Samenvatting
Onterechte, angstoproepende cognities over de eigen gezondheid vormen de kern van hypochondrie. Maar de status van deze cognities is onduidelijk. Sommigen vinden ze ego-dystoon en benadrukken het obsessieve karakter ervan, anderen beschouwen ze als ego-syntoon gepieker. Verondersteld kan worden dat de hypochondere patiënt zijn negatieve gezondheidscognities soms onzinnig vindt, maar soms ook volkomen terecht, afhankelijk van de situatie. De interne dialoogtheorie stelt daarom dat er in het denken van de hypochondere patiënt niet één, maar twee ’ inhoudelijk tegengestelde ’ cognitieve schema's aanwezig zijn: een gezondheidsschema met geruststellende, en een ziekteschema met angstoproepende cognities. Elk schema wordt afzonderlijk en door een verschillende set van triggers geactiveerd. Het ene schema activeert bovendien het andere. Beide schema's komen even vaak voor en zijn even geloofwaardig. Het resultaat is een permanente twijfel over de eigen gezondheid bij de hypochonder. Een pilotstudie bevestigde de aanwezigheid en gelijkwaardigheid van de beide cognitieve schema's. De consequenties van de interne dialoogtheorie voor de behandeling van hypochondrie worden aangegeven.
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Abstract
Unjustified, catastrophizing health-related cognitions are the core of hypochondriasis. However, the status of these cognitions is unclear. Some regard them as ego-dystone and emphasize the obsessive aspects; others regard them as ego-syntone worrying. It was assumed that hypochondriac patients sometimes find their negative health cognitions senseless, but in other situations regard them as adequate. In the proposed, so called ‘internal dialogue theory’ it is therefore assumed that two opposing cognitive schemes characterize hypochondriacal thinking: a health scheme containing reassuring thoughts, and an illness scheme with anxiety-triggering cognitions. These schemes have equal credibility and both schemes are used with the same frequency. Each scheme is activated by a different set of triggers and activation of one schema may serve as a trigger for activation of the other, resulting in a permanent doubt about the status of the own health. A pilot study confirms the presence of both cognitive schemes. Consequences of the internal dialogue theory for the treatment of hypochondriasis are indicated.
Dr. A.J.M. Schmidt is verbonden aan het departement medische, klinische en experimentele psychologie, Faculteit der Geneeskunde van de Universiteit Maastricht.
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Schmidt, A. Hypochondrie als interne gezondheidsdialoog. DITH 21, 49–54 (2001). https://doi.org/10.1007/BF03060252
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DOI: https://doi.org/10.1007/BF03060252