither myself or the Dr got on as well as the Dr knew I had health anxiety but because I was hiding it from him he did not talk about it etc etc .
I now have a GP that I can talk to, admit what I am worrying about and he is happy to discuss in detail why he isn't worried but also happy to refer me if he thinks it will help me. This is one advantage of trying to see the same Dr .
Plus my anxiety cannot be hidden in any medical setting as all they ahve to do it take my pulse and blood pressure:) At this point I always have to say I have severe white coat syndrome !
MyNameIsTerry
30-04-15, 10:11
The thing is though, the physical symptoms of anxiety are seldom imagined, they're very real symptoms and they are caused by a bodily reaction to heightened stress. This is where I do agree that GP's fail at times, they don't really explain the mechanism behind the physical sensations, they just tell you it's caused by anxiety and leave it at that.
If, for instance, your GP tells you that your dizziness or rapid heart rate is caused by anxiety, then went on to explain the effects of adrenaline and hyperventilation on your nervous system, that would of course make more sense. It's very counter intuative to the layperson to think a mental issue can cause physical sensations, so I do wholeheartedly agree that doctors as a whole must put more effort into explaining the how and why, rather than just pointing to a diagnosis and expecting you to be satisfied.
In totally agree with that, Gary.
I wonder whether it stems partly from the old days when the attitude was "doctor knows best". I know my dad, who is in his seventies, is willing to just accept what his doctor says at face value.
So, is it just an older way of handling patients that is starting to become irrelevant?
My psychiatrist told me at one point not to even bother asking him to send me for any test at all because the answer would be no. According to him I could have every test known to man and when the last one was done I would start thinking that it had been a long time since I had those other ones so something might show now... I accepted that but it wasn't easy. I think my GP pointing out that I was exposing myself to unnecessary radiation was the thing that really got through to me.
MyNameIsTerry
30-04-15, 10:43
Thats something I know I see from only reading a small number of the threads on the HA board, people wanting to have new tests because the others were a while ago. Its almost like its a form of maintainence for the rest of their days.
I think its right that the professionals are assertive. When it comes to physical issues, they are certainly the best judge there. If something truly could be an issue, they would never put you at risk because they know they will get the consequences back.
I think it comes down to something CPE mentions in his sticky thread & blog, if you can say you have found that good doctor, let them be firm with you. I recall he had his GP deny tests.
From my OCD I know every time I engage in a ritual, I reinforce my own problems. HA & OCD share a lot in common that way.
I think you are right about the having a lot in common. I always say that I never experienced any type of HA until after the birth of my last child nearly 14 years ago. I've also said here that it all started with my eyes and a fear of going blind. That one still raises its ugly head now and then. But you know what is interesting Terry? I can remember when I was a little girl about 10 years old I had this thing where I had to close one eye, open it, close the other eye, open it, close the other eye again and so on 8 times. It had to be exactly 8 times. I would do it regularly. Eventually I stopped but as the years passed I would go through little periods when I would revert to doing it again so it wasn't just a childhood phase. It sounds very OCD doesn't it? It is the only obsessive behaviour that I can remember engaging in. I sometimes wonder though if that is where my HA first started.
countrygirl
30-04-15, 11:14
My psychiatrist told me at one point not to even bother asking him to send me for any test at all because the answer would be no. According to him I could have every test known to man and when the last one was done I would start thinking that it had been a long time since I had those other ones so something might show now... I accepted that but it wasn't easy. I think my GP pointing out that I was exposing myself to unnecessary radiation was the thing that really got through to me.
So true. I also have been exposed to enough radiation due to the old fashioned tests before ultrasound and mri. Even mri is new enough to not really know the very long term effects!
Your psychiatrist spoke the truth as we all know.
I think you get a larger dose of radiation with CT scans than you do with MRI. There are now CT scans which emit only low doses but only certain places have them. I think.
MyNameIsTerry
30-04-15, 11:30
They say OCD presents in childhood. I did some reflecting on this myself a while back and found a few behaviours that point to anxiety.
- I would put the top on my pen, take it off and put it back on again. This would repeat a few times.
- I can remember flicking the light switch on & off a few times.
Oddly, there was no anxiety involved, it was something I just did and didn't understand why.
This was at secondary school so I would be around 11-13 then.
