Question

Please match the following case with its disorder type and specify which treatments would be effective. The options are Anxiety, Somatic symptoms, & Dissociative Disorder, personality disorders, mood disorders, eating disorders, Schizophrenia or other Psychotic Disorders. Additionally, please specify the subtype and prognosis.  

CASE #1

Present Illness: The client was a 24-year-old married woman coming to the clinic complaining of anxiety and stress. She was working part-time as a waitress and found her job extremely stressful. She had also discovered that her husband was having an affair with an old girlfriend and she had trouble getting the affair out of her mind. Her main concerns, however, were about her health. Any time she experienced minor physical symptoms such as breathlessness or a headache, she was afraid she had a serious illness. A headache indicated a brain tumor. Breathlessness was an impending heart attack. Other sensations were quickly elaborated into the possibility of AIDS or cancer. She was afraid to go to sleep at night for fear that she would stop breathing. She avoided exercise, drinking, and even laughing because the resulting sensations upset her. Public restrooms and, on occasion, public telephones were feared as sources of infection.

The major trigger of uncontrollable anxiety and fear was the news in the newspaper and on television. Each time an article or show appeared on the ‘disease of the month,’ she found herself irresistibly drawn into it, intently noting symptoms that were part of the disease. She even watched her dog closely to see whether he was coming down with the dreaded disease. Only with great effort could she dismiss these thoughts after several days. Real illness in a friend or relative would incapacitate her for days at a time.

Past history: Gail was married at 21 and looked forward to a new life. As one of many children in a lower-middle-class household, she felt weak and somewhat neglected and suffered from low self-esteem. An older stepbrother berated and belittled her when he was drunk. Her mother and stepfather refused to listen to her or believe her complaints. But she believed that marriage would solve everything; she was finally someone special. Unfortunately, it didn’t work out that way. She soon discovered her husband was continuing an affair with an old girlfriend.

Gail’s fears developed during the first year of her marriage, around the time she learned of her husband’s affair. At first, she spent a great deal of time and more money than they could afford going to the doctors. Over the years, she heard the same thing during each visit: “There’s nothing wrong with you; you’re perfectly healthy.” Finally, she stopped going, as she became convinced her concerns were excessive, but her fears did not go away and she was chronically miserable.

Mental Status: The client was dressed casually, but her clothing was clean and her appearance was unremarkable. Throughout the interview, she nervously plucked at her shorts, and shifted from side to side in the chair. Vocabulary was average, speech was somewhat concrete. She did make eye contact but shifted her gaze away when the questions were about her marriage. No obvious signs of delusions or hallucinations.

Answer 1

The client is suffering from Hypochondriasis which is a subtype of somatoform disorders.

The main symptom of hypochondriasis is excessive worrying about health. The worrying is so extreme that it leads to anxiety. Gail also worried excessively about her health. The following were her concerns :

Any time she experienced minor physical symptoms such as breathlessness or a headache, she was afraid she had a serious illness.

A headache indicated a brain tumor.

Breathlessness was an impending heart attack.

Other sensations were quickly elaborated into the possibility of AIDS or cancer.

She was afraid to go to sleep at night for fear that she would stop breathing.

She avoided exercise, drinking, and even laughing because the resulting sensations upset her.

Public restrooms and, on occasion, public telephones were feared as sources of infection.

The major trigger of uncontrollable anxiety and fear was the news in the newspaper and on television. Each time an article or show appeared on the ‘disease of the month,’ she found herself irresistibly drawn into it, intently noting symptoms that were part of the disease.

She even watched her dog closely to see whether he was coming down with the dreaded disease.

Real illness in a friend or relative would incapacitate her for days at a time.

Prognosis for hypochondriasis :

Individual psychotherapy which focuses predominantly on presenting complaints, fears and beliefs is helpful for the treatment of hypochondriasis. Antianxiety drugs can also be used. Good outcome is usually associated with illnesses of less than 3 years duration, the absence of an additional diagnosis of a personality disorder. It appears that the prognosis of treated hypochondriacal neurosis is good in a substantial proportion of patients.