A belief that real or imagined physical symptoms are signs of a serious illness despite medical reassurance that they are not.

Alternative Names

Hypochondriacal neurosis; Hypochondria

Causes, incidence, and risk factors

A person suffering form hypochondriasis is preoccupied with physical health despite medical reassurance and the lack of physical findings. There is an unrealistic fear of serious disease. There is no specific cause of hypochondriasis, but it frequently develops in people or relatives of those who have had a disease. Furthermore, the sickness that the person worries about can change frequently; one week it could be cancer, the next a heart attack. It is therefore assumed that the disorder is prompted by psychological factors unrelated to actual medical illness. The duration of this disorder is usually 6 months or longer. Frequent appointments with health care providers are typical, and time from work may be lost. It occurs in men and women with equal frequency.

Signs and tests

A physical examination should be performed to rule out underlying organic disease, but invasive diagnostic tests should be minimized. A psychological evaluation should be performed to rule out other related disorders.

Treatment

A supportive relationship with a health care provider is the mainstay of treatment. There should be one primary provider to avoid unnecessary diagnostic tests and procedures. The health care provider should inform the person that no organic disease is present, but that continued medical follow-up will help control the symptoms. The person with hypochondriasis feels real distress, so the symptoms should not be denied or challenged by others. The person should be encouraged to discuss other problems rather than reinforcing the symptoms. Family cooperation will be helpful. The person with hypochondriasis and the family need to be helped to find ways to deal with stress other than developing new symptoms. Because one of the problems with hypochondriasis is frequent emergency visits, having regularly scheduled doctor visits at set times can set boundaries and give the patient something to look forward to.

Expectations (prognosis)

Generally, the disorder is chronic unless the psychological factors or underlying mood disorder are mediated.

Complications

There is a possibility that real disease may be overlooked in people with hypochondriasis because of previously unfounded complaints. Complications may result from invasive testing and multiple evaluations looking for the cause of symptoms. Dependency on pain relievers or sedatives may develop. A poor relationship with the health care provider seems to worsen the condition, as does evaluation by many providers.

Calling your health care provider

Try to maintain a healthy relationship with your primary health care provider. Avoid going to multiple providers.

Prevention

Mental health intervention may be helpful for people prone to this condition (in some cases).