I can also remember a period over a few weeks where I would need to keep using the toilet for a number 2 several times. I can remember also feeling worried about being able to access the school toilets because they were locked inbetween breaks so you needed a key of a teacher and it was a subject that was joked about by others if you used it. I would have been about 15 by then.
I can also remember skin picking earlier than this. I know that is something that is argued in on the OCD spectrum but at the moment it seems to be defined on its own, the same with the hair pulling.
After that, nothing aside from the skin picking. Then I hit my thirties and due to many years of living for the stress I didn't see the signs for the last 6 months, which I now know were warnings and bang, I started to have anxiety attacks at my desk. Thats when it all spiralled and some obsessive thinking over sleep & changing sleep routines became a problem. In the year leading up to me relapse, when I had been back in work and much better for a couple of years, I started to get much more obsessive. The relapse hit after a lot of sleep problems which are always an issue for me and I went off again. My GP tried Duloxetine this time and it did to me what that gamma ray machine did to the Incredible Hulk...within weeks I was flooded with endless routines all day long. It took me over a year to strip them back, it was horrendous.
So, I must have had the traits and it just needs the right trigger. For me, it was Duloxetine.
I find HA intriguing hence talking to people on here although I don't have the same issues. I like to try to understand others as it helps me to understand myself. From reading some things about HA I found that some professionals argue it should be on the OCD spectrum so it becomes a subtype or form of OCD. Currently there are 2 different diagnostic manuals that seem to be used (the US DSM version and the WHO ICD version, but the WHO ICD is due to take over soon I think) and these have a slightly different way of diagnosing HA. Both seem to make it a ruling out exercise. Where OCD is prsent in one, they diagnose it as part of existing OCD. BDD has to be ruled out as well (most likely because BDD seems to be classed as partly an OCD issue).
Then there is the issue that GAD can be used to swallow HA up which I'm not convinced about because obsessions are not necessarily part of GAD and neither is the compulsion style behaviour.
The difference is even defined as: HA means you are worried about already having something and OCD means you are worried about getting it. This seems to be disputed in some material as well and it seems so intertwined if they diagnose this way as I would have thought with HA that you can be both of those, whereas in OCD it is normally about HIV/AIDS, infections, psychiatric illness, etc and how you are trying to prevent developing them (but even people with OCD can fear they didn't do enough to stop it).
Its no wonder its hard to understand with all that going on!
Fair points, not disagreeing, not outrightly saying my way is best. Just some advice in my experience on what to do in a specific situation.
I would say err on the side of caution. If your symptoms are characteristic of panic attacks then yes pushing and pushing for a full body check up is ridiculous. But doctors nowadays especially in the UK really are under pressure and GPs are often out the loop and trying to cut back on money being spent due to that state of the government and economy etc etc ( ie they dont like doing tests).
If something, or many thing, is plaguing someone day in day out and they've tried a lot of things over a long period of time, investigations need to be done and its a doctors duty to help that patient feel well or at least take steps to rule out serious illness.
---------- Post added at 10:49 ---------- Previous post was at 10:37 ----------
Definitely agree with a&E though. Don't go unless its serious please and don't lie to people in a situation where very sicks people lives are at stake. Or go to a triage service in a hospital if you're not sure. Call 111, they will help and err on the side of caution for you. I banged my head a year ago and felt very dizzy and sick 9 hours later, called 111 who directed me to the wrong place who then directed me to A&E but I wouldn't have gone on my own in that situation.
I couldn't breathe not long ago and went to a triage in the hospital, they put me at the front of the que. Gave me an inhaler. Very helpful.
I think there is very little understanding of HA. My psychiatrist told me that when he was undertaking his training he was told by a mentor that it was unlikely that he would ever meet a true hypochondriac and after 30+ years he never had. According to him Health Anxiety is not the same thing as hypochondria.
MyNameIsTerry
30-04-15, 11:55
How did he define it? I know the DSM now has a specific term for it but I think the WHO manual left it under hypochondria (I would have to check that to be sure though)
As far as I'm aware, hypochondriasis is the assumption that you're seriously ill even in the absence of any physical symptoms. Health anxiety is the act of blowing already existing symptoms out of proportion. In my opinion, that's the major difference. Hypochondriacs believe they're ill with absolutely no reason, health anxiety sufferers do have symptoms but instantly attach the worst case scenario to them.
My diagnosis was panic disorder with hypochondria features.
