Unlike conversion disorder where an individual perceives a
functional disorder and simply use it to escape from uncomfortable situations,
hypochondriacs have no real illness, but is overly obsessed over normal bodily functions.
They read into the sensations of these normal bodily functions the presence of a feared
Because of misinterpreting bodily symptoms, the patient becomes
preoccupied with ideas or fears of
having a serious illness.
investigation and reassurance do not relieve these ideas.
These ideas are not
delusional (as in Delusional Disorder) and are not restricted to concern about
appearance (as in Body Dysmorphic Disorder).
They cause distress that
is clinically important or impair work, social or personal functioning.
They have lasted 6
months or longer.
These ideas are do better
explained by Generalized Anxiety Disorder, Major Depressive Episode,
Obsessive-Compulsive Disorder, Panic Disorder, Separation Anxiety or a
different Somatoform Disorder.
Some disorders have similar or even the same symptoms. The clinician, therefore, in
his/her diagnostic attempt has to differentiate against the following disorders which need
to be ruled out to establish a precise diagnosis.
Obsessive Compulsive Disorder
Generalized Anxiety Disorder
Panic Disorder can often cause prominent somatic complaints with no organic basis
This is a chronic illness which usually develops in middle
age or later. Patients become excessively worried about a physical symptom and cannot
shake the idea that something is seriously wrong with them. They are not overtly
delusional in this belief, but they hang on to the idea (or worry) with great tenacity
despite evidence to the contrary. They seek many tests and much reassurance from their
physicians, who tend to get annoyed because the patients are rarely satisfied, complain
frequently about their care, and may get worse when they are offered reassurance. The
patients often seem highly invested in their own suffering. Males and females are equally
affected, and such patients tend to have obsessive and/or paranoid personality traits.
A supportive relationship with a health care
provider is the mainstay of treatment. 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.