Patient Education

Educational approaches provide accurate information, allowing the patient to realize somatic
symptoms are exceedingly common, with only a small proportion caused by disease and most compatible
with physical health.
Accurate information about the relationship of a threatening stimulus and its somatic
consequences can influence the severity of autonomic responses, subjective distress, and behavior.
Maladaptive iatrogenic beliefs must be countered. Providing a small amount of information at a
time and repeating it is best.
For excellent patient education resources, visit eMedicineHealth's Mental Health
Center and Depression Center. Also, see eMedicineHealth's patient education article Chronic Fatigue
Syndrome.
For mild and short-lived symptoms, the primary medical provider could provide detailed education
(symptoms, course, monitoring, diagnosis, and treatment) about the medical condition about which the
patient is concerned.
Education should additionally focus on the role of anxiety and how anxiety could increase
autonomic activity or arousal and, thereby, cause the body to misattribute certain physical sensations and
symptoms.
For more persistent and chronic hypochondriasis, especially in situations where the patient has
already failed treatment with multiple providers, education needs be delivered in small doses, when the
time is right, and after the establishment of a firm patient-provider relationship.
The tailoring of education delivery as applied to mild versus severe symptoms has not been
systematically studied.
Since hypochondriasis may be precipitated by psychosocial stress, family support is likely to be
additionally helpful. However, the role of family education requires further investigation.
Even in the absence of formal research into family education for hypochondriasis, several practical
pointers are recommended:

The patient needs to give permission to involve family members in diagnosis and treatment
planning decisions.
Family members need to be told that the physician will not keep secrets from the patient; ie,
anything family members tell the physician about the patient will be shared, with direct attribution, to the
patient.
Family members need to understand that the distress the patient feels is real even if the
conviction about illness is false or cannot be substantiated.
Family members should not enable overuse of medical services by reinforcing patients requests
for excessive interventions.
Family members should be encouraged to support the outpatient chronic disease model for
hypochondriasis as described above.
Family members should be educated on the common psychiatric comorbidity of hypochondriasis
and help the patient self-monitor for mood and anxiety symptoms and seek help for these separately.
Family or couples therapy should be considered in patients where family and marital discord is a
major source of conflict that is contributing to psychological distress. Alternatively, family therapy should
be considered in patients whose symptoms have cause major distress to family dynamics that either
seem to perpetuate current symptoms.
Given that these patients are often comfortable with computer searches, websites specific to
hypochondriasis may be helpful to recommend to patients and families: