Hypochondriasis

For the anatomical term, see Hypochondrium.

visit medical facilities, sometimes obsessively. Other victims of this disease will never speak about it.

Hypochondriasis also known as hypochondria, health

phobia, health anxiety or illness anxiety disorder,
refers to worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the condition of body or mind despite the absence
of an actual medical condition.[1] An individual suering from hypochondriasis is known as a hypochondriac.
Hypochondriacs become unduly alarmed about any physical or psychological symptoms they detect, no matter
how minor the symptom may be, and are convinced that
they have, or are about to be diagnosed with, a serious
illness.[2]

1 Characteristics
Hypochondriasis is categorized as a somatic amplication
disordera disorder of perception and cognition[1]
that involves a hyper-vigilance of situation of the body or
mind and a tendency to react to the initial perceptions in
a negative manner that is further debilitating. Hypochondriasis manifests in many ways. Some people have numerous intrusive thoughts and physical sensations that
push them to check with family, friends, and physicians.
For example, a person who has a minor cough may think
that they have tuberculosis.[8] Or sounds produced by organs in the body, such as those made by the intestines,
might be seen as a sign of a very serious illness to patients
dealing with hypochondriasis.[9]

Often, hypochondria persists even after a physician has

evaluated a person and reassured them that their concerns
about symptoms do not have an underlying medical basis or, if there is a medical illness, their concerns are far
in excess of what is appropriate for the level of disease.
Many hypochondriacs focus on a particular symptom as
the catalyst of their worrying, such as gastro-intestinal
problems, palpitations, or muscle fatigue. To qualify for
the diagnosis of hypochondria the symptoms must have
been experienced for at least 6 months.[3]

Other people are so afraid of any reminder of illness that

they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Yet others live in despair and
The DSM-IV-TR denes this disorder, Hypochondria- depression, certain that they have a life-threatening dissis, as a somatoform disorder[4] and one study has shown ease and no physician can help them. Some consider the
it to aect about 3% of the visitors to primary care disease as a punishment for past misdeeds.[10]
settings.[5] The newly published DSM-5 replaces the diHypochondriasis is often accompanied by other psyagnosis of hypochondriasis with the diagnoses of Sochological disorders. Bipolar disorder, clinical depresmatic Symptom Disorder and "Illness Anxiety Disorsion, obsessive-compulsive disorder (OCD), phobias, and
[6]
der".
somatization disorder are the most common accompanyHypochondria is often characterized by fears that minor ing conditions in people with hypochondriasis, as well as
bodily or mental symptoms may indicate a serious ill- a generalized anxiety disorder diagnosis at some point in
ness, constant self-examination and self-diagnosis, and a their life.[11]
preoccupation with ones body. Many individuals with
Many people with hypochondriasis experience a cycle
hypochondriasis express doubt and disbelief in the docof intrusive thoughts followed by compulsive checking,
tors diagnosis, and report that doctors reassurance about
which is very similar to the symptoms of obsessivean absence of a serious medical condition is unconvinccompulsive disorder. However, while people with
ing, or short-lasting. Additionally, many hypochondrihypochondriasis are afraid of having an illness, patients
acs experience elevated blood pressure, stress, and anxwith OCD worry about getting an illness or of transmitiety in the presence of doctors or while occupying a
ting an illness to others.[10] Although some people might
medical facility, a condition known as "white coat synhave both, these are distinct conditions.
drome". Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the dis- Patients with hypochondriasis often are not aware that deorder can become a disabling torment for the individual pression and anxiety produce their own physical sympwith hypochondriasis, as well as his or her family and toms, and mistake these symptoms for manifestations of
friends.[7] Some hypochondriacal individuals completely another mental or physical disorder or disease. For exavoid any reminder of illness, whereas others frequently ample, people with depression often experience changes
in appetite and weight uctuation, fatigue, decreased in1

3 CAUSE

terest in sex and motivation in life overall. Intense anxiety is associated with rapid heartbeat, palpitations, sweating, muscle tension, stomach discomfort, dizziness, and
numbness or tingling in certain parts of the body (hands,
forehead, etc.).

D. Most commonly used exclusion criteria: not

occurring only during any of the schizophrenia
and related disorders (F20-F29, particularly
F22) or any of the mood disorders (F30-F39).

