Hypochondriasis (Hypochondriacal Neurosis)

Exaggerated concern for one’s physical health; unrealistic interpretation of signs or sensations as abnormal; preoccupation with fear of having serious disease, despite medical reassurance of no diagnosis of physical disorder.

1. Assessment:
   1. Preoccupation with symptoms; sweating, peristalsis, heartbeat, coughing, muscular soreness, skin eruptions.
   2. Occurs in both men and women in adolescence, 30s, or 40s.
   3. History of long, complicated shopping for doctors and refusal of mental health care.
   4. Organ neurosis may occur (e.g., cardiac neurosis).
   5. Personality trait: compulsive.
   6. Prevalence of anxiety and depression.
   7. Controls relationships through physical complaints.
2. Analysis/nursing diagnosis:
   1. Personal identity disturbance related to perception of self as ill in order to meet needs for dependency, attention, affection.
   2. Displaced anxiety related to inability to verbalize feelings.
   3. Fear related to not being believed.
   4. Powerlessness related to feelings of insecurity.
   5. Altered role performance: disruption in work and interpersonal relations related to regression and need gratification through preoccupation with fantasized illness; and related to control over others through physical complaints.

4. General nursing care plans/implementation for somatoform disorders:
   1. Long-term goals:
      1. Develop interests outside of self. Introduce to new activities and people.
      2. Facilitate experiences of increased feelings of independence.
      3. Increase reality perception and problem-solving ability.
      4. Emphasize positive outlook and promote positive thinking. Reassure that symptoms are anxiety related, not a result of physical disease.
      5. Develop mature ways for meeting affection needs.
   2. Short-term goals:
      1. Prevent anxiety from mounting and becoming uncontrollable by recognizing symptoms, for early intervention.
      2. Environment: warm, caring, supportive interactions; instill hope that anxiety can be mastered.
      3. Encourage client to express somatic concerns verbally. Encourage awareness of body processes.
      4. Provide diversional activities.
      5. Develop ability to relax rather than ruminate or worry. Help find palliative relief through anxiety reduction (slower breathing, exercise).
   3. Health teaching:
      1. Relaxation training as self-help measures.
      2. Increase knowledge of appropriate and correct information on physiological responses that accompany anxiety.
      
      
5. General evaluation/outcome criteria:
   1. Does not isolate self.
   2. Discusses fears, concerns, conflicts that are self originated and not likely to be serious.
   3. Decides which aspects of situation can be overcome and ways to meet conflicting obligations.
   4. Looks for things of importance and value.
   5. Deliberately engages in new activities other than ruminating or worrying.
   6. Talks self out of fears.
   7. Decrease in physical symptoms; is able to sleep, feels less restless.
   8. Makes fewer statements of feeling helpless.
   9. Can freely express angry feelings in overt way and not through symptoms.