Hypochondriasis

Definition
Hypochondriasis is a psychosomatic disorder (as in a mental illness with
physical symptoms) in which the subject has an excessive fear of or preoccupation
with a serious illness, despite medical testing and reassurance to the contrary. It
was formerly called hypochondriacal neurosis.
Although hypochondriasis is often considered a disorder that primarily affects
adults, it is now increasingly recognized in children and adolescents. In addition,
hypochondriasis may develop in elderly people without previous histories of healthrelated fears. The disorder accounts for about 5% of psychiatric patients and is
equally common in men and women.

Symptomps
Preoccupation with fears of having, or the idea that one has, a serious
disease based on the person's misinterpretation of bodily symptoms.
The preoccupation persists despite appropriate medical evaluation and
reassurance
The belief in preoccupation is not of delusional intensity (as in Delusional
Disorder, Somatic Type) and is not restricted to a circumscribed concern
about appearance (as in Body Dysmorphic Disorder).
The preoccupation causes clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
The duration of the disturbance is at least 6 months.
The preoccupation is not better accounted for by Generalized Anxiety
Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive
Episode, Separation Anxiety, or another Somatoform Disorder.

Causes
The causes of hypochondriasis are not precisely known. Children may have physical symptoms
that resemble or mimic those of other family members. In adults, hypochondriasis may
sometimes reflect a self-centered character structure or a wish to be taken care of by others; it
may also have been copied from a parent's behavior. In elderly people, hypochondriasis may be
associated with depression or grief. It may also involve biologically based hypersensitivity to
internal stimuli.
Most hypochondriacs are worried about being physically sick, although some express fear of
insanity. The symptoms reported can range from general descriptions of a specific illness to
unusual complaints. In many instances the symptoms reflect intensified awareness of ordinary
body functions, such as heartbeat, breathing, or stomach noises. It is important to understand that

a hypochondriac's symptoms are not "in the head" in the sense of being delusional. The
symptoms are real, but the patient misinterprets bodily functions and attributes them to a serious
or even lethal cause.

Treatment
The goal of therapy is to help the patient (and family) live with the symptoms and to
modify thinking and behavior that reinforces hypochondriacal symptoms. This
treatment orientation is called supportive, as distinct from insight-oriented, because
hypochondriacs usually resist psychological interpretations of their symptoms.
Supportive treatment may include medications to relieve anxiety. Some clinicians
look carefully for "masked" depression and treat with antidepressants.

Key terms
Somatoform disorder A category of psychiatric disorder characterized by conversion of
emotional distress into physical symptoms or by symptoms of physical illness that have no
discernible organic cause. Hypochondriasis is classified as a somatoform disorder.
Supportive therapy Any form of treatment intended to relieve symptoms or help the patient
live with them rather than attempt changes in character structure.