---------- Post added at 21:04 ---------- Previous post was at 20:51 ----------
Yes Gary I agree. The problem is how exaggerated the symptoms become. For instance, you walk up 3 flights of stairs and get slightly breathless. This has been happening for years and it hasn't ever bothered you. You knew it was because you were out of shape. BUT one day it happens as usual and you focus on it. "Oh no isn't breathlessness one of the symptoms of heart disease" you ask yourself. Suddenly you start noticing how difficult it has become to breathe normally. You start trying to take deep breaths because you feel like your body is being starved of oxygen. Now you get breathless just walking from point A to point B. At some stage you turn up at Emergency convinced you are going to have a heart attack. They run tests and assure you nothing is wrong with your heart. You feel so relieved and make the long trek to your car without even a hint of breathlessness.
Just my two cents...
I find it disconcerting that there is a direct and implied sense in this thread to outright lie and/or avoid the aspect of one's anxiety with a medical professional.
Is there a valid point about a bias and attitude concerning mental illness from the medical profession? Yes, in some cases, and I would say in most cases here there is due to the very fact this is an anxiety forum and just about everyone here has several stories of running to the doctor, ER, A&E or whatever urgent care type facility there is in your country.
Many here have had more tests done than I have and I have had serious physical illnesses! A doctor worth anything at all, after spending $$$$$$'s in an education and countless hours studying and practicing medicine would be just irresponsible and downright stupid to put his/her career and professional life at risk to fob off something he/she thought were serious due to someone's admitted anxiety issues. I believe that's why they'll order tests initially. They have to cover their butts even if they think 100% it's anxiety.
People with anxiety get sick too. I'm not saying in any way shape or form they don't. Anxiety sufferers have REAL physical symptoms. Fact is, they're just not medically sinister in nature. There are good doctors and not so good doctors. Just keep in mind even a not so good doctor is a little better at recognizing a serious situation than Dr. Google is.
Positive thoughts
MyNameIsTerry
01-05-15, 06:31
FMP,
I agree with your opinion of how doctors would be crazy to take a chance that could cost them their careers. It makes no sense for them to do it, yet it sadly does happen. (NOTE: in now mentioning news reports, I can't remember EVER seeing anxiety involved, I just want to make that clear) I don't know about in your country but we get a lot of news articles about NHS staff and even failing NHS standards. In some cases we even get doctors involved in criminal activities and these are the rarest of all. We only hear about the more major stuff, forums can tell stories of the lesser issues and so I wonder whether the same statement is true when it comes to more minor ailments? I would hope the same standard of care is maintained though.
So, does this play in part in patient bias? I know people with HA are very sensitive to what they read just from the threads on here about it so does this also play a part in HA in that you can be more suggestible over standards of care because a completely non related area of the NHS has been found to be lacking, negligent or failing government standards.
I won't give examples because I fear they could be triggering for some but they have been splashed across the newspapers and on TV and its a bit depressing what we are seeing about the NHS. I have seen some about individual mental health issues and then we have the investigative reporters filming poor standards.
As a non HA sufferer, this does influence me a bit. It wouldn't influence me about the standard of the GP's at my surgery but it has influenced me about the one handling my case. This is because he has been proven to be quite poor so I think "well, he's like the other incompetants we read about" but I still see the other GP's the way I always did.
Its not an anxiety thing either in that respect, I've asked people withuot anxiety disorders and some are quite critical of the NHS. I found this was again because of individual issues in their own care so the news reporting seems to add on top.
---------- Post added at 06:31 ---------- Previous post was at 05:37 ----------
As far as I'm aware, hypochondriasis is the assumption that you're seriously ill even in the absence of any physical symptoms. Health anxiety is the act of blowing already existing symptoms out of proportion. In my opinion, that's the major difference. Hypochondriacs believe they're ill with absolutely no reason, health anxiety sufferers do have symptoms but instantly attach the worst case scenario to them.
This is the criteria os the current WHO ICD-10 which according to NICE is used in the UK.
The ICD-10 defines hypochondriasis as follows:
A. Either one of the following:
A persistent belief, of at least six months' duration, of the presence of a maximum of two serious physical diseases (of which at least one must be specifically named by the patient).
A persistent preoccupation with a presumed deformity or disfigurement (body dysmorphic disorder).
B. Preoccupation with the belief and the symptoms causes persistent distress or interference with personal functioning in daily living, and leads the patient to seek medical treatment or investigations (or equivalent help from local healers).
