The term hypochondriasis (or hypochondria also called pathophobia, or disease anxiety) is a clinical form of anxiety disorders characterized by unjustified and excessive concern for one’s own or others’ health, with the belief that any symptom experienced by a subject is a sign of a severe disease.

The term hypochondria derives from the Greek ὑποχόνδρια, composed of the prefix υπό (under) and χόνδρος (cartilage of the thorax), indicating a malaise, known since ancient times, which was believed to be localized in the abdominal fascia. Consequently, the treatments were those related to abdominal pain. Only later it was understood that the cause of this malaise was related to psychological aspects of the individual.

The characteristic sign is the obsessive observation of objective symptoms related to one’s own body (e.g., gastrointestinal problems, heart palpitations, or muscle aches) that engage the subject in a process of continuous listening and self-diagnosis that can also be severely debilitating. In fact, some patients experience the typical symptoms of an anxiety disorder such as high blood pressure, palpitations and physical stress.

Often, the concern remains even after a medical evaluation in which it is ascertained that these symptoms do not indicate any actual disease, or at least not a disease serious enough to justify the level of anxiety and fear of the hypochondriac.

Treatment is predominantly psychotherapeutic, with more evidence for cognitive-behavioral therapy. It is estimated that up to 5% of the population may suffer from the disorder during their lifetime.

Hypochondriacs, in the absence of a somatic disease, experience a continuous and intense concern for their physical health and complain of more or less vague discomfort, widespread or localized, and always experienced with considerable anxiety and concern. This is an erroneous and tenacious belief of being ill, linked in some way to an altered relationship of a subject with his own body. Hypochondria can manifest in a variety of mental illnesses.

It often appears in neurotic personalities, who almost constantly accuse a vague and painful underlying malaise, from which more specific and quite diverse disorders occasionally emerge (visual disturbances, dizziness, breathlessness, palpitations, chest pains, digestive or urinary disorders, muscle or joint pains, alterations in sensitivity, etc.) that are described by the hypochondriac with extreme meticulousness and abundance of detail. These distressing sensations are invariably associated with anxiety, each sensation being experienced, feared and interpreted as a warning or symptom of a serious illness.

The thoughts of these imaginary patients are strongly focused on the problem of health and for this reason, sometimes, they are closed to any other interest: they continuously consult their doctor and other specialists, undergoing chemical and instrumental tests whose result is reassuring only very precariously and fleetingly. Often hypochondria occurs at times when a certain decline in physical efficiency, such as during the climacteric, leads to focus attention and concerns on their bodies. The anxiety that accompanies hypochondria may be associated with depression.

In the context of psychosis, unlike in neurotic syndromes, hypochondria can assume a character of considerable gravity. In some forms of endogenous depression and schizophrenia, hypochondriac delirium can occur, i.e., a delusional belief in a non-existent infirmity, in which the delirium can manifest itself with particularly absurd and bizarre contents (inversion of the position of the two cerebral hemispheres, petrification of the heart, etc.).

In all cases of hypochondria the horizons of existence tend to narrow progressively, with a concentration of interest increasingly exclusive on his own body and detachment from the surrounding world. It is accepted that in the onset of a hypochondriac syndrome may play a role a certain degree of constitutional predisposition, on which act negatively external conditioning, such as reading medical texts or direct knowledge of the medical history of individuals suffering from serious diseases or died in particularly dramatic circumstances.

In psychoanalysis, some interpret hypochondria as a form of retreat of sexual desire or libido onto one’s own body, when its normal projection onto the outside is difficult or frustrating; others frame hypochondriacal thinking in the context of a persecutory symbolism, in which persecution comes from the body itself rather than from the outside. The treatment of hypochondria depends on that of the fundamental illness. Often, especially in neurotic forms, there is a progressive improvement of hypochondria with psychotherapeutic or even psychoanalytic support: in fact, it is thus possible to make accessible to criticism and self-criticism (and thus in a certain way control) the pathological shift of individual attention from the external world to one’s own body.

Symptoms of hypochondria

Symptoms of hypochondria can be traced to concerns about:

  • bodily functions (e.g., heartbeat, perspiration, or peristalsis);
  • minor physical changes (e.g., a minor injury or an occasional cold);
  • vague or ambiguous physical sensations (e.g., “tired heart,” “sore veins”).

The patient attributes these symptoms or signs to the suspected illness and is very concerned about their meaning and cause. In disease anxiety (also called disease phobia), concerns may be about numerous systems, at different times or simultaneously. Alternatively, there may be concern about a specific organ or a single disease (e.g., fear of heart disease).

Repeated medical examinations, diagnostic tests, and reassurances from physicians do little to alleviate concern about illness or physical suffering. For example, a person who is worried about having heart disease will not be reassured by repeated negative findings on physical examinations, ECG, or even cardiac angiography.

Hypochondriac individuals may become alarmed if they read or hear about an illness. But also if they learn that someone has become ill, or because of observations, feelings, or events concerning their body. For those with hypochondria, fear of illness often becomes a central part of the person’s self-image, a habitual topic of conversation, and a way of responding to life’s stresses.

Behaviors related to hypochondria

Two types of typical, opposing behaviors are highlighted if you have hypochondria:

  • Excessive seeking of medical assistance.
  • Avoidance of medical care.

The hypochondriac disorder in fact can lead a person to be alarmed to the point of wanting to control every minimum physiological symptom, with the hope of preventing disease. Conversely, such concern may be voluntarily avoided, for fear of discovering a serious disease.

It is typical for people who experience the disorder to always go to physical health centers, being healthy at all checkups. Some physicians may react negatively, due to the insistence of patients’ requests, creating misunderstandings. Conversely, patients may increase their level of anxiety if doctors are interested in their case and want to investigate further.

Hypochondria and other disorders

To properly diagnose hypochondria, it is necessary to differentiate it from other related disorders. In many medical conditions, for example, when a person is suffering from an illness, it is normal to manifest a state of anxiety. However, if this anxiety is disproportionate to the severity of the illness and is not time-limited (but exceeds 6 months), then Health Anxiety Disorder may be diagnosed.

In Somatic Symptom Disorder, there is concrete, identifiable physical symptomatology in the patient, whereas in Illness Anxiety Disorder, the symptoms are minimal and it is the patient’s worry that is relevant.

In other anxiety disorders, such as generalized anxiety and panic attacks, the worries are general or closely related to what triggers the attack, while in the disease anxiety disorder the content of the concern is exclusively related to health.

In Obsessive-Compulsive Disorder the thoughts may be about health, but they are intrusive and concern the fear of contracting a future disease, while disease anxiety concerns the present situation. Moreover in hypochondria there are no obsessions and compulsions.
Also in the Major Depressive Disorder can be present worries about one’s own health condition or the onset of disease, however such thoughts are related to depressive episodes and lack the continuity typical of hypochondriac disorder. It is possible to diagnose both disorders if such continuity is present.

Finally, unlike psychotic disorders, in Health Anxiety Disorder there are no delusional ideas: the person is aware that the disease he fears is not present, but still feels the symptoms, while the psychotic is firmly convinced of the presence of his imaginary disease. In addition, in psychotic-type disorders, the ideas are exaggerated and bizarre, whereas in hypochondria, extremely distorted beliefs do not develop.

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