Kaygı Sarmalı: Sağlık Kaygısı Olan Bireylerin Kişisel Deneyimlerinin Nitel Bir İncelemesi

Yıl 2022, Cilt: 42 Sayı: 1, 165 - 198, 29.04.2022

Burcu Pınar Bulut Özlem Bozo

https://doi.org/10.26650/SP2021-935379

Öz

Hipokondriya bu semptoma sahip bireylerin ‘gerçek’ bir hastalığın yokluğunda fiziksel şikayetler yaşamaları bakımından beden-zihin problemine dair tartışmaların merkezinde yer almaktadır. Bu çalışmanın amacı da hipokondriyak şikayetleri olan bireylerin ‘hastalıklarını’ ya da bu konudaki kaygılarını nasıl deneyimlediklerini araştırmaktır. Ayrıca, bu kişilerin özellikle doktorlarla olmak üzere onay arayışında oldukları kişilerle ilişki kurma biçimleri anlaşılmaya çalışılmıştır. Araştırmanın katılımcıları, 19-55 yaşları arasındaki sağlık kaygıları yüksek olan 14 kişiden oluşmaktadır. Çalışmanın verisi yüz yüze yapılan yarı-yapılandırılmış görüşmeler aracılığıyla toplanmıştır. Katılımcıların öznel deneyimlerini çalışmak için sistematik bir yaklaşım sunan Yorumlayıcı Fenomenolojik Analiz yöntemi kullanılmıştır. Sonuç olarak dört üst tema ortaya çıkmıştır ve bu temalar ‘sağlık kaygısına yapılan nedensel atıflar: ‘halledilmemiş bir mesele olarak kayıp’, ‘semptomun girbadına sürüklenmek’, ‘deneyimlerini adlandırması ve belirsizliği ortadan kaldırması için bir uzmana yapılan sonsuz çağrı’ ve ‘her şerde bir hayır vardır: hasta olmanın/hasta hissetmenin faydaları’ şeklindedir. Bu çalışmanın sonuçları hem ruh sağlığı çalışanları hem de diğer sağlık çalışanları için önemlidir çünkü uzmanlar tarafından yapılan fiziksel-psikolojik bozukluk ayrımının sağlık kaygısı olan kişilerin gerçekleriyle uyuşmadığı görülmektedir. Bu kişilerin semptomlarının başlangıcıyla ilişkilendirdikleri bir kayıp deneyiminin ön plana çıkması da bu kişilerle çalışırken kayıp konusu üzerinde durmanın önemine işaret etmektedir. Ayrıca katılımcıların sağlık durumları ile ilgili kendilerine verilen bilgilerin rahatlatıcı etkisinin kısa vadeli olduğu ve “hastalıklarının ne olduğuna” dair süregiden bir arayışları olduğu gözlemlenmiştir. Bu nedenle de uygulanan tedavilerin odağında bedensel belirtilerin ciddi bir duruma işaret etmediği bilgisinin kişilere verilmesinin işe yaramayacağı düşünülmüştür. Sonuç olarak hipokondri hastaları ile çalışan terapistlerin, hasta ile terapötik bir ittifak kurduktan sonra, bu kişilerin kendilerinde ne olduğunu bilme isteklerinin sürekliliğini anlamalarına yardımcı olmaları gerektiğini söylemek mümkündür.

Anahtar Kelimeler

Hipokondriya, sağlık kaygısı, somatizasyon, yorumlayıcı fenomenolojik analiz

A Helix of Anxiety: A Qualitative Analysis of the Personal Experiences of Individuals with Health Anxiety

