Hypochondriasis

The dominant feature of hypochondriasis (previously referred to as hypochondriacal neurosis) 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.

Hypochondriasis appears to be equally common in men and women. It can begin at any age, but onset most frequently occurs between ages 20 and 30. The course of the disease usually is chronic, although the severity of symptoms may vary.

Causes

Hypochondriasis isn't linked to any specific cause. However, this disorder frequently develops in people or the relatives of those who have experienced an organic disease. It allows the patient to assume a dependent sick role to ensure 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.

Signs and Symptoms

• Preoccupation with a serious illness for at least six months
• Persistent fear of illness despite reassurance to the contrary from healthcare providers
• Difficulty maintaining a job, keeping relationships, and performing normal daily activities

Treatment

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 but that continued medical follow-up will help control 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 they resist psychiatric treatment.

Prevention

Hypochondriasis may be difficult to prevent in a health-conscious society, in which people are constantly exposed to messages reminding them to seek regular medical screenings for a variety of illnesses, and telling them in detail about the illnesses of celebrities and high-ranking political figures. Trendy new diagnostic techniques like full-body MRIs may encourage people with hypochondriasis to seek unnecessary and expensive medical consultations. Referring patients with suspected hypochondriasis to psychotherapy may also help to reduce their overuse of medical services.