What is hypochondriasis?
Hypochondriasis is an anxiety that manifests itself in and around the body. The patient with hypochondriasis constantly fears and believes that any bodily symptom that he or she experiences is attributable to a serious and/or malignant medical illness. A patient with hypochondriasis fears that she will die from this medical condition or she has a medical condition that is not diagnosable with appropriate clinical or physical examination and/or laboratory findings. This anxiety can take over the life of the patient’s mind. A hypochondriac with a pimple on his penis believes it can become a lethal, sexually transmitted disease. A numbness on the finger can cause concern that it is the first symptom of a brain tumor. Nausea can be interpreted as stemming from ovarian cancer, and that worry, like in any other condition, can mushroom into an all-consuming pattern. The evaluation and management of hypochondriasis usually responds best to regular visits with an internist or family medicine doctor who can reassure the patient, over time, that he is not dying. However, psychological treatment-if these anxious patients are willing to engage in it-can be markedly helpful. The key is to try to help the person see that the discomfort that she is feeling stems from anxiety rather than from a bodily condition, and to then focus on the patient’s need to create the anxiety rather than the actual somatic disturbance. Oftentimes, there will be a history in the family of someone who has been sick and has received love and attention for being sick. The patient then has a learned behavior of obtaining gratification by being in the sick role. It may create “legitimate” attention for a patient who does not attend a given family function, or it may be a means to get attention that otherwise would not be permissible in a family system. For example, a patient who harbors longstanding resentment and jealousy towards a sibling but knows that displays of frustration and aggression will only create family havoc might unwittingly find themselves in an emergency room on the day of the sibling’s graduation from college, being evaluated again for a brain tumor after experiencing a migraine headache.
Term:
Hypochondriasis – an exaggerated fear that one has an illness or disease based on a misinterpretation of a bodily symptom and without any medical basis.
What is obsessive-compulsive disorder?
Obsessive-compulsive disorder is characterized by intensive obsessions and/or compulsions which patients experience and which absolutely interfere with workings of their minds and lives. Obsessions are commonly known as worries, fears, thoughts, or feelings that one cannot stop thinking about. Hearingmusical passages, counting numbers, or repeating words over and over again may be other avenues of the anxiety’s expression. A compulsion, on the other hand, is a ritual that one performs to undo the fear that one experiences from the obsession. For example, if someone becomes intensely fearful of being dirty, then she might have the compulsion of washing her hands. If someone becomes fearful that he will set the apartment on fire, so he will combat the fear by repeatedly returning to the apartment to check the stove, etc., only to then do it all over again. Obsessive-compulsive disorder is not to be confused with an obsessive personality style found in someone who likes things to be arranged in a particular way or to be in control of any given project. Obsessive-compulsive disorder is a much higher level of private obsession and/or compulsion, which impairs someone’s life. In addition to impairing function, it can disintegrate a family structure inasmuch as family members become hostage to the patient’s symptoms. For example, if a patient insists that food be washed in a particular way, hours, and hours can be spent with the preparation of a meal.
Obsessive-compulsive disorder is generally treatable or at least manageable with the right kind of medication. However, understanding the context in which symptoms arise can also provide huge therapeutic relief. Patients often report experiencing the heightening of their obsessive-compulsive symptoms just as they feel an overwhelming flood of rage. So, it makes sense to consider the obsession as a method to distract the person from the very rage that he so feels and fears. Likewise, a connection between sexual urges and obsessive-compulsive preoccupation with the perceived dangerous consequences of acting on these sexual urges occurs time and again. Understanding these links can deepen both psychotherapeutic engagement and benefit.
Rick’s comments:
My OCD rituals mostly revolve around attempts to keep myself safe despite actions that I take that are self-destructive and dangerous. If I eat a very sugary dessert even though I am a diabetic, I might repeat the phrase “I’ll try to do better” every time I stand up or sit down. Do I really believe that this will keep me safe? No. Then again, a baseball pitcher
who makes certain that he doesn’t step on the white lines as he runs off the field doesn’t really believe that this will make his curve ball better; he does it as an attempt to gain additional control over his situation, to gain an edge beyond what his talent provides. Since it is easy for the player to avoid touching the lines, there is no risk of failing to fulfill this ritual and thus losing his “advantage” over the hitter. This is not OCD-it’s a simple, doable ritual which does not intrude on the player’s ability to function. What, however, if the white-lines skipping was only the beginning? What if the pitcher, in order to feel in control or safe, has to always throw curveballs to left-handed hitters, fastballs down the middle of the plate to right-handed hitters and only high pitches from the fifth inning on while the thought “I must not give up a home run” swirls endlessly around in his mind and he must avoid looking at the shortstop and left fielder during even innings. This is how OCD can intrude on, even ravage, a life, and it’s what people coping with OCD, including me, go through on a day-to-day basis. That’s why it’s good to know-very good to know-that it is treatable.
Term:
Compulsion – a behavior, such as washing one’s hands multiple times an hour, in response to an obsessive thought.
What is social phobia?
Social phobia is, in its essence, an extreme fear of social interactions. It can be experienced as being scared of riding the elevator at work, going on a date, eating in public, or presenting at a work conference. The patient expects the worst possible outcome. The life history of such a patient might involve a highly critical or substance-abusing parent who became disinherited and then attacked the patient when she was a young child. Perhaps these attacks occurred while the child did exciting things. The patient learned to associate feeling anxious with feeling excited. Social phobia, therefore, creates a kind of a compromise. The patient can keep a critical parent alive in her mind by keeping herself inhibited from progressing in life. While she recreates and remembers these painful times, she also keeps the hopes alive of rising in life (the elevator), sharing intimacy with close friends over a meal (the date or eating in public), or exhibiting her natural talents (the conference presentation), hopes about which all children regularly talk and fantasize.