Öz

Hypochondria is at the center of debates about the mind-body problem in that those individuals with this symptom experience physical complaints in the absence of ‘real’ illness. The study examined how individuals with hypochondriac complaints experience their ‘illnesses’ or anxiety about it. Also, how they establish their interpersonal relationships with the people they get reassurance, especially with physicians, was understood. The sample consisted of 14 individuals with high health anxiety, and their ages were between 19-55 years old. The data were collected through face-to-face semi-structured interviews. The Interpretative Phenomenological Analysis method, which offers a systematic approach to study participants’ subjective experiences, was used. As a result, four superordinate themes emerged: ‘Causal attributions of health anxiety: Loss at the core as unfinished business,’ ‘Being drawn into a vortex of symptoms,’ ‘Endless calls to experts for naming own experiences and eliminating uncertainty,’ and ‘Every cloud has a silver lining: Benefits of being/feeling ill.’ The findings are important for both mental and physical health professionals working with these individuals since the experts’ physical-psychological distinction does not correspond with the reality of those people. The prominence of a loss experience that these people associate with the onset of their symptoms also points to the importance of dwelling on the issue of loss while working with these people. In addition, it was observed that the information given to the participants about their health status had a short-term relaxing effect, and they had an ongoing search for “what their illnesses are.” For this reason, it was thought that providing information that the physical symptoms do not indicate a serious situation at the focus of the treatments applied would not work. In conclusion, it is possible to say that therapists working with patients with hypochondria should help them understand the continuity of their desire to know what is happening in them after establishing a therapeutic alliance with the patient.

Anahtar Kelimeler

Hypochondriasis, health anxiety, somatization, interpretative phenomenological analysis