hypochondriasis according to the

In some cases, hypochondriasis responds well to The DSM-IV denes
[4]
following
criteria:
antipsychotics, particularly the newer atypical antipsychotic medication.[12][13]
A. Preoccupation with fears of having, or
If a person is ill with a medical disease such as diabetes or
the idea that one has, a serious disease based
arthritis, there will often be psychological consequences,
on the persons misinterpretation of bodily
such as depression. Some even report being suicidal. In
symptoms.
the same way, someone with psychological issues such as
B. The preoccupation persists despite approdepression or anxiety will sometimes experience physipriate medical evaluation and reassurance.
cal manifestations of these aective uctuations, often in
C. The belief in Criterion A is not of deluthe form of medically unexplained symptoms. Common
sional intensity (as in Delusional Disorder,
symptoms include headaches; abdominal, back, joint,
Somatic Type) and is not restricted to a
rectal, or urinary pain; nausea; fever and/or night sweats;
circumscribed concern about appearance (as
itching; diarrhea; dizziness; or balance problems. Many
in Body Dysmorphic Disorder).
people with hypochondriasis accompanied by medically
D. The preoccupation causes clinically sigunexplained symptoms feel they are not understood by
nicant distress or impairment in social,
their physicians, and are frustrated by their doctors reoccupational, or other important areas of
peated failure to provide symptom relief.
functioning.
E. The duration of the disturbance is at least 6
months.
F. The preoccupation is not better ac2 Diagnosis
counted for by Generalized Anxiety Disorder,
Obsessive-Compulsive Disorder, Panic DisorThe ICD-10 denes hypochondriasis as follows:
der, a Major Depressive Episode, Separation
Anxiety, or another Somatoform Disorder.
A. Either one of the following:
The newly published DSM-5 replaces the diagnosis of
hypochondriasis with illness anxiety disorder.[6]
A persistent belief, of at least
six months duration, of the
presence of a maximum of
two serious physical diseases
3 Cause
(of which at least one must be
specically named by the paHypochondria is currently considered a psychosomatic
tient).
disorder, as in a mental illness with physical
A persistent preoccupation
symptoms.[14] Cyberchondria is a colloquial term
with a presumed deforfor hypochondria in individuals who have researched
mity or disgurement (body
medical conditions on the Internet. The media and the
dysmorphic disorder).
Internet often contribute to hypochondria, as articles,
TV shows and advertisements regarding serious illnesses
such as cancer and multiple sclerosis often portray
B. Preoccupation with the belief and the sympthese diseases as being random, obscure and somewhat
toms causes persistent distress or interference
inevitable. Inaccurate portrayal of risk and the identicawith personal functioning in daily living, and
tion of non-specic symptoms as signs of serious illness
leads the patient to seek medical treatment or
contribute to exacerbating the hypochondriacs fear that
investigations (or equivalent help from local
they actually have that illness.
healers).
C. Persistent refusal to accept medical advice
that there is no adequate physical cause for the
symptoms or physical abnormality, except for
short periods of up to a few weeks at a time
immediately after or during medical investigations.

Major disease outbreaks or predicted pandemics can also

contribute to hypochondria. Statistics regarding certain
illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease.
Overly protective caregivers and an excessive focus on
minor health concerns have been implicated as a potential
cause of hypochondriasis development.[15]

3
It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age
of a parents premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suering from
the same disease that caused their parents death, sometimes causing panic attacks with corresponding symptoms.

The term hypochondriasis for a state of disease without

real cause reected the ancient belief that the viscera of
the hypochondria were the seat of melancholy and sources
of the vapor that caused morbid feelings.[24] Until the
early 18th century, the term referred to a physical disease caused by imbalances in the region that was below
your rib cage (i.e., of the stomach or digestive system).
For example, Robert Burton's The Anatomy of Melancholy (1621) blamed it for everything from 'too much
[25]
Family studies of hypochondriasis do not show a genetic spittle' to 'rumbling in the guts".
transmission of the disorder. Among relatives of people
suering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common 6 See also
than in average families.[10] Other studies have shown that
Cyberchondria
the rst degree relatives of patients with OCD have a
higher than expected frequency of a somatoform disor Mithridatism
der (either hypochondriasis or body dysmorphic disor[16]
der).
Mnchausen syndrome
Nocebo

Treatment

Common to the dierent approaches to the treatment of

hypochondriasis is the eort to help each patient nd a
better way to overcome the way his/her medically unexplained symptoms and illness concerns rule her/his life.
Current research makes clear that this excessive worry
can be helped by either appropriate medicine or targeted
psychotherapy.
Recent scientic studies have shown that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs; e.g., uoxetine and paroxetine) are effective treatment options for hypochondriasis as demonstrated in clinical trials.[17][18][19][20][21] CBT, a talking
therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is
found helpful in reducing the intensity and frequency of
troubling bodily symptoms. SSRIs can reduce obsessive
worry through adjusting neurotransmitter levels and have
been shown to be eective as treatments for anxiety and
depression as well as for hypochondriasis.
Another treatment that has proved eective in the treatment of hypochondriasis is exposure therapy. In one
study, this was shown to be equally as eective as cognitive therapy and the improvements in condition were
maintained after the study.[22]

Etymology

Among the regions of the abdomen, the hypochondrium

is the uppermost part. The word derives from the Greek
term hypokhondrios, meaning of the soft
parts between the ribs and navel from hypo (under) and
khondros, or cartilage (of the sternum). Hypochondria in
Late Latin meant the abdomen.[23]

