September 14, 2011

Hypochondriasis is a psychiatric illness in which individuals experience anxiety about misinterpreted physical symptoms that they fear or believe indicate the presence of an undiagnosed medical disease. For example, a mark on the skin may be interpreted as cancer or a sign of AIDS, or sweating may be interpreted as a heart condition. This anxiety and associated behavior cause significant distress and/or impairment in work, social, or other areas of functioning for at least 6 months or longer. People with this disorder may seek frequent medical attention and diagnostic testing. Although tests may be negative, it is usually not enough to convince the person with hypochondriasis that nothing is wrong. The person with this disorder may be willing to acknowledge that their fears are exaggerated or that there is nothing seriously wrong with them, but in general fear and anxiety persist. Over time, the person with this disorder may focus almost exclusively on their fears of disease, which may limit their social conversations and interrupt their family and work lives.

One of the many somatoform disorders, hypochondriasis affects from 1% to 5% of the general population. Somatoform disorders are those disorders in which an individual complains of physical symptoms but the symptoms cannot be fully explained by any medical or other mental disorder. Other somatoform disorders include somatization disorder, conversion disorder, undifferentiated somatoform disorder, pain disorder, and body dysmorphic disorder. It is important to make the distinction between hypochondriasis and malingering. Individuals with hypochondriasis are not fabricating symptoms intentionally as are those who are malingering. Instead, they experience valid symptoms (usually amplified normal physical sensations) that cause them distress whether or not one is able to find a diagnosable disease.

Hypochondriasis affects both women and men of any race or socioeconomic status. It can occur at any time in the life span. Generally, this disorder arises in individuals who have had a serious illness or have witnessed a relative with a medical illness. Death in someone close to the patient or other psychosocial stressors are sometimes related to the onset of this disorder. Two thirds of patients with hypochondriasis have a cooccurring mental disorders such as anxiety, depression, or other somatoform disorders.

Primary care physicians are frequently the first to see these patients, with prevalence rates higher than in the general population ranging from 2% to 7%. Patients with hypochondriasis will usually “doctor shop” until they find one they feel understands their complaints and complies with their demands for medical testing. Physicians are often frustrated with these patients since they make frequent visits and efforts to reassure them go unheard. Patients usually resist referrals to mental health providers, believing that their symptoms are solely physical.

There are several strategies used in the treatment of hypochondriasis, although none are definitive. Cognitive-behavioral treatment has shown some promising results. Therapy is designed to target the dysfunctional beliefs and behaviors that accompany hypochondriasis. In the few studies that have been conducted, results suggest that cognitive-behavioral therapy leads to improvements in hypochondriasis symptoms, including reduction of fears of illness and somatic complaints.

There is a paucity of research on the pharmacotherapy of primary hypochondriasis. Pharmacotherapy to address common coexisting mental disorders (panic, obsessive-compulsive disorder, and depression) seems to help improve the symptoms of hypochondriasis. Medication should be started at subtherapuetic doses since patients with hypochondriasis are not likely to tolerate significant side effects.

Medical management of patients in the primary care office involves building a trusting doctor-patient relationship. It is recommended that visits be scheduled regularly whether current symptoms warrant it or not. Frequent visits coupled with attentive listening and examination are useful approaches to therapy. Tests and consultations are to be limited to those for which there is an obvious indication, not for reassurance sake. Referrals to a psychiatrist should be attempted to examine current psychosocial stressors.

The long-term prognosis of hypochondriasis is guarded. Symptoms of hypochondriasis sometimes dissipate if a bona fide medical disorder is uncovered, which validates the individual’s experience. In some individuals, symptoms completely remit. More frequently, symptoms are chronic and of a variable nature. One study showed that two thirds of medical outpatients continued to receive the diagnosis of hypochondriasis after 5 years even though symptoms may have declined and role functioning improved during this time period.

SEE ALSO: Anxiety disorders, Depression, Psychosomatic disorder

Suggested Reading

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.
  • Barsky, A. J. ( 2001). The patient with hypochondriasis. New England Journal of Medicine, 345, 1395-1399.
  • Barsky, A. J., Fama, J. M., Bailey, E. D., & Ahern, D. K. (1998). A prospective 4to 5-year study of DSM-III-R hypochondriasis. Archives of General Psychiatry, 55, 737-744.
  • Starcevic, V., & Lipsett, D. R. (Eds.). (2001). Hypochondriasis: Modern perspectives on an ancient malady. New York: Oxford University Press.

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