Kaynakça

• American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association. google scholar
• Arndt, J., Routledge, C., Cox, C. R., & Goldenberg, J. L. (2005). The worm at the core: A terror management perspective on the roots of psychological dysfunction. Applied and Preventive Psychology, 11 (3), 191-213. doi:10.1016/j.appsy.2005.07.002 google scholar
• Aydemir, O., Kırpınar, I., Satı, T., Uykur, B., & Cengisiz, C. (2013). Reliability and validity of the Turkish version of the Health Anxiety Inventory [Sağlık Anksiyetesi Ölçeği’nin Türkçe için güvenilirlik ve geçerlilik çalışması],. Archives of Neuropsychiatry, 50(4), 325-332. doi:10.4274/ npa.y6383 google scholar
• Barrett, L. (2011). Beyond the brain: How body and environment shape animal and human minds. Princeton University Press. google scholar
• Barsky, A. J., & Klerman, G. L. (1983). Overview: Hypochondriasis, bodily complaints, and somatic styles. The American Journal of Psychiatry, 140(3), 273-283. google scholar
• Baumgartner, S. E., & Hartmann, T. (2011). The role of health anxiety in online health information search. Cyberpsychology, Behavior, and Social Networking, 14(10), 613-618. doi:10.1089/ cyber.2010.0425 google scholar
• Beckett, J. J. (2009). Health anxiety and hypochondriasis: The patient’s perspective (Master’s thesis). Massey University, Albany, New Zealand. Retrieved from https://mro.massey.ac.nz/ handle/10179/12724 google scholar
• Berrios, G. E. (2001). Hypochondriasis: History of the concept. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 3-20). Oxford University Press. google scholar
• Bishop, G. D. (1994). Health psychology: Integrating mind and body. Allyn & Bacon. google scholar
• Bowlby, J. (1969). Attachment and loss: Vol. 1: Attachment. London: Hogarth Press. google scholar
• Brakoulias, V. (2014). DSM-5 bids farewell to hypochondriasis and welcomes somatic symptom disorder and illness anxiety disorder. Australian and New Zealand Journal of Psychiatry, 48(7), 688-688. doi:10.1177/0004867414525844 google scholar
• Breuer, J., & Freud, S. (1893-1895). Studies on hysteria. In J. Strachey (Ed. and Trans.), The standard edition of the complete psychological works of Sigmund Freud (Vol. 2, pp. 1-305). London: Hogarth Press. google scholar
• Brown, F. (1936). The bodily complaint: A study of hypochondriasis. Journal of Mental Science, 82(339), 295-359. google scholar
• Burgess, J. P. (2017). For want of not: Lacan’s conception of anxiety. In E. Eklundh, A. Zevnik, & E-P. Guittet (Eds.), Politics of anxiety (pp. 17-36). London: Rowman & Littlefield Ltd. google scholar
• Burgoyne, B. (2004). Editorial - Spring 04. The Journal of the Centre for Freudian Analysis and Research, 14, 4-8. google scholar
• Butler-Rees, E. (2011). Body dysmorphic disorder: A psychoanalytic perspective. Higher Diploma Final Year Project, Dublin Business School. google scholar
• Canellopoulos, L. (2010). The bodily event, jouissance and the (post) modern subject. Recherches en Psychanalyse, 10(2), 321a-328a. doi:10.3917/rep.010.0141 google scholar
• Chan, Z. C., Fung, Y. L., & Chien, W. T. (2013). Bracketing in phenomenology: Only undertaken in the data collection and analysis process. The Qualitative Report, 18(30), 1-9. google scholar
• Chapman L. (1999). Psychosomatic disorders: A psychoanalytic category. Retrieved from http://www. therapeia.org.uk/documents/Psychosomatics.pdf google scholar
• Christogiorgos, S., Tzikas, D., Widdershoven-Zervaki, M. A., Dimitropoulou, P., Athanassiadou, E., & Giannakopoulos, G. (2013). Hypochondriacal anxieties in adolescence. Open Psychology Journal, 6, 6-9. google scholar
• Comay, R. (n.d.) Hypochondria and its discontents, or, the geriatric sublime. Crisis & Critique, 3(2), 41-58. Retrieved from http://crisiscritique.org/special09/comay.pdf google scholar
• Craig, T., Drake, H., Mills, K. and Boardman, A.P. (1994) The South London Somatisation Study II: Influence of stressful life events, and secondary gain. British Journal of Psychiatry, 165(2), 248-258. doi:10.1192/bjp.165.2.248 google scholar
