Hypochondriasis

What Is It?

Hypochondriasis is a persistent fear of having a serious medical illness. A person with this disorder tends to misinterpret normal sensations, bodily functions and mild symptoms as a sign of an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be a sign of a serious disease.

A person with hypochondriasis may be especially concerned about a particular organ system (such as the cardiac or digestive system). A doctor's reassurance and even a complete medical evaluation often will not calm the person's fears. Or, if it does calm them, other worries may emerge days later.

Generally, people with this disorder do not become delusional. They may admit the possibility that their fears are exaggerated. They may, however, only accept being told they are ill.

There is a tendency to go from doctor to doctor, looking for one that will confirm the presumed illness. The patient and the doctors may become frustrated or angry. The intensive search for illnesses that cannot be found sometimes interferes with the person getting proper care if a true medical illness should occur.

Some people with this disorder have had a serious illness in the past, particularly in childhood. Somatic symptoms may become more intense after a stressful event, for example, the death of a loved one. Hypochondriasis can occur at any age, and in both men and women. Often the disorder starts in young adulthood, and it can last many years.

Although being ill is uncomfortable, it can bring benefits, such as the attention and care of family members, friends, and doctors, and relief from responsibilities. Sometimes, hypochondriasis is motivated by these secondary advantages, usually not consciously.

Less commonly, a person is feigning illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. When someone consciously seeks such advantages, the condition is called malingering. Hypochondriasis is different from malingering. In hypochondriasis, the patient is not pretending, but believes the illness is real; he or she truly feels ill.

Symptoms

Symptoms of hypochondriasis include:

• Preoccupation with having serious illness
• Misinterpretation of body symptoms
• Persistent fear despite medical reassurance
• Absence of delusions or psychosis
• Clinical distress or functional impairment

Diagnosis

The diagnosis usually is suspected by a primary care physician and confirmed by a psychiatrist or other mental health professional. The diagnosis is based on a person's medical complaints and history, and a doctor's physical examination and laboratory tests. The disorder may be accompanied by severe anxiety symptoms or obsessive-compulsive symptoms. Fear or exaggerated concerns about medical illness also may appear as part of other mental disorders, such as the various forms of depression, schizophrenia or somatization disorder.