'And what if you were wrong, Doctor?' A narrative illustration of the hypochondriacal vicious cycle
Keywords:
Hypochondriasis, Illness anxiety disorder, Narrative medicine, Stomach neoplasmsAbstract
A 59-year old man suffers from illness anxiety disorder. The patient, caught in a hypochondriacal vicious cycle, is convinced of having stomach cancer although medical practitioners have discarded such a diagnosis. He requires them to prove him wrong; however, he distrusts the rigor with which medical examinations of his stomach are carried out, and so the cycle continues. Narratives are known to help one make sense of one's own, and also of other people's actions and intentions. The author shares a narrative that represents a patient's speech which was translated from Spanish into English by the author. By de-constructing the patient's narrative, the author aims to demonstrate how a narrative approach can help doctors to empathize with hypochondriacal patients, earn their trust, and break the vicious cycle of repeated hospital visits and doctor shopping.
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References
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing. 2013.
van den Heuvel OA, Veale D, Stein DJ. Hypochondriasis: considerations for ICD-11. Rev Bras Psiquiatr; 2014;36(suppl 1):21-7.
Almalki M, Al-Tawayjri I, Al-Anazi A, Mahmoud S, Al-Mohrej A. Case Report: A recommendation for the management of Illness Anxiety Disorder patients abusing the health care system. Case Rep Psychiatry [Internet]. 2016 [cited 2018 May 23];2016:3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4897678/pdf/CRIPS2016-6073598.pdf
Hedman E, Axelsson E, Andersson E, Lekander M, Ljotsson B. Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial. Br J Psychiatry. 2016;209:407-13.
Weck F, Nagel LC, Höfling V, Neng JMB. Cognitive therapy and exposure therapy for hypochondriasis (health anxiety): A 3-year naturalistic follow-up. J Consult Clin Psychol. 2017;85(10):1012-7.
Ariso JM. Enhancing second-order empathy in medical practice by supplementing patients’ narratives with certainties. BMC Med Educ [Internet]. 2018 Mar 14 [cited 2018 May 26];18(1):35. Available from: https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1145-y
Granek M. Hypochondriasis, acting out and counter-acting out. Br J Med Psychol. 1989;62(Pt 3):257-64.
Persing JS, Stuart SP, Noyes R, Happel RL. Hypochondriasis: the patient’s perspective. Int J Psychiatry Med [Internet]. 2000 Dec 24 [cited 2018 May 23];30(4):329-42. Available from: http://journals.sagepub.com/doi/10.2190/KMXW-T53N-BTDW-GTGH
Tomasetti C, Vogelstein B. Variation in cancer risk among tissues can be explained by the number of stem cell divisions. Science. 2015;347(6217):78-81. doi: 10.1126/science.1260825.
Fionda S, Furnham A. Hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine and modern health worries predict patient satisfaction. JRSM open [Internet]. 2014 Nov [cited 2018 May 23];5(11):2054270414551659. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25408919
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Copyright (c) 2018 José MarÃa Ariso
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