• Cronin, C., & Lowes, J. (2016). Brief encounters with qualitative methods in health research: Phenomenology and interpretative phenomenological analysis. The Cumbria Partnership Journal of Research, Practice and Learning, 5(1), 8-12. google scholar
• Doherty-Torstrick, E. R., Walton, K. E., & Fallon, B. A. (2016). Cyberchondria: Parsing health anxiety from online behavior. Psychosomatics, 57(4), 390-400. doi:10.1016/j.psym.2016.02.002 google scholar
• Erol, N., Kılıç, C., Ulusoy, M., Keçeci, M., & Simşek, Z. (1998). Türkiye ruh sağlığı profili raporu [Mental health profile report of Turkey]. Ankara, Türkiye Cumhuriyeti Sağlık Bakanlığı Temel Sağlık Hizmetler Genel Müdürlüğü. google scholar
• Feldstein, R. Fink, B. and Jaanus, M. (Eds.). (1995). Reading seminar XI: Lacan’s four fundamental concepts of psychoanalysis: The Paris seminars in English. New York: SUNY Press. google scholar
• Fenichel, O. (2005). The psychoanalytic theory of neurosis. Routledge, London. Retrieved from Taylor & Francis e-Library. https://doi.org/10.4324/9780203754436 google scholar
• Florian, V., & Mikulincer, M. (1998). Symbolic immortality and the management of the terror of death: The moderating role of attachment style. Journal of Personality and Social Psychology, 74(3), 725-734. google scholar
• Freud, S. (1914). On narcissism: An introduction. In J. Strachey and A. Freud (Trans. & Eds.). The standard edition of the complete psychological works of Sigmund Freud, Volume XIV (19141916), pp. 67-102. London: Hogarth Press. google scholar
• Freud, S. (1953). A Case of hysteria: Three essays on the theory of sexuality and other works (1905). In J. Strachey, A. Strachey and A. Tyson (Eds.), The standard edition of the complete psychological works of Sigmund Freud, Volume VII (1901-1905), pp. 123-246). London: Hogarth Press. google scholar
• Freud, S. (1959/1896). Further remarks on the defense neuro-psychoses. In E. Jones (Ed.) & J. Riviere (Trans.) Collected papers (Vol. 1), pp. 155-182. New York: Basic Books. (Original work published in 1896). google scholar
• Furer, P., & Walker, J. R. (2008). Death anxiety: A cognitive-behavioral approach. Journal of Cognitive Psychotherapy, 22(2), 167-182. doi:10.1891/0889-8391.22.2.167 google scholar Gallager, C. (Ed.). (2002). The object of psychoanalysis: The seminar of Jacques Lacan: Book XIII. London: Karnac Books. google scholar
• Gessert, A. (2004). The body in hypochondria - some thoughts. The Journal of the Centre for Freudian Analysis and Research, Spring, 14, 11-17. google scholar
• Ghanizadeh, A., & Firoozabadi, A. (2012). A review of somatoform disorders in DSM-IV and somatic symptom disorders in proposed DSM-V. Psychiatria Danubina, 24(4), 353-358. google scholar
• Grinnell, G. (2010). The age of hypochondria: Interpreting romantic health and illness. Basingstoke: Palgrave Macmillan. google scholar
• Hazan, C., & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524. google scholar
• Hedman, E., Andersson, G., Andersson, E., Ljotsson, B., Ruck, C., Asmundson, G.J., & Lindefors, N. (2011). Internet-based cognitive-behavioural therapy for severe health anxiety: Randomised controlled trial. British Journal of Psychiatry, 198, 230-236. doi:10.1192/bjp. bp.110.086843 google scholar
• Holloway, I. (2005). Qualitative research in health care. McGraw-Hill Education (UK). google scholar
• Hunter, J. J., & Maunder, R. G. (2001). Using attachment theory to understand illness behavior. General google scholar
• HospitalPsychiatry, 23(4), 177-182. doi:10.1016/S0163-8343(01)00141-4 google scholar
• James, A., & Wells, A. (2002). Death beliefs, superstitious beliefs and health anxiety. British Journal of Clinical Psychology, 41(1), 43-53. doi:10.1348/014466502163787 google scholar
• Jones, S. M., Andersen, M. R., & Litwin, P. (2020). Avoidance and reassurance seeking in response to health anxiety are differentially related to use of healthcare. Journal of Public Health. doi:10.1007/ s10389-020-01299-8 google scholar
• Kirmayer, L. J., & Young, A. (1998). Culture and somatization: Clinical, epidemiological, and ethnographic perspectives. Psychosomatic Medicine, 60(4), 420-430. google scholar
