The Patient with Hypochondriasis

Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
New England Journal of Medicine (Impact Factor: 55.87). 12/2001; 345(19):1395-9. DOI: 10.1056/NEJMcp002896
Source: PubMed
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    • "In employees with temporary and moderate levels of health anxiety this may be enough to continue the process of RTW. In employees with persistent and high levels of health anxiety which result in hampering process of RTW a referral for cognitive behavioral therapy (CBT) is according literature the best intervention [26, 27]. "
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    ABSTRACT: The primary objectives were to compare the duration of sickness absence in employees with high levels of somatic symptom severity (HLSSS) with employees with lower levels of somatic symptom severity, and to establish the long-term outcomes concerning return to work (RTW), disability and discharge. Secondary objective was to evaluate determinants of the duration of sickness absence in employees with HLSSS. 489 sick-listed employees registered with five Occupational Health Physician (OHP) group practices were included in this study. We measured their baseline scores for somatic symptoms severity, depressive disorders, anxiety disorders, health anxiety, distress and functional impairment. The OHPs filled in a questionnaire on their diagnosis. A prospective 2-year follow-up was carried out to assess the long-term outcomes concerning sickness absence, and retrospective information was gathered with regard to sickness absence during the 12 months before the employees were sick-listed. The median duration of sickness absence was 78 days longer for employees with HLSSS. They more often remained disabled and were discharged more often, especially due to problems in the relationship between the employer and the employee. HLSSS, health anxiety and older age contributed to a longer duration of sickness absence of employees. High levels of somatic symptom severity are a determinant of prolonged sickness absence, enduring disabilities and health-related job loss. Occupational health physicians should identify employees who are at risk and adhere to guidelines for medically unexplained somatic symptoms.
    Journal of Occupational Rehabilitation 04/2010; 20(2):264-73. DOI:10.1007/s10926-010-9239-3 · 2.80 Impact Factor
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    • "Barsky [52] and Holder-Perkins et al. [53] recommend additional strategies that are helpful utilization and containment techniques. Physicians should focus on patient care rather than cure. "
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    ABSTRACT: Background Individuals with somatic preoccupation constitute a substantial number of primary care patients. Somatically preoccupied patients are challenging to primary care physicians for several reasons including patient complaints consuming a great deal of physician time, expense to diagnose and treat and strain on the physician-patient relationship. This paper examines and discusses how disruptions in early attachment relationships such as often occurs when a female is a victim of child sexual abuse may result in somatic preoccupation in adulthood. Treatment utilizing attachment theory Attachment theory provides a useful framework for primary care physicians to conceptualize somatic preoccupation. Utilization and containment techniques grounded in an understanding of attachment dynamics aid the physician in developing a sound physician-patient relationship. Successfully engaging the patient in treatment prevents misunderstandings that frequently derail medical care for somatically preoccupied patients.
    Osteopathic Medicine and Primary Care 02/2008; 2(1):6. DOI:10.1186/1750-4732-2-6
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    The Journal of hand surgery 07/2008; 33(6):985-7. DOI:10.1016/j.jhsa.2008.05.007 · 1.67 Impact Factor
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