spouse who creates symptoms in the other spouse.
In Munchausen’s syndrome by proxy, which may
have legal consequences, protection of the other
person is of utmost importance.
See also CHILD ABUSE; DOMESTIC VIOLENCE; ELDER
ABUSE; SOMATIZATION DISORDERS.
generalized anxiety disorder (GAD) A psycho-
logic condition in which the person experiences
exaggerated worry and anxiety that generates
physical symptoms such as excessive sweating,
trembling, and tics or MUSCLEtwitches. Gastroin-
testinal symptoms, such as NAUSEAand DIARRHEA,
are also common. Symptoms may be episodic
(come and go) or persistent (always present) and
often interfere with, though do not prevent, the
person’s function in the world. People who have
GAD commonly have other psychologic condi-
tions as well, such as DEPRESSION, OBSESSIVE–COM-
PULSIVE DISORDER (OCD), POST-TRAUMATIC STRESS
DISORDER(PTSD), PANIC DISORDER, orPHOBIA.
After medical and NEUROLOGIC EXAMINATIONto
rule out organic or neurologic causes for symp-
toms, the doctor is likely to recommend treatment
that combines PSYCHOTHERAPYand ANTIANXIETY MED-
ICATIONS. Some people also benefit from ANTIDE-
PRESSANT MEDICATIONS(notably selective serotonin
reuptake inhibitors; SSRIs), which further reduce
agitation and provide a more balanced emotional
landscape. For some people GAD is a limited con-
dition that, once successfully treated, does not
return. For many people, however, GAD is a
chronic or recurrent condition that periodically
requires treatment. Researchers do not know
what causes GAD, and there are no measures to
prevent its development.
See also ORGANIC BRAIN SYNDROME; PARKINSON’S
DISEASE.
hallucination A false sensory perception such as
hearing voices or seeing objects that are not there.
Hallucinations may affect any or a combination of
the five senses—vision, hearing, taste, touch, and
smell. Hallucinations may occur in numerous psy-
chiatric conditions as well as neurologic conditions
such as ALZHEIMER’S DISEASEand PARKINSON’S DIS-
EASE. They may also occur as undesired side effects
of numerous medications and sometimes with
high FEVER. A hallucination is entirely real to the
person experiencing it. When the cause of persist-
ent hallucination is not clear, the doctor may
undertake comprehensive NEUROLOGIC EXAMINATION
and psychiatric examination.
See also COGNITIVE FUNCTION AND DYSFUNCTION;
DELUSION.hypochondriasis Obsessive fear that something
is wrong with one’s physical health. Though it is
normal to worry about health, even inappropri-
ately or excessively at times, the person who has
hypochondriasis is inordinately preoccupied with
observations of natural body functions that he or
she perceives as indications of illness. This worry
may be so overwhelming as to periodically pre-
vent the person from engaging in normal activi-
ties. The person frequently sees health-care
providers to evaluate these perceived symptoms.
COGNITIVE THERAPYand BEHAVIOR MODIFICATION THER-
APYare often successful in helping people recog-
nize and understand the dysfunctional nature of
their health worries and learn ways to manage
their worry and anxiety. HYPNOSISis also some-
times helpful.
See also BODY DYSMORPHIC DISORDER; CONVERSION
DISORDER; FACTITIOUS DISORDERS; SOMATIZATION DISOR-
DER; STRESS AND STRESS MANAGEMENT.insanity A legal term within the practice of med-
icine that identifies the circumstance in which a
person is cognitively or emotionally unable to
make decisions and manage his or her affairs,
including matters related to health care. In mat-
ters of law, a clinical diagnosis of insanity gener-
ally means a person was unaware of the difference
between right and wrong at the time of a specific
action, though in the United States this varies
among states. Insanity is not a clinical diagnosis.
See also NERVOUS BREAKDOWN.376 Psychiatric Disorders and Psychologic Conditions