Prevalence of disease anxiety disorder in diabetes
The prevalence of disease anxiety disorders associated with diabetes is very high. An article published in the British Medical Journal in 2016 titled "Prevalence and influencing factors of depression and anxiety symptoms in Chinese adults with type 2 diabetes: a study The report "Horizontal Study" pointed out that among 893 Chinese patients with type 2 diabetes aged 18 to 84 years old, the prevalence of anxiety symptoms was 43.6%; Taiwanese scholars from the "National Health Insurance Database" from 2002 to 2004 A random sample survey of more than 200,000 data came to the conclusion that "the one-year prevalence of anxiety disorders among diabetic patients was 128.76‰ in 2000, and the cumulative prevalence increased to 289.89‰ in 2004." This shows the growth trend. severity.
In addition, an article titled "Exploring Health Anxiety in Diabetes: Prevalence and Impact" published in the Journal of Health Psychology in 2014 stated that more than 400 patients with type 1 Of those with type 2 diabetes or type 2 diabetes who completed a questionnaire assessing disease anxiety, 24.1% reported increased "disease anxiety," with anxiety higher among younger people, women, single people, and those recently diagnosed with diabetes. serious.
Two Types of Illness Anxiety Disorders
Illness anxiety usually refers to anxiety that is very strong relative to one's physical condition. Patients with disease anxiety often have two manifestations: one is care-seeking, that is, often seeks medical services; the other is care-avoidant, that is, rarely uses medical services. The following two cases illustrate these two types.
Case 1 Care-seeking type
58 years old, male, fasting blood sugar is basically normal, and postprandial blood sugar is slightly higher. The doctor recommends adjusting your diet and lifestyle, observing, and not taking medication for the time being. He went to the special needs clinic every week. In order to measure his post-meal blood sugar every day, he ate very few staple foods. Therefore, the measured post-meal blood sugar result showed normal, but he felt that he had cheated and was inaccurate, and he felt torn. It greatly affects work and life.
Case 2 Care avoidance type
63-year-old female, with a history of diabetes. Her wound had difficulty healing after coronary stent surgery. She avoided going to the hospital for dressing changes after being discharged from the hospital. The wound did not heal for a long time, and she was anxious at home all day long.
We all know that the purpose of monitoring blood sugar every day is to better control the condition, not to deceive ourselves; we also know that dressing-changing clinics are opened in major hospitals, and there are dedicated people responsible for caring for wounds. It is best for the family members to give this woman a hospital dressing clinic, but she didn’t dare go.
At this moment, we need to understand why they have disease anxiety disorder in the cases, and then face and solve the life problems caused by it together.
Sources of illness anxiety disorder
Sources of illness anxiety disorders broadly fall into two categories: adaptive problems and traumatic problems.
1. Adaptability issues
It is common among those who are sensitive and timid. They suddenly get sick and are later frightened by the comments of people around them, such as saying that diabetes will lead to blindness or amputation. For this type of patients, only a little more time and patience are needed. Medical workers and family members should explain the condition of the disease to the patients, and encourage the patients to carry out standardized treatment and self-management. Then there will be no problems. Slowly, the patients will be able to eliminate their anxiety. . The patient in Case 2 above falls into this category. After psychological consultation, we learned that she lived in a rural area in her early years and believed that diabetes was a terrible and incurable disease. When her children stayed in the big city, she came to help take care of them, and even had a coronary stent after she developed diabetes. In fact, she was frightened. She thought that diabetes would cause blindness. She was afraid and refused. She was afraid that the treatment would make it worse, so she did not dare to go to the hospital.
She didn't know much about diabetes. At this time, she only needed to patiently explain it to her and provide some supportive education to help her understand the disease and its treatment, and she gradually became less anxious. Just like a child who is afraid of flying, if you take your child on a plane a few more times, the child will adapt and no longer be afraid.
2. Traumatic issues
It refers to the patient's current anxiety about the disease. It is not simply the fear caused by the disease, but the psychological trauma in his early years that has not been resolved and has been suppressed in his heart. Now having diabetes has stimulated his previous trauma, and new Old and grudges are intertwined. At this time, our first priority was to deal with his past psychological trauma, rather than teach him about diabetes.
For example, in Case 1 above, he is a 58-year-old business executive who graduated from college and is rational. He knows that he has been socializing for a long time and his blood sugar is high. If he pays a little attention, there will be no problem.
Why is he so anxious? At this time, the doctor explained to him that the condition was very mild, and it was not even diabetes. Now the blood sugar reminds you that you need to pay attention to your lifestyle. There is nothing wrong with your body, how good you are, etc. Saying these words to him has no effect. Because it's not the diabetes itself that makes him anxious, it's not an adaptation problem.
After psychological consultation, I learned that during the three-year natural disaster in his family, an elderly person starved to death due to hypoglycemia. Therefore, his long-term habit was to carry chocolate with him wherever he traveled. Even though it melted in his bag, he still wanted to carry it with him just in case he needed it in case of emergencies.
In addition, if he has a meeting at work until 1 p.m., he feels that he should have lunch and does not go to eat. He feels very uncomfortable and feels that his body will be damaged as a result.
Why is he so anxious? Because someone in the family was starving to death, his father and everyone in the family told him that eating was important when he was a child. Eat more good food when you are young, and you will be healthy when you grow up. The whole family will be enveloped in this atmosphere.
In view of his situation, we should first let him fully express and vent that part of the trauma, and realize that people in that era had to eat more to survive, but in this era, it is better to eat less. In the past, they ate big fish and meat, but now they eat light food. It is popular among rich people to eat vegetarian food. If this part of the psychological trauma is not discussed, diabetes education alone will have no effect.
When facing anxiety problems, whether it reaches the level of a psychological disorder or not, we need to understand the nature of the anxiety so as to treat the symptoms
Medication. If anxiety is adaptive, we need to be patient and do some diabetes support education. You should also actively communicate with professionals and ask them if you have any questions you don’t understand or are worried about. When the problems are solved, the patient’s anxiety symptoms will be significantly improved.
When the patient feels that the knowledge about diabetes is very clear about his or her condition, and the self-management of diabetes is good, then if he is still worried about this problem in this situation, please consider whether this anxiety is related to the psychological complex of his own growth experience. In this part, patients can self-aware, or they can find a professional psychological counselor to explore the crux of the problem.
