Abstract
Objective:To examine the views hypochondriacal patients have of their physicians, and their physicians’ assessments of the hypochondriacal patients.
Design:A sample of patients meeting DSM-III-R diagnostic criteria for hypochondriasis was obtained by screening consecutive medical outpatients. They underwent a battery of self-report questionnaires and structured interviews, their medical records were audited, and their physicians completed questionnaires about them. A random sample of nonhypochondriacal patients from the same clinic served as a comparison group.
Setting:A large general medicine outpatient clinic of an academic teaching hospital.
Patients:41 DSM-III-R hypochondriacs and 71 comparison patients.
Measurements and main results:Hypochondriacal patients were more dissatisfied with their physicians than were comparison patients. Physicians rated the hypochondriacal patients as more frustrating to care for, more help-rejecting, and more demanding. Physician ratings of how hypochondriacal their patients were correlated significantly with their ratings of how frustrating they considered the patients (R2=0.36)and with objective measures of how hypochondriacal the patients were (incremental R 2=0.08).Physician estimates of anxiety and depression in the hypochondriacal patients were not statistically related to patient anxiety and depression. In contrast, physician estimates of patient anxiety and depression were significantly associated with the presence of anxiety and depression in comparison patients.
Conclusions:The physician’s use of the term hypochondriasis is closely associated with his or her frustration with the patient and is associated with objective measures of the extent of hypochondriacal symptoms. In addition, the presence of DSM-III-R hypochondriasis impairs the physician’s accuracy in assessing the levels of the patient’s anxiety and depression.
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References
Barsky AJ, Klerman GL. Overview: hypochondriasis, bodily complaints, and somatic styles. Am J Psychiatry. 1983;140:273–83.
Brown HN, Vaillant GE. Hypochondriasis. Arch Intern Med. 1981;141:723–6.
Lipsitt DR. Medical and psychological characteristics of “crocks.” Psychiatr Med. 1970;1:15–25.
Ford CV. The somatizing disorders: illness as a way of life. New York: Elsevier Biomedical, 1983;76–97.
Kellner R. Somatization and hypochondriasis. New York: Praeger, 1986.
Kuch JH, Schuman SS, Curry HB. The problem patient and the problem doctor or do quacks make crocks? J Fam Pract. 1977;5:647–53.
Diagnostic and statistical manual of mental disorders, third edition—revised. Washington, DC: American Psychiatric Association, 1987.
Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry. 1967;113:89–93.
Pilowsky I. A general classification of abnormal illness behaviors. Br J Med Psychol. 1978;51:131–37.
Beaber RJ, Rodney WM. Underdiagnosis of hypochondriasis in family practice. Psychosomatics. 1984;24:39–45.
Handback JW, Revelle W. Arousal and perceptual sensitivity in hypochondriacs. J Abnorm Psychol. 1978;87:523–30.
Kasteler J, Kane RL, Olsen DM, Thetford C. Issues underlying prevalence of “doctor-shopping” behavior. J Health Soc Behav. 1976;17:328–39.
Derogatis LR, Lipman RS, Covi L, Rickels K, Uhlenhuth EH. The Hopkins Symptoms Check List (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.
Derogatis LR, Rickels K, Uhlenhuth EH, et al. The Hopkins Symptom Check List. In: Pichot P, Oliver-Martin R, eds. Psychological measurements in psychopharmacology. Basel, Switzerland: Karger, 1981;79–110.
Lipman RS, Covi L, Shapiro AK. The Hopkins Symptom Check List (HSCL): factors derived from the HSCL-90. Psychopharmacol Bull. 1977;13:43–5.
Barsky AJ, Wyshak G, Klerman GL. Hypochondriasis: an evaluation of the DSM-III criteria in medical outpatients. Arch Gen Psychiatry. 1986;43:493–500.
Robins LN, Helzer JE, Croughan J, Ratcliff. National Institute of Mental Health Diagnostic Interview Schedule: its history, characteristics, and validity. Arch Gen Psychiatry. 1981;38:381–9.
Hyler SE, Rieder RO, Spitzer RL, et al. Personality Diagnostic Questionnaire-R. New York: New York State Psychiatric Institute, 1987.
Hyler SE, Lyons M, Rieder RD, Young L, Williams JBW, Spitzer RL. The factor structure of self-report DSM-III Axis II symptoms and their relationship to clinicians’ ratings. Am J Psychiatry. 1990;147:751–7.
Jette AM, Davies AR, Cleary PD, et al. The Functional Status Questionnaire: reliability and validity when used in primary care. J Gen Intern Med. 1986;1:143–9.
Barsky AJ, Wyshak G, Klerman GL. The relationship between hypochondriasis and medical morbidity. Arch Intern Med. 1991;151:84–8.
Groves JE. Taking care of the hateful patient. N Engl J Med. 1978;298:883–7.
Bender D. A reexamination of the crock. In: Wahl CW, ed. new dimensions in psychosomatic medicine. Boston: Little, Brown & Co., 1964;273–81.
Katon W, Williamson P, Ries R. A prospective study of 60 consecutive psychiatric consultations in a family medicine clinic. J Fam Pract. 1981;13:47–55.
Oxman TE, Harrigan J, Kues J. Diagnostic patterns of family physicians for somatoform, depressive, and anxiety disorders. J Fam Pract. 1983;17:439–46.
Barsky AJ, Wyshak G, Klerman GL. Medical and psychiatric determinants of outpatient medical utilization. Med Care. 1986;24:548–60.
Parker G, Lipscombe P. The relevance of early parental experiences to adult dependency, hypochondriasis, and utilization of primary physicians. Br J Med Psychol. 1980;53:355–63.
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Supported by research grant MH 40487 from the National Institute of Mental Health.
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Barsky, A.J., Wyshak, G., Latham, K.S. et al. Hypochondriacal patients, their physicians, and their medical care. J Gen Intern Med 6, 413–419 (1991). https://doi.org/10.1007/BF02598162
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DOI: https://doi.org/10.1007/BF02598162