In hypochondriasis, people are preoccupied with the fear of having a serious disease or are preoccupied with the belief that they actually have a disease. These feelings are usually based on a misinterpretation of normal bodily sensations or minor physical symptoms.

• People believe that signs of normal body functions, such as a grumbling in the intestines or sweating, indicate a serious physical disorder.
• Even though a thorough medical evaluation determines that no physical or other mental disorder can account for the symptoms, people remain preoccupied with their concerns.
• A supportive, trustful relationship with a doctor may help, but referral to a psychiatrist is often needed.

Hypochondriasis begins most commonly during early adulthood and appears to affect both sexes equally.

Symptoms

People misinterpret normal bodily functions or minor physical symptoms that are not related to any abnormality or disorder. These symptoms may include abdominal bloating, rumbling in the abdomen, awareness of the heartbeat, sweating, pain, and fatigue. People may describe their symptoms in minute detail. They think that the symptoms indicate a serious physical disorder. For example, they may think headaches indicate a brain tumor. The symptoms cause them great distress. As people become increasingly concerned with health issues, personal relationships and work performance often suffer.

Examination and reassurance by a doctor do not relieve the concerns of people with hypochondriasis. They tend to believe that the doctor has somehow failed to find the underlying disorder.

Some people with hypochondriasis also have depression or anxiety.

Hypochondriasis often persists, lasting years. In some people, it comes and goes. Some people recover completely.

Munchausen Syndrome: Faking Illness for Attention
Munchausen syndrome is not a somatoform disorder, but its features are somewhat similar. That is, mental health problems underlie physical symptoms. The key difference is that people with Munchausen syndrome consciously fake the symptoms of a physical disorder. They repeatedly fabricate illnesses and often wander from hospital to hospital for treatment. However, Munchausen syndrome is more complex than simple dishonest fabrication and simulation of symptoms. The disorder is associated with severe emotional problems. People with the disorder are usually quite intelligent and resourceful. They not only know how to mimic diseases but also have sophisticated knowledge of medical practices. They can manipulate their care so that they are hospitalized and subjected to intense testing and treatment, including major operations. Their deceits are conscious, but their motivation and quest for attention are largely unconscious. Munchausen by proxy is a bizarre variant of Munchausen syndrome. In it, a caregiver (often a parent) intentionally produces or feigns symptoms in someone in their care (often a child). The caregiver falsifies the child's medical history and may injure the child with drugs or add blood or bacterial contaminants to urine specimens. All is done in an effort to fake disease. The motivation for such behavior appears to be a psychologic need to experience the role of a sick person through a substitute (proxy). People with this disorder also have a pathologic need for attention and an intense relationship with the child.

Diagnosis

Hypochondriasis is suspected when healthy people with minor symptoms are preoccupied with the significance of the symptoms and do not respond to reassurance after a thorough medical evaluation.

The diagnosis of hypochondriasis is confirmed if the situation persists for at least 6 months despite a medical evaluation and a doctor's reassurance and if the symptoms cannot be attributed to depression or another mental health disorder.

Treatment

Treatment can be difficult because people with hypochondriasis believe that something inside the body is seriously wrong. Reassurance does not relieve these concerns. However, a supportive, trustful relationship with a caring doctor is beneficial, especially if regular visits are scheduled. If symptoms are not adequately relieved, people may benefit from referral to a psychiatrist or another mental health practitioner for further evaluation and treatment, with continuing care by the primary doctor.

Treatment with serotonin reuptake inhibitors, a class of antidepressants, may be effective. Cognitive-behavioral therapy may also relieve symptoms.

Last full review/revision June 2008 by Katharine A. Phillips, MD