Psychosomatic medicine
Sickness behavior
Somatoform disorder
Somatopsychic
Somatosensory amplication
Medical students disease
Man u
Valetudinarian
The Imaginary Invalid

7 References
[1] Avia, M. D., and M. A. Ruiz. Recommendations for the
Treatment of Hypochondriac Patients. Journal of Contemporary Psychotherapy. 35.3 (2005): 301-313. Print.
[2] Kring A.M. et al. 2007. Abnormal Psychology. 10th ed.
USA: Wiley
[3] Goldberg R.J. MD.2007 Practical Guide to the Care of
the Psychiatric Patient 3rd ed. Mosby-Elsevier: USA.
[4] American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised,
Washington, DC, APA, 2000.
[5] Escobar JI, Gara M, Waitzkin H, Silver RC, Holman
A, Compton W (1998). DSM-IV hypochondriasis in
primary care. Gen Hosp Psychiatry 20 (3): 1559.
doi:10.1016/S0163-8343(98)00018-8. PMID 9650033.
[6] http://www.mayoclinic.org/medical-professionals/
clinical-updates/psychiatry-psychology/
diagnostic-statistical-manual-mental-disorders-redefines-hypochondriasis

9 FURTHER READING

[7] Olatunji, B. O., Etzel, E. N., Tomarken, A.J., Ciesielski, B. G., & Deacon, B. (2011). The eects of safety
behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy 49: 719728.
doi:10.1016/j.brat.2011.07.008.

[21] Greeven A, Van Balkom AJ, Visser S, Merkelbach JW,

Van Rood YR, Van Dyck R, Van der Does AJ, Zitman
FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized
controlled trial. Am J Psychiatry 2007; 164:91-99.

[8] Daniel L. Schacter, Daniel T. Gilbert, Daniel M. Wegner.(2011).Generalized Anxiety Disorder.Psychology

second edition.

[22] Visser, S.; Bouman, T. K. (2001). The treatment of

hypochondriasis: exposure plus response prevention vs
cognitive therapy. Behaviour research and therapy 39
(4): 423442. doi:10.1016/S0005-7967(00)00022-X.
PMID 11280341.

[9] Hypochondriasis. CareNotes. Thomson Healthcare,

Inc., 2011. Retrieved 6 April 2012.
[10] Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder.
Psychiatr Clin North Am 2000; 23:605-616.

[23] hypochondria (n.)". Etymonline. Retrieved 14 April

2015.
[24] Susan Harvey (February 21, 2010). Hypochondria. The
Virtual Linguist.

[11] Barsky AJ: Hypochondriasis and obsessive-compulsive

disorder. Psychiatr Clin North Am 1992; 15:791-801.

[25] Leslie Mann (July 11, 2012). New book tries to explain
the roots of hypochondria. Chicago Tribune.

[12] Wenning MT, Davy LE, Catalano G, Catalano MC

(2003). Atypical antipsychotics in the treatment of delusional parasitosis. Annals of Clinical Psychiatry 15 (3
4): 2339. doi:10.3109/10401230309085693. PMID
14971869.

8 External links

[13] Harth, Wolfgang; Uwe Gieler; Daniel Kusnir; Francisco

A. Tausk (2008). Clinical Management of Psychodermatology. Springer. p. 36. ISBN 9783540347187. In
delusional cutaneous hypochondriasis, atypical neuroleptics are the therapy of rst choice (for example, risperidone and olanzapine or aripiprazole).
[14] Ford, Allison. Hypochondria: Can You Worry Yourself
Sick?". divine caroline. divine caroline. Retrieved 19
November 2012.
[15] Hypochondriasis. CareNotes. Thomson Healthcare,
Inc., 2011. Health Reference Center Academic. Retrieved April 5, 2012.
[16] Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R,
Liang KY, Cullen BAM, Grados, MA, Nestadt G: The
relationship of obsessive-compulsive disorder to possible
spectrum disorders: results from a family study. Biological Psychiatry 2000, 48:287-293.
[17] Barsky AJ, Ahern DK: Cognitive behavior therapy for
hypochondriasis: a randomized controlled trial. JAMA
2004; 291:1464-1470.
[18] Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell
M, Ludgate J, Ahmand S, Richards HC, Gelder M: Two
psychological treatments for hypochondriasis, a randomized controlled trial. Br J Psychiatry 1998; 173:218-225.
[19] Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz D, Liebowitz MR: The pharmacotherapy
of hypochondriasis. Psychopharmacol Bull 1996; 32:607611.
[20] Fallon BA, Qureshi AI, Schneiner FR, Sanchez-Lacay A,
Vermes D, Feinstein R, Connelly J, Liebowitz MR: An
open trial of uvoxamine for hypochondriasis. Psychosomatics 2003; 44:298-303.

Hypochondriasis at DMOZ

9 Further reading
Belling, Catherine. 2012. A Condition of Doubt:
The Meanings of Hypochondria. New York: Oxford University Press. ISBN 978-0199892365.

10
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