Question

Briefly describe the presentation of two people. One is diagnosed with hypochondriasis and one is diagnosed with somatization disorder.

Answer 1

• Illness anxiety disorder is a recent term for what used to be diagnosed as hypochondriasis. People diagnosed with IAD strongly believe they have a serious or life-threatening illness despite few or no symptoms. Yet their concerns are very real to them.
• Even if they go to doctors and no illnesses are found, they are generally not reassured and their obsessive worry continues. IAD can also trigger worries in people who do have a physical illness that they are sicker than they really are. The disorder is not about the presence or absence of illness, but the psychological reaction.
  
• High level of anxiety and alarm over personal health status is experienced.
• Excessive health-related behaviors (e.g., repeatedly checking body for signs of illness) or shows abnormal avoidance (e.g., avoiding doctors’ appointments and hospitals).
• A person with somatization disorder is chronically preoccupied with numerous "somatic" (physical) symptoms over many years. These symptoms, however, cannot be explained fully by a non-psychiatric diagnosis. Nonetheless, the symptoms cause significant distress or impair the person's ability to function.
• The person is not "faking." Somatization disorder is a medical problem. The disorder, however, is probably related to brain functioning or emotional regulation rather than the area of the body that has become the focus of the patient's attention. The symptoms are real and are not under the person's conscious control.
• People with somatization disorder report multiple medical problems over many years, involving several different areas of the body. For example, the same person might have back pain, headaches, chest discomfort, and stomach or urinary distress. Women often report irregular periods. Men may report erectile dysfunction (impotence).
• People with somatization disorder do get diagnosable medical illnesses, too, so doctors must be careful not to dismiss symptoms too easily.
• A person with somatization disorder also may have symptoms of anxiety and depression. He or she may begin to feel hopeless and attempt suicide, or may have trouble adapting to the stresses of life. The person may abuse alcohol or drugs, including prescription medications.
• In somatization disorder the patient's attention is directed at the somatic symptoms themselves, whereas in hypochondriasis symptoms are generally less elaborate and the patient is concerned about a possible underlying illness.
• As a result, hypochondriacal patients experience higher levels of anxiety, whereas patients with somatization disorder experience lower levels of anxiety or no anxiety at all.