Clinical Features

Patients with hypochondriasis tend to present with a set of core symptoms that include a fear of disease, the conviction of having a disease, and a bodily preoccupation or absorption associated with multiple somatic complaints (Folks et al. 2000). Patients often complain of a poor relationship with their physicians, have feelings of frustration and anger toward their physicians, and are prone to "doctor shopping." Patients with hypochondriasis are particularly prone to somatosensory amplification and may experience significant secondary gain as a result of their ability to adopt the sick role. Complications may arise as a result of exposure to unnecessary treatments and procedures. Adolescents may manifest subclinical forms of the disorder, such as unrealistic concerns about having AIDS or cancer (Fritz et al. 1997).

Hypochondriasis is frequently associated with anxiety disorders (Noyes 1999). Individuals with hypochondriasis have symptoms similar to those seen in obsessive-compulsive disorder (OCD) and

Table 8-3. DSM-IV diagnostic criteria for hypochondriasis

A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical evaluation and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in delusional disorder, somatic Type) and is not restricted to a circumscribed concern about appearance (as in body dysmorphic disorder).

D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months.

F. The preoccupation is not better accounted for by generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, a major depressive episode, separation anxiety, or another somatoform disorder.

Specify if:

With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable often may have a comorbid diagnosis of OCD. The lifetime prevalence of OCD in patients with hypochondriasis is 8%, compared with 2% in the general population (Barsky 1992). OCD is marked by an elevated, overvalued ideation, which in the case of hypochondriasis would be a strong disease conviction (Neziroglu et al. 2000).

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