BEING ILL WITH ILLNESS

According to the concept of Hypochondriasis, which is mentioned above and included in the Diagnostic Book of Mental Diseases DSM 5 under the title of Somatoform Disorders, the individual experiences a mental disorder characterized by the fear that he/she has a serious disease by passing the physical symptoms and sensations that he/she already has through a real and unreasonable evaluation framework. (Köroğlu, 2004) Although you are more likely to see people with this disorder in hospital environments than in their own homes, they have a tendency to talk more than the physicians who treat them, although they explain their complaints at length. In addition, although they are not diagnosed with a disease, they are not satisfied with a single physician, they want to get approval from another physician. However, they cannot be content with this, they also go through programs such as the internet, medical books, and health programs. In other words, they struggle with life and head in order to find a disease for themselves. In particular, although the most common disease of people with this disease is cancer, they can quickly diagnose themselves with the slightest symptom that can be seen in other diseases. 

How about briefly mentioning how this discomfort found its place in history?

In the early ages, the Ancient Greeks, together with Hippocrates, thought that the abdominal organs were the cause of the emotional disorders that people had, but the word “Hypochondrium” was used since these times, although it represented the underside of the ribcage. However, the treatment of hypochondriasis as a mental illness for the first time was expressed by Thomas Syendham. Pilowski, on the other hand, was the first modern researcher to examine hypochondriasis under three dimensions: excessive effort, fear of disease, and belief in disease. However, this disturbance was included in the DSM-II for the first time in 1968. (Hollifield et al, 2005)

So, what is the lifetime incidence of this disease, both in terms of gender and age?

Studies have shown that the lifetime incidence of hypochondriasis is between 1-5%. APA (2000). However, the incidence of this disorder is higher in gastroenterology, otolaryngology, neurology and endocrinology classes. (Hollifield et al, 2005) Although hypochondriasis is likely to occur at any age, it has generally been found to start in young adulthood. (APA, 2000) In addition, studies in general indicate that this disorder is seen equally in women and men. (Asmundson et al, 2001)

Where does the source of this discomfort come from, can we briefly mention the underlying causes?

In fact, although there is no definitive data on the etiology of somatoform disorders, no clear evidence has been found on the basis of hypochondriasis, whether there is a genetic transition or not. Many researches show that the fact that a person engages in such a mental struggle against his body and has somatic sensitivity shows that the experiences and learning experienced in childhood are important as the primary etiological factor. Here, it is seen that the symptom experienced by many children is almost the same as family members. Adult symptoms, on the other hand, are similar to the symptoms that parents can notice in childhood. (Hollifield et al, 2005)

If we briefly evaluate the cause of this discomfort through certain theories;

First of all, according to the psychodynamic approach, with the suppression and displacement of hostile impulses, depending on the prevention of the discharge of these impulses, there is an increase in tension in the organs or a narcissistic introversion and the transfer of libidinal emotions to the organs.

According to the cognitive approach, children who grow up under the influence of misconceptions and beliefs about their health, especially of anxious parents, may find themselves in automatic thoughts about their bodily sensations when they reach adulthood, such as whether I have a serious disease or whether I will die.

According to the Social Learning Theory, it is stated that the mislearning of the patient's role, which facilitates coping with problems in the early periods, and inappropriate living in adulthood cause this.

Another approach we will add here is that hypochondriasis should be evaluated within a type of Obsessive  Compulsive Disorder (OCD). Underlying this situation are obsessions that the person is seriously ill and compulsions that the person shows health-seeking behavior.

Is there no way for these people, who are almost afflicted with this disease, to be saved from being "sick", must they live for life?

Of course, there is a cure for this disorder, but the most important criterion is that the individual is willing to undergo this treatment and does not show resistance. Frequent and regular examinations of these patients will make them feel that they are taken seriously by their doctors and, as a matter of fact, will give them confidence in their doctors. In this environment of trust, attention should be shifted in different directions so that the patient does not constantly focus on his symptoms. (Köroğlu, 2004). The patient should be prevented from going around, and the purpose of the drug given to him/her should be clearly stated. (Köroğlu, 2007)

Especially, Cognitive therapy, behavioral therapy, cognitive behavioral therapy, behavioral stress management and psychoeducation have all been found to be effective in reducing hypochondriasis. ||(Thomson, 2007). It has been observed that the "in vivo exposure  and response prevention" technique, which is accepted as one of the behavioral treatment directions, is very effective in the treatment of hypochondriasis. Within the scope of Cognitive Behavioral Therapy, it is aimed to transform dysfunctional and automatic thoughts that cause the individual to think without affirmation into various alternative thoughts. (Hoffman et al., 2013) Within the framework of this approach, while the therapist and the patient actively cooperate in the sessions, first of all, current problems are examined and focused on this day, and it is aimed to be one's own therapist in a sense by proposing a number of solutions in order to solve the problems they encounter throughout their lives. (Şahin, 2014) 

Health is very important to every person, but if you're at a point where your health is in trouble, a point where you really can't get out, don't hesitate to get support from a health professional. The most important key to getting through this process is to be aware of what you are doing and to act in accordance with the right information and advice in order to increase your awareness.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed, text rev). Washington, DC: Author.

Asmundson GJG. Taylor S. Sevgur S. Cox BJ. Health anxiety: Classification and clinical features. In G. J. G. Asmundson, S. Taylor, & B. J. Cox (Eds.) Health anxiety: Clinical and research perspectives on hypochondriasis and related disorders (pp. 3 of 21 New York: Wiley.

Çetinkaya, E. and Özer, Ö (2021). Hamidiye Medical Faculty Student Lecture Notes Mental Health and Diseases. Istanbul: University OF Health Sciences

Köroğlu E. Psychonosology. Descriptive Clinical Psychiatry. Ankara: Physicians Publication Union, 2004: 381-408.

Köroğlu E, Güleç C. Basic Book of Psychiatry. Second edition, Ankara: HYB Basım Yayın, 2007: 386-389.

Hollifield MA. Somatoform Disorders. In: Kaplan HI, Sadock BJ. editors. Comprehensive Textbook of Psychiatry 8th ed. Lippincott Williams & Wilkins; 2005; 1800-1828.

Hofmann SG, Asmundson, G. J., & Beck, A. T. T. The science of cognitive therapy. Behavior Therapy. 2013; 44:199- 212.

Judith S. Beck TGP. Cognitive Behavioral Therapy: Basics and Herbs. Şahin M, editor: Nobel Academic Publishing;

Thomson AB, Page LA. Psychotherapies for hypochondriasis. Cochrane Database Syst Rev 2007; 4: CD006520.