• Klein, M. (1935). A contribution to the psychogenesis of manic-depressive states. International Journal of Psycho-Analysis, 16, 145-174. google scholar
• Koch, T. (1995). Interpretive approaches in nursing research: The influence of Husserl and Heidegger. Journal of Advanced Nursing, 21(5), 827-836. doi:10.1046/j.1365-2648.1995.21050827.x google scholar
• Lipsitt, D. R. (2014). Psychodynamic models and therapeutic approaches to hypochondriasis. In V. Starcevic & R. Noyes (Eds.), Hypochondriasis and health anxiety: A guide for clinicians (pp. 222240). Oxford University Press. google scholar
• Lipsitt, D. R. (2015). Hypochondriasis and somatization disorder: New perspectives. In H. Leigh & J. Streltzer (Eds.), Handbook of consultation-liasion psychiatry (2nd ed., pp. 317-334). New York: Springer. google scholar
• Munir, K., Ergene, T., Dag, I., Erol, N., & Aker, T. (2006). The Republic of Turkey National Mental Health Policy. Ankara: Ministry Health Turkey. google scholar
• Noyes, R., Stuart, S. P., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., & Yagla, S. J. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65(2), 292300. google scholar
• Noyes, R., Stuart, S., Longley, S. L., Langbehn, D. R., & Happel, R. L. (2002). Hypochondriasis and fear of death. The Journal of Nervous and Mental Disease, 190(8), 503-509. doi:10.1097/01. NMD.0000026619.27653.B4 google scholar
• Okita, M., Kobori, O., Okita, K., Hasegawa, T., Shiraishi, T., & Iyo, M. (2016). The motivations and characteristics of seeking reassurance in health anxiety: A qualitative study of Japanese samples. Chiba Medical Journal, 92(1), 1-9. google scholar
• Papis, K. G. (2015). Emotional intelligence and sociotropy-autonomy in young women with DSM-IV-TR hypochondriasis: A mixed-method study (Doctoral dissertation). University of Wolverhampton, United Kingdom. Retrieved from https://wlv.openrepository.com google scholar
• Pope, C., & Mays, N. (1995). Qualitative research: Reaching the parts other methods cannot reach: An introduction to qualitative methods in health and health services research. British Medical Journal, 311(6996), 42-45. google scholar
• Richards, A. D. (1981). Self theory, conflict theory, and the problem of hypochondriasis. The Psychoanalytic Study of the Child, 36(1), 319-337. google scholar
• Rosenfeld, H. A. (1958). Some observations on the psychopathology of hypochondriacal states. International Journal of Psycho-Analysis, 39, 121-124. google scholar
• Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(05), 843-853. doi:10.1017/S0033291702005822 google scholar
• Sata, M. J., & Munday, C. C. (2017). Primary and secondary gain. In V. Zeigler-Hill & T. K. Shackelford (Eds.), Encyclopedia of personality and individual differences (pp. 1-4). Springer International Publishing. google scholar
• Scarella, T. M., Laferton, J. A., Ahern, D. K., Fallon, B. A., & Barsky, A. (2016). The relationship of hypochondriasis to anxiety, depressive, and somatoform disorders. Psychosomatics, 57(2), 200207. doi:10.1016/j.psym.2015.10.006 google scholar
• Segall, A. (1976). The sick role concept: Understanding illness behavior. Journal of Health and Social Behavior, 17(2), 162-169. google scholar
• Singh, K., Fox, J. R., & Brown, R. J. (2016). Health anxiety and internet use: A thematic analysis. Cyberpsychology: Journal of Psychosocial Research on Cyberspace, 10(2), 98120. doi:10.5817/CP2016-2-4 google scholar
• Smith, J. A. (2011). Evaluating the contribution of interpretative phenomenological analysis. Health Psychology Review, 5(1), 9-27. doi:10.1080/17437199.2010.510659 google scholar
• Smith, J. A., & Eatough, V. (2007). Interpretative phenomenological analysis. In E. Lyons A. Coyle (Eds.), Analysing qualitative data in psychology (pp. 35-50). Los Angeles, London, New Delhi, Singapore: Sage Publications. google scholar
• Smith, J. A., Flowers, P., & Larkin, M. (2009). Interpretative phenomenological analysis: Theory, method and research. London: SAGE. google scholar
• Smith, J. A., Harre, R., & Van Langenhove, L. (1995). Idiography and the Case-Study. In J. A. Smith, R. Harre & L. Van Langenhove (Eds), Rethinking psychology (pp. 59-69). London: Sage. google scholar
