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Hypochondria (Hypochondriasis)

Hypochondria, also called Hypochondriasis, is a somatic disorder that is characterized by the belief that the patient has one or more serious medical conditions. Patients will misinterpret physical symptoms as a sign of serious disease, and persist in this belief in spite of reassurance from doctors. They exhibit preoccupation with these symptoms, though they are not delusional. This preoccupation causes social and occupational impairment. A patient may find a mark on their skin and become convinced that it is cancerous, or hear normal digestive sounds and think he/she has a serious stomach disorder or illness. Patients with hypochondriasis are often concerned about a specific organs or illnesses, like heart disease or stomach cancer. Patients with this disorder may admit their fears are exaggerated, but they persist in the belief that they are ill. Hypochondriacs go from doctor to doctor, trying to find a doctor that will confirm their illness. The focus of the patient’s preoccupation with perceived illness is typically the benefit of the attention that illness brings to them. Family, friends, co-workers and doctors all give them attention and support, and the patient is relieved from day-to-day responsibilities, though the patient is rarely aware of this motivation.

The hypochondriac is not pretending. Rather, he/she truly believes the illness is real and actually feels ill. Somatic symptoms can become more intense after a specific event like the death of a family member or a divorce. The disorder often starts in young adulthood, and it can be chronic, lasting for many years. Patients may be predisposed to this order by a prior trauma or illness from childhood, and the disorder can run in families, though it is unclear whether it is hereditary or simply a learned behavior. Hypochondriacal symptoms are often associated with other mental disorders, including depression and schizophrenia. Hypochondriasis may occur in episodes lasting months or years with remission for equally long periods.

What are the symptoms?

Because hypochondriac patients feel and exhibit physical symptoms of disease or illness, many of the signs of this disorder are in physical complaints that cannot be attributed to a true or specific illness by thorough testing and medical examination.

Primary Symptoms of Hypochondria

• Patient is preoccupied with illness or fear of illness
• Patient has persistent, unqualified concerns about health (not appearance) but is not delusional
• Appropriate, thorough medical exam and testing does not reassure the patient that they are well
• Patient may have associated depression or suffer from schizophrenia, organic brain syndrome, or dysthymic disorder, panic disorder, generalized anxiety disorder
• Patient misses work or social events and exhibits impairment in these areas because of ‘perceived’ illnesses
• Patient seeks advice of many doctors, going from one to another, to find one that will diagnose disease or illness
• Symptoms seem to shift and change and are often non-specific or lack detail
• Symptoms last for at least six months

How is it diagnosed and treated?

Because the patient presents with physical complaints, doctors must first perform a thorough physical examination with appropriate blood tests, x-rays and other tests to rule out or verify their physical complaints. Since accompanying depression and other mental disorders may be coincident, the patient may also undergo a mental evaluation.

Real disease and illness is often overlooked in diagnosed hypochondriacs, because their complaints were previously unfounded, so it is important that the doctor review all possible causes for symptoms before ruling out a true disease or disorder.

Treatment(s) can include:

• Medication, if appropriate: Antidepressants, anti-anxiety medication or antipsychotic medication in severe cases
• Psychotherapy if appropriate
• Cognitive Behavioral Therapy

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