The dominant feature of hypochondriasis is an unrealistic misinterpretation of the severity and significance of physical signs or sensations as abnormal. This leads to preoccupation with fear of having a serious disease, which persists despite medical reassurance to the contrary. Hypochondriasis causes severe social and occupational impairment. It isn’t due to other mental disorders, such as schizophrenia, mood disorder, or somatization disorder.
The course of hypochondriasis is usually chronic, although the severity of symptoms may vary.
Hypochondriasis isn’t linked to a specific cause, but it commonly develops in people who have experienced an organic disease or in their relatives. It allows the patient to assume a dependent sick role to ensure that his needs are met. Such a patient is unaware of these unmet needs, and doesn’t consciously cause his symptoms. Stress increases the risk of developing hypochondriasis.
Hypochondriasis occurs in men and women with equal frequency. It can begin at any age, but onset usually occurs between ages 20 and 30.
The dominant feature of hypochondriasis is the misinterpretation of symptoms — usually multiple complaints that involve a single organ system — as signs of serious illness. As the medical evaluation proceeds, complaints may shift and change. Symptoms, which can range from specific to general, vague complaints, typically are associated with a preoccupation with normal body functions.
The hypochondriacal patient will relate a chronic history of waxing and waning symptoms. Commonly, he will have undergone multiple evaluations for similar symptoms or complaints of serious illness. His past contacts with health care professionals make him quite knowledgeable about illness, diagnosis, and treatment.
For characteristic findings in patients with this condition, see Diagnosing hypochondriasis.
The goal of treatment is to help the patient continue to lead a productive life despite distressing symptoms and fears. After medical evaluation is complete, the patient should be told clearly that he doesn’t have a serious disease. Continued medical follow-up, however, will help monitor his symptoms. Providing a diagnosis won’t make hypochondriasis disappear, but it may ease the patient’s anxiety.
Regular outpatient follow-up can help the patient deal with his symptoms and is necessary to detect organic illness. (Up to 30% of these patients develop an organic disease.) Because the patient can be demanding and irritating, consistent follow-up may be difficult.
Most patients don’t acknowledge any psychological influence on their symptoms and resist psychiatric treatment.
❑ Provide a supportive relationship that lets the patient feel cared for and understood. The patient with hypochondriasis feels real pain and distress, so don’t deny his symptoms or challenge his behavior.
❑ Firmly state that medical test results were normal. Instead of reinforcing his symptoms, encourage him to discuss his other problems, and urge his family to do the same.
❑ Recognize that the patient will never be symptom-free, and don’t become angry when he won’t give up his disease. Such anger can drive him to yet another unnecessary medical evaluation.
❑ Help the patient and his family find new ways to deal with stress other than the development of physical symptoms.
Review other book chapters online related to Hypochondriasis:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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