Hastalık Kaygısı Bozukluğu ve Yönetimi
Özet
Hastalık kaygısı bozukluğu (eski adıyla hipokondriazis), kişinin ciddi bir hastalığa sahip olduğu ya da olabileceği yönünde aşırı endişe ve korku duymasıyla karakterize, genel popülasyonda %0.0-4.5, birinci basamakta ise %3-9 oranında görülen bir rahatsızlıktır. DSM-5 ile birlikte tanı kriterlerinde sadeleşmeye gidilmiş; belirgin bedensel belirtilerin olmadığı veya hafif olduğu durumlarda kaygı ve buna bağlı aşırı sağlık davranışları (bakım arama veya kaçınma) ön plana alınmıştır. Psikotik bozukluklar, bedensel belirti bozukluğu ve panik bozukluk gibi durumlar ayırıcı tanıda önemli bir yer tutmaktadır. Kuramsal açıdan çözülmemiş içsel çatışmalar, olumsuz otomatik düşünceler ve yer değiştirme savunma mekanizmalarıyla açıklanan bu bozukluğun vaka yönetiminde, hekimlerin hastaya şüphe uyandırmayacak netlikte fiziksel bir hastalık bulunmadığını belirtmesi ve gereksiz tıbbi işlemlerden kaçınması iatrojenik zararları önlemek adına kritiktir. Tedavide en etkin yöntem maliyet avantajı da sağlayan Bilişsel Davranışçı Terapi (BDT) olup, özellikle maruziyet ödevleri gibi davranışçı müdahalelerin semptomları azaltmada etkili olduğu kanıtlanmıştır; ayrıca ilaç tedavisinde sıklıkla SSRI'lar tercih edilmektedir.
Illness anxiety disorder (formerly hypochondriasis) is a condition characterized by excessive worry and fear that one has or might acquire a serious illness, with a prevalence of 0.0-4.5% in the general population and 3-9% in primary care. With DSM-5, the diagnostic criteria were simplified; in cases where somatic symptoms are absent or mild, anxiety and related excessive health behaviors (care-seeking or avoidance) are emphasized. Conditions such as psychotic disorders, somatic symptom disorder, and panic disorder play a key role in differential diagnosis. Theoretically explained by unresolved internal conflicts, negative automatic thoughts, and displacement defense mechanisms, the case management requires physicians to state clearly and leave no doubt that there is no physical illness, which is critical to avoid unnecessary medical procedures and prevent iatrogenic harm. Cognitive Behavioral Therapy (CBT), which also offers cost advantages, is the most effective treatment method, and behavioral interventions like exposure homework have been proven effective in reducing symptoms; additionally, SSRIs are frequently preferred in medical treatment.
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