Differential Treatment Response Between Hypochondriasis With and Without Prominent Somatic Symptoms.

Brian A Fallon,Martina Pavlicova,David K Ahern,Arthur J Barsky,Cale Basaraba

doi:10.3389/fpsyt.2021.691703

Abstract

Background: Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment.Methods: This exploratory study used a unique database from a prior trial of 193 individuals with DSM-IV hypochondriasis who had been randomly assigned to either cognitive behavioral therapy, fluoxetine, combined therapy, or placebo. Two subgroups were newly defined—no/low somatic burden (n = 42) and prominent somatic burden (n = 151). Response was defined by ≥30% improvement in hypochondriasis.Results: Among high somatic hypochondriacal participants, compared to placebo, the odds of being a responder were significantly greater among those who received fluoxetine, either alone (OR = 4.46; 95% CI: 1.38, 14.41) or with cognitive behavioral therapy (OR = 3.56; 95% CI: 1.19, 10.68); the estimated odds were not significantly different for those receiving cognitive behavioral therapy alone (OR = 1.81; 95% CI: 0.59, 5.54). In contrast, among low somatic hypochondriacal participants, compared to placebo, the observed odds of being a responder were similar in magnitude and direction for those who received cognitive behavioral therapy, either alone (OR = 3.00; 95% CI: 0.38, 23.68) or in combination with fluoxetine (OR = 3.60; 95% CI: 0.62, 21.03), compared to the odds for those receiving fluoxetine alone (OR = 0.90; 95% CI: 0.14, 5.65). High somatic hypochondriacal individuals assigned to any fluoxetine group had significantly greater odds of being a responder than those who had not received fluoxetine (OR = 2.70; 95% CI: 1.33, 5.48). Low somatic hypochondriacal individuals assigned to any cognitive behavioral therapy group had significantly greater odds of being a responder than those who had not received cognitive behavioral therapy (OR = 8.03; 95% CI: 1.41, 45.67).Conclusion: These findings indicate that somatic symptom burden may be important in guiding treatment selection among individuals with marked health anxiety, as hypochondriacal individuals with high somatic burden responded more often to fluoxetine while those with low somatic burden responded more often to cognitive behavioral therapy. Systematic replication with larger studies is needed.

Highlights

Hypochondriasis is a prevalent and disabling disorder for which pharmacotherapy and cognitive behavioral therapy have each been shown to reduce hypochondriacal symptoms [1]
Of the 151 HYP-HS participants, 53 (35.0%) individuals met criteria for treatment response, with the highest proportion of responders found in the FLX treatment group (46.9%) followed by the cognitive behavioral therapy (CBT)+FLX group (45.2%) (Table 2, HYP-HS Observed)
The mean final dose of fluoxetine was 29.6 mg for HYP-LS and 29.9 mg for HYP-HS; this difference in mean final dose was not significantly different. This exploratory study indicates that hypochondriacal participants with prominent somatic symptoms may be more likely to respond to fluoxetine than to CBT, while hypochondriacal participants without prominent somatic symptoms may be more likely to respond to CBT than to fluoxetine

Summary

Introduction

Hypochondriasis is a prevalent and disabling disorder for which pharmacotherapy and cognitive behavioral therapy have each been shown to reduce hypochondriacal symptoms [1]. The present exploratory study aims to address this question by comparing treatment response among individuals with hypochondriasis with and without prominent somatic symptoms. We use data collected during a prior large randomized controlled clinical trial of pharmacotherapy vs cognitive behavioral therapy (CBT) for DSM-IV hypochondriasis [3]. That study confirmed the predicted pattern of efficacy: joint treatment with CBT and fluoxetine had higher responder rates than individual therapy alone which in turn had higher rates than placebo. If a differential treatment response to psychotherapy or pharmacotherapy were found in the reduction of hypochondriacal symptoms within these two subgroups, this would suggest that somatic symptom burden may be a useful guide for clinicians in treatment selection to optimize treatment response. Health anxiety may exist with or without prominent somatic symptoms, but the impact of somatic symptoms on treatment response is unclear. The study objective was to examine this question further as symptom burden may impact choice of type of treatment

Methods

Results

Discussion

Conclusion