C. Persistent refusal to accept medical advice that there is no adequate physical cause for the symptoms or physical abnormality, except for short periods of up to a few weeks at a time immediately after or during medical investigations.
D. Most commonly used exclusion criteria: not occurring only during any of the schizophrenia and related disorders (F20-F29, particularly F22) or any of the mood disorders (F30-F39).
I checked to find F20-29 covers forms of Schizophrenia, psychotic and delusional disorders. F30-39 is various depressive episodal types, bipolar, cyclothymia, dysthymia, etc.
WHO don't make any comparison to other anxiety disorders hence comorbidity seems to be allowed. The US version, currently DSM-V, is a little different because it excludes BDD and will allow for a diagnosis to fit inside other anxiety disorders or somatoforms as long as it can be justified it better fits under them.
In the WHO ICD-10, Hypocondriacal Disorder is F45.2 under F45 Somatoform Disorders.
Here is the actual text from ICD-10 that covers Somatoform Disorders including Hypocondriacal Disorder. This is just the introduction:
F45 Somatoform disorders
The main feature of somatoform disorders is repeated presentation of physical symptoms, together
with persistent requests for medical investigations, in spite of repeated negative findings and
reassurances by doctors that the symptoms have no physical basis. If any physical disorders are
present, they do not explain the nature and extent of the symptoms or the distress and preoccupation
of the patient. Even when the onset and continuation of the symptoms bear a close relationship with
unpleasant life events or with difficulties or conflicts, the patient usually resists attempts to discuss the
possibility of psychological causation; this may even be the case in the presence of obvious depressive
and anxiety symptoms. The degree of understanding, either physical or psychological, that can be
achieved about the cause of the symptoms is often disappointing and frustrating for both patient and
doctor.
In these disorders there is often a degree of attention-seeking (histrionic) behaviour, particularly in
patients who are resentful of their failure to persuade doctors of the essentially physical nature of their
illness and of the need for further investigations or examinations.
Differential diagnosis. Differentiation from hypochondriacal delusions usually depends upon close
acquaintance with the patient. Although the beliefs are long-standing and appear to be held against
reason, the degree of conviction is usually susceptible, to some degree and in the short term, to
argument, reassurance, and the performance of yet another examination or investigation. In addition,
the presence of unpleasant and frightening physical sensations can be regarded as a culturally
acceptable explanation for the development and persistence of a conviction of physical illness.
Excludes: dissociative disorders (F44.-)
hair-plucking (F98.4)
lalling (F80.0)
lisping (F80.8)
nail-biting (F98.8)
psychological or behavioural factors associated with disorders or diseases classified elsewhere
(F54)
sexual dysfunction, not caused by organic disorder or disease (F52.-)
thumb-sucking (F98.8)
tic disorders (in childhood and adolescence) (F95.-)
Tourette's syndrome (F95.2)
trichotillomania (F63.3)
Here is the actual text from ICD-10 that covers Hypocondriacal Disorder.
F45.2 Hypochondriacal disorder
The essential feature is a persistent preoccupation with the possibility of having one or more
serious and progressive physical disorders. Patients manifest persistent somatic complaints or
persistent preoccupation with their physical appearance. Normal or commonplace sensations and
appearances are often interpreted by a patient as abnormal and distressing, and attention is usually
focused on only one or two organs or systems of the body. The feared physical disorder or
disfigurement may be named by the patient, but even so the degree of conviction about its
presence and the emphasis upon one disorder rather than another usually varies between
consultations; the patient will usually entertain the possibility that other or additional physical
disorders may exist in addition to the one given pre-eminence.
Marked depression and anxiety are often present, and may justify additional diagnosis. The
disorders rarely present for the first time after the age of 50 years, and the course of both symptoms
and disability is usually chronic and fluctuating. There must be no fixed delusions about bodily
functions or shape. Fears of the presence of one or more diseases (nosophobia) should be classified
here.
This syndrome occurs in both men and women, and there are no special familial characteristics (in
contrast to somatization disorder).
Many individuals, especially those with milder forms of the disorder, remain within primary care
or nonpsychiatric medical specialties. Psychiatric referral is often resented, unless accomplished
early in the development of the disorder and with tactful collaboration between physician and
psychiatrist. The degree of associated disability is very variable; some individuals dominate or
manipulate family and social networks as a result of their symptoms, in contrast to a minority who
function almost normally.