• Smith, J. A., & Osborn, M. (2003). Interpretative phenomenological analysis. In J. A. Smith (Ed.), Qualitative Psychology: A practical guide to research methods (pp. 51-80). London: Sage. google scholar
• Starcevic, V. (1989). Contrasting patterns in the relationship between hypochondriasis and narcissism. British Journal of Medical Psychology, 62(4), 311-323. google scholar
• Starcevic, V., & Lipsitt, D. R. (2001). Introduction. Hypochondriasis: Modern perspectives on an ancient malady (pp. 11-14). Oxford University Press. google scholar
• Starcevic, V., & Noyes, N. (2014). Introduction and key issues. Hypochondriasis and health anxiety: A guide for clinicians (pp. 1-7). Oxford: Oxford University Press. google scholar
• Stegge, B. M., Tak, L. M., Rosmalen, J. G., & Voshaar, R. C. O. (2018). Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review. Journal of Psychosomatic Research, 115, 58-65. doi:10.1016/j.jpsychores.2018.10.002 google scholar
• Strachan, E., Schimel, J., Arndt, J., Williams, T., Solomon, S., Pyszczynski, T., & Greenberg, J. (2007). Terror mismanagement: Evidence that mortality salience exacerbates phobic and compulsive behaviors. Personality and Social Psychology Bulletin, 33(8), 1137-1151. doi:10.1177/0146167207303018 google scholar
• Stuart, S., & Noyes, R. (1999). Attachment and interpersonal communication in somatization. Psychosomatics, 40, 34-43. google scholar
• Sulkowski, M. L., Mariaskin, A, & Storch, E. A. (2011). Obsessive-compulsive spectrum disorder symptoms in college students. Journal of American College Health, 59(5), 342-348. google scholar
• Taylor, R. B. (2016). White coat tales: Medicine’s heroes, heritage, and misadventures. New York, NY: Springer-Verlag. google scholar
• te Poel, F., Baumgartner, S. E., Hartmann, T., & Tanis, M. (2016). The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking. Journal of Anxiety Disorders, 43, 32-40. doi:10.1016/j.janxdis.2016.07.009 google scholar
• Tyrer, P., Wang, D., Crawford, M., Dupont, S., Cooper, S., Nourmand, S., Lazarevic, V., Philip, A., & Tyrer, H. (2020). Sustained benefit of cognitive behaviour therapy for health anxiety in medical patients (CHAMP) over 8 years: A randomised-controlled trial. Psychological Medicine, 1-9. doi:10.1017/S003329172000046X google scholar
• van den Heuvel, O. A., Veale, D., & Stein, D. J. (2014). Hypochondriasis: Considerations for ICD-11. Brazilian Journal of Psychiatry, 36, 21-27. doi:10.1590/1516-4446-2013-1218 google scholar
• Wahl, C. W. (1963). Unconscious factors in the psychodynamics of the hypochondrical patient. Psychosomatics, 4, 9-14. google scholar
• Warwick, H. M. (1989). A cognitive-behavioural approach to hypochondriasis and health anxiety. Journal ofPsychosomatic Research, 33(6), 705-711. google scholar
• Wearden, A., Perryman, K., & Ward, V. (2006). Adult attachment, reassurance seeking and hypochondriacal concerns in college students. Journal of Health Psychology, 11(6), 877-886. doi:10.1177/1359105306069086 google scholar
• Weck, F., Richtberg, S., Jakob, M., Neng, J. M., & Höfling, V. (2015). Therapist competence and therapeutic alliance are important in the treatment of health anxiety (hypochondriasis). Psychiatry Research, 228(1), 53-58. doi:10.1016/j.psychres.2015.03.042 google scholar
• Willig, C. (2001). Introducing qualitative research in psychology. Adventures in theory and method. Buckingham, Philadelphia: Open University Press. google scholar
• Wilton, R. D. (2003). Locating physical disability in Freudian and Lacanian psychoanalysis: Problems and prospects. Social and Cultural Geography, 4(3), 369-389. doi: 10.1080/14649360309069 google scholar
• Wintrebert, D. (2009). Hypochondria between belief and certainty. L’Information Psychiatrique, 85(1), 43-49. doi:10.1684/ipe.2009.0427 google scholar
• Xiong, G. L., Bourgeois, J. A., Chang, C. H., Liu, D., & Hilty, D. M. (2007). Hypochondriasis: Common presentations and treatment strategies in primary care and specialty settings. Clinical Practice, 4(3), 323-338. doi:10.2217/14750708.4.3.32 google scholar