How to Encourage Hypochondriac Patients to Seek Medical Help - Psychiatry

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How to encourage patients with illness anxiety to seek medical care?


Hello, doctor.
My brother is 28 years old and has often experienced discomfort in specific areas of his body since childhood.
He frequently undergoes examinations and exhibits anxiety, constantly researching online and visiting numerous doctors without feeling reassured.
He insists that he is unwell and believes that the doctors have missed something, but it always turns out to be a false alarm.
However, six months ago, he suddenly told me that he woke up and noticed that his vision was unclear.
Since then, he has seen many specialists and undergone various repeated tests; I estimate he has consulted over 20 doctors.
Each doctor has told him that his vision is normal and that there is no significant issue, assuring him that it will not have a major impact on his eyes.
Yet, he does not believe them and even suspects that he has a rare disease that could lead to blindness.
He keeps telling me that his vision is getting worse and is afraid to ride a bike or go out, which has caused significant barriers to his employment, daily life, and social interactions.
His emotions are very unstable, and he has had multiple thoughts of self-harm.
This situation has also caused distress for our family, as we take turns supporting him day and night.
I am truly scared; on one hand, I fear what would happen if he really has an incurable disease as he claims.
On the other hand, comparing his symptoms to the diagnostic criteria for illness, I feel they align closely, but I am not a doctor and do not dare to make a conclusion.
The problem arises when I suggest that, given he has seen so many doctors without resolution, he might consider seeing a psychiatrist.
He strongly resists this idea, insisting that it is a physiological issue unrelated to his mental health, claiming that seeing a psychiatrist will not improve his vision, and so on.
I really want to help him, but I feel utterly helpless.
I know he is suffering, but he cannot seem to stop fixating on his concerns.

Shan Yi, 20~29 year old female. Ask Date: 2021/01/17

Dr. Wu Enliang reply Psychiatry


Hello, online friend: Seeking medical attention should not be forced.
You might try to persuade him by saying, "When certain elements in the brain are imbalanced, the body can become very sensitive.
What may start as slight vision problems can escalate to significant difficulties in seeing clearly...
It may require some medications to help restore those brain elements! If the ophthalmologist can't help, perhaps you should consider consulting a physician from another specialty; otherwise, it seems you're suffering a lot!" If he still won't be persuaded, you could recommend a physician who specializes in both psychiatry and internal medicine or family medicine.
For example, you can check https://www.nymc.com.tw/doctors.php.
Such physicians are not very common, but there should be some in your area with both specialties.
Dr.
Wu Enliang.

Reply Date: 2021/01/17

More Info


Encouraging hypochondriac patients, like your brother, to seek medical help can be a challenging task, especially when they are deeply entrenched in their beliefs about their health. Hypochondria, or health anxiety, often leads individuals to misinterpret normal bodily sensations as signs of serious illness, resulting in excessive worry and frequent medical consultations. Here are some strategies that may help you encourage your brother to seek the appropriate medical support:
1. Empathy and Understanding: Start by acknowledging his feelings and fears. It’s important to validate his experiences without dismissing them. You might say something like, “I can see that you’re really worried about your vision, and it’s understandable to feel that way when you’re experiencing something unusual.” This approach can help him feel heard and less isolated in his anxiety.

2. Educate Gently: Providing information about health anxiety in a non-confrontational way can be beneficial. You might share articles or resources that explain how anxiety can manifest physically and how it can affect perception. This could help him understand that his symptoms might not be solely due to a physical issue.

3. Suggest a Comprehensive Evaluation: Instead of focusing on the eye issue alone, suggest a comprehensive evaluation by a healthcare professional who specializes in both physical and mental health. A holistic approach can help address both his physical symptoms and the underlying anxiety. You might say, “What if we see a doctor who can look at both your vision and how you’re feeling overall? It might give us a clearer picture.”
4. Introduce the Idea of Mental Health Support: Frame the suggestion to see a mental health professional as a way to gain additional support rather than as a dismissal of his physical symptoms. You could say, “Sometimes, talking to someone who understands how our minds and bodies work can really help. It doesn’t mean you’re imagining things; it just means you’re getting all the support you need.”
5. Encourage Gradual Steps: If he is resistant to seeing a mental health professional, suggest starting with small steps. This could include journaling his thoughts and feelings or practicing mindfulness techniques to help manage anxiety. Gradual exposure to the idea of seeking help can make it feel less daunting.

6. Involve Trusted Individuals: If there are family members or friends he trusts, consider involving them in the conversation. Sometimes, hearing similar suggestions from multiple people can reinforce the idea that seeking help is a positive step.

7. Highlight the Importance of Professional Guidance: Emphasize that while it’s good to be proactive about health, it’s also crucial to rely on professionals who can provide accurate assessments. You might say, “Doctors have a lot of training to help us understand what’s going on with our bodies. It’s okay to seek their advice and trust their expertise.”
8. Address Safety Concerns: Given that he has expressed thoughts of self-harm, it’s vital to take these feelings seriously. If he is in immediate danger, seek professional help right away. Encourage him to talk to someone who can provide support, whether it’s a friend, family member, or mental health professional.

9. Be Patient: Change takes time, especially when it comes to deeply ingrained beliefs about health. Continue to offer your support and understanding, even if he resists the idea of seeking help initially.

10. Seek Support for Yourself: Caring for someone with health anxiety can be emotionally taxing. Consider seeking support for yourself, whether through counseling or support groups, to help you cope with the stress of the situation.

In conclusion, while it can be difficult to encourage someone with hypochondria to seek help, approaching the situation with empathy, education, and patience can make a significant difference. By framing the conversation around comprehensive care and mental health support, you can help your brother take steps toward healing and understanding his condition better.

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