Diagnostic guidelines
For a definite diagnosis, both of the following should be present:
(a)persistent belief in the presence of at least one serious physical illness underlying the presenting
symptom or symptoms, even though repeated investigations and examinations have
identified no adequate physical explanation, or a persistent preoccupation with a
presumed deformity or disfigurement;
(b)persistent refusal to accept the advice and reassurance of several different doctors that there is
no physical illness or abnormality underlying the symptoms.
Includes:body dysmorphic disorder
dysmorphophobia (nondelusional)
hypochondriacal neurosis
hypochondriasis
nosophobia
Differential diagnosis. Differentiation from the following disorders is essential:
Somatization disorder. Emphasis is on the presence of the disorder itself and its future
consequences, rather than on the individual symptoms as in somatization disorder. In
hypochondriacal disorder, there is also likely to be preoccupation with only one or two possible
physical disorders, which will be named consistently, rather than with the more numerous and
often changing possibilities in somatization disorder. In hypochondriacal disorder there is no
marked sex
differential rate, nor are there any special familial connotations.
- 132 -
Depressive disorders. If depressive symptoms are particularly prominent and precede the
development of hypochondriacal ideas, the depressive disorder may be primary.
Delusional disorders. The beliefs in hypochondriacal disorder do not have the same fixity as those
in depressive and schizophrenic disorders accompanied by somatic delusions. A disorder in which
the patient is convinced that he or she has an unpleasant appearance or is physically misshapen
should be classified under delusional disorder (F22.-).
Anxiety and panic disorders. The somatic symptoms of anxiety are sometimes interpreted as signs
of serious physical illness, but in these disorders the patients are usually reassured by physiological
explanations, and convictions about the presence of physical illness do not develop.
In order to understand the other Somatoform Disorders you would need to read the rest but its a bit big to paste in here. It is interesting though because I can recall a thread not long ago about people who's focus would change from one to another as opposed to having long term themes and this fits into some of the others in this category.
A locum GP once told me never to volunteer that I had anxiety if I ever had to go to A&E. She said that they should find that out for themselves but offering the information would just make them jump to conclusions.
FMP, you have always received excellent care and attention for what are extremely serious and life-threatening conditions. I received outstanding medical care when I nearly died after giving birth to my daughter. My father received the very best of care at A&E on the last day of his life.
When there is an emergency the medical profession are second-to-none. When it comes to HA the medical profession just haven't got the patience (but they have got the patients!) Pardon the pun-it's not at all funny but priority will always go to physical illnesses.
MyNameIsTerry
01-05-15, 10:28
Thats interesting, Pulisa. Was that anxiety in general or specifically HA?
They really should have the checks built in to make an accurate diagnosis so its refreshing a GP perspective on it.
I'm with Gary the entire way through this thread. And like terry said (even though it's a very arduous task), finding a doctor who you can talk freely with about your symptoms and have them listen to you whilst also being very aware of your anxiety, is essential. It's not something we should hide or that they should discount. Some do and others don't but think too much about it. The key is learning to trust the doctors.
What I've found interesting is that there is a certain pattern to the way a post is written by an HA sufferer. Among other things, reassurance seeking stands out. Having read 10's of thousands of posts, I've come to recognize this. So much so that I can spot an HA sufferer via a post right away on the cancer boards.
Making the same connection, I would have to conclude that a medical professional can make the same connection too. How many times has there been a post about someone going to A&E etc. and being upset that the doctor started asking questions about being under stress and not addressing the physical concern etc.?... Being sent home or being told it was just anxiety? It's a very common theme and one I see here on a regular basis. Why do you think that is?
I get it concerning the NHS. Every country has a different way to handle their medical care. I didn't realize that doctors in the UK don't have to acquire malpractice insurance as everything is managed through the NHS. It's a different story in the US where malpractice insurance is a very expensive necessity of every physician. That being said, based on the population and the actual number of litigated claims in the UK, the incidence of malpractice is incredibly low. But yes, doctors are human, there are good and bad and people make mistakes.
Of course the bad incidents make news. After all, news is 90+% about negative things. They'll report one bad incident over a story about a doctor that saved someone's life any day.
I really do get it. When was diagnosed with cancer, I started out locally. I learned as much as I could concerning methods of treatment and researched hospitals. The local hospital had some iffy ratings for cancer treatment and that made me uncomfortable. I won't get into the details of what took place but after visiting Johns Hopkins (#1 for H&N in the US), it was a no brainer to seek treatment there. As was stated, finding a doctor you trust and addresses both your physical and mental well being is key.
