Hypochondriasis is preoccupation with the fear of having, or with the idea that one has, a serious disease, based on misinterpretation of nonpathologic physical symptoms or normal bodily functions. Hypochondriasis is nonvolitional; the exact cause is unknown. Diagnosis is confirmed when fears and symptoms persist for ≥ 6 mo despite reassurance after thorough medical evaluation. Treatment includes establishing a consistent, supportive physician-patient relationship; cognitive-behavioral therapy and drug therapy may help.
Hypochondriasis most commonly begins during early adulthood and appears to occur equally among men and women.
Symptoms and Signs
A wide array of fears may derive from misinterpreting nonpathologic physical symptoms or normal bodily functions (eg, borborygmi, abdominal bloating and crampy discomfort, heartbeat, sweating). The location, quality, and duration of symptoms are often described in minute detail, but symptoms are usually not associated with abnormal physical findings. Symptoms impair social and occupational functioning or cause significant distress.
The course is often chronic—fluctuating in some, steady in others. Some patients recover.
The diagnosis is suggested by the history and confirmed when symptoms persist ≥ 6 mo despite appropriate medical evaluation that excludes a physical disorder and reassurance, and when the symptoms are not better accounted for by depression or another mental disorder.
Treatment is difficult because patients believe that something is seriously wrong and that the physician has failed to find the real cause. A trusting relationship with a caring, reassuring physician can nonetheless prove beneficial. If symptoms are not adequately relieved, patients may benefit from a psychiatric referral while continuing under the care of the primary physician.
Treatment with serotonin reuptake inhibitors may be helpful, as may cognitive-behavioral therapy.
Last full review/revision June 2008 by Katharine A. Phillips, MD