But to outright lie, withhold information or exaggerate to get the attention one believes they need to feed the dragon? It hurts all involved and perpetuates the stigma of mental illness.
Positive thoughts
MyNameIsTerry
03-05-15, 04:42
What I've found interesting is that there is a certain pattern to the way a post is written by an HA sufferer. Among other things, reassurance seeking stands out. Having read 10's of thousands of posts, I've come to recognize this. So much so that I can spot an HA sufferer via a post right away on the cancer boards.
Making the same connection, I would have to conclude that a medical professional can make the same connection too. How many times has there been a post about someone going to A&E etc. and being upset that the doctor started asking questions about being under stress and not addressing the physical concern etc.?... Being sent home or being told it was just anxiety? It's a very common theme and one I see here on a regular basis. Why do you think that is?
I get it concerning the NHS. Every country has a different way to handle their medical care. I didn't realize that doctors in the UK don't have to acquire malpractice insurance as everything is managed through the NHS. It's a different story in the US where malpractice insurance is a very expensive necessity of every physician. That being said, based on the population and the actual number of litigated claims in the UK, the incidence of malpractice is incredibly low. But yes, doctors are human, there are good and bad and people make mistakes.
Of course the bad incidents make news. After all, news is 90+% about negative things. They'll report one bad incident over a story about a doctor that saved someone's life any day.
I really do get it. When was diagnosed with cancer, I started out locally. I learned as much as I could concerning methods of treatment and researched hospitals. The local hospital had some iffy ratings for cancer treatment and that made me uncomfortable. I won't get into the details of what took place but after visiting Johns Hopkins (#1 for H&N in the US), it was a no brainer to seek treatment there. As was stated, finding a doctor you trust and addresses both your physical and mental well being is key.
But to outright lie, withhold information or exaggerate to get the attention one believes they need to feed the dragon? It hurts all involved and perpetuates the stigma of mental illness.
Positive thoughts
Its something that is going to require understanding both sides of the argument and having enough detail to make a good call. Doctors do make mistakes or miss things and anxiety disorder sufferers inflate issues, read into things too much and can respond badly believing they have been misjudged or dismissed. I tend to assume nothing and wait for as many possible clues as possible to see who could be in the wrong or whether there could be a misconception.
We've got private GP's too over here and they seem to be getting more popular in some areas where the waiting times are bad and people can afford them. I would assume they have the same kind of insurance as your guys do. The NHS protects the rest and whilst its great having free care for all, nationalisation does bring a double edge because when its your time to complain, you have everyone against you.
I've worked in an industry that has gone through privatisation and there were arguments (good & bad) on either side but before they went private the customer was often fighting "the system" as opposed to a dept. That system brings a lot of power with it so they can choose the rules if they wish to and only the committed or wealthy will challenge it.
In terms of malpractice, yes I would imagine so. The NHS is quite adept at pay offs to keep things low profile too as we find out from time to time. Not considering the rogues, its the damaging news of entire hospitals placeed under investigation that I think could cause some worry. These are big events and exposed by those who regulate standards or whistleblowers. You just wouldn't expect to see something like this so its bound to knock peoples confidence in the profession.
I would never lie to a doctor about my symptoms or my anxiety. I do believe that after seeing the same patient with HA over and over again with their list of imaginary illnesses there exists the very real possibility that even the best doctor is going to be tempted to conclude that the latest illness is also imaginary. However if it has reached that point then one would need to wonder why the doctor hasn't referred the patient for counselling anyway. When my own doctor referred me he did so after I kept turning up with numerous concerns about my health. I remember him saying that my thinking had become morbid and it was time to see someone.
biggerthanmybody
09-05-15, 18:55
I know where you're coming from. I took Zoloft for 7 years (and I'm about to go back on it) and every time I would go to the dr and they took the medication history, even if I told them the Zoloft was for depression, not anxiety (which it really was for both but I'd only mention the depression), I could see it in their face - they immediately brushed off any concern I had as just being anxiety or depression. It's like they had the attitude "well you're on psych meds, so there's nothing physically wrong with you". And I wasn't going to the dr excessively or anything, IMO. In fact, I hate going to the dr - going to the dr is one of my biggest fears. So feeling brushed off or judged over taking an antidepressant just felt wrong.
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