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Hypochondriasis

Hypochondriasis is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • In DSM-5, 75% of patients with hypochondriasis are classified in the new diagnostic category of somatic symptom disorder (300.82), and 25% of patients with hypochondriasis are now classified in the new diagnostic category of illness anxiety disorder (300.7) (1).
  • 6 months existence of the following:
    • ≥1 physical symptoms associated with the belief that these physical symptoms are a manifestation of an underlying serious illness
    • Fear and anxiety that a serious illness is present in the body and, unless treated, may cause significant harm and lead to death or serious impairment and disability
    • Standard medical workup and reassurance that such a serious illness is not present is not effective in curing the fear.
    • The patient’s beliefs have an obsessive quality.
    • The patient typically is engaged in behaviors seeking a physical diagnosis that would explain his or her somatic symptoms.
  • Synonym(s): hypochondriacal neurosis; hypochondria; health anxiety; cyberchondria, Briquet syndrome

Epidemiology

Incidence
  • Predominant sex: male = female; women tend to seek help more frequently than men.
  • Predominant age: Most common onset is in the 3rd to 4th decade of life.

Prevalence
  • In the United States, 1–4.5% of the general population
  • 4–6% of medical outpatients meet criteria for hypochondriasis.
  • In 25–50% of all primary care visits, no physical cause is found to explain the patient’s presenting symptoms (2)[A].

Etiology and Pathophysiology

  • Biologic: Some evidence suggests that patients with hypochondriasis may have a lower threshold and a lower discomfort tolerance. Recent studies suggest that hypochondriacal patients have smaller pituitary volumes.
  • Childhood events: The experience of numerous or serious actual medical illnesses during childhood may predispose to hypochondriasis at a later age.
  • Life events: Experience of life-threatening medical diseases may predispose some to become overly sensitive to physical symptoms and overly worried about the recurrence of an acute relapse of chronic illness. These illnesses may be experienced by the patient or by a close family member or friend.
  • Psychodynamics: Some view hypochondriasis as the patient’s psychodynamic manifestation of coping with intrapsychic subconscious emotions of guilt, shame, low self-esteem, and a narcissistic overindulgence with self; others, as a manifestation of an individual’s need for attention by overly identifying with the sick role, which offers an acceptable way of alleviating anxiety by seeking valid reassurance from a medical authority
  • Anxiety/depression: Some patients with an underlying anxiety or depressive disorder experience their psychiatric illness in the form of physical symptoms, which in some patients may become a chronic behavior, turning into a full-blown hypochondriasis even after their underlying anxiety or depression has been alleviated.
  • Sociocultural: Some cultures view mental and emotional symptoms in a pejorative way, blaming the patient for the illness when the symptoms are mental and feeling more empathy when the symptoms are physical. In such cultures, patients with physical symptoms get more attention, empathy, and respect and are not blamed for causing their illness.
  • Cognitive: Patients with hypochondriasis overestimate their risk of developing a serious illness. They also tend to minimize their past experiences and behaviors of good health.

Genetics
Some studies show an increased prevalence of hypochondriasis in families, especially among identical twins and first-degree relatives.

Risk Factors

  • Exposure to life-threatening medical conditions in self or others and multiple medical procedures in childhood, adolescence, or adult life
  • Being raised by an overprotective parent who is obsessed with excessive worries about health and illness
  • Family history of hypochondriasis

Commonly Associated Conditions

  • Anxiety disorders
  • Depressive disorders: up to 40%
  • Obsessive-compulsive disorder
  • Somatization disorder
  • Conversion disorder
  • Pain disorder
  • Body dysmorphic disorder
  • Undifferentiated somatoform disorder
  • Personality disorders

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Citation

Stephens, Mark B., et al., editors. "Hypochondriasis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816015/all/Hypochondriasis.
Hypochondriasis. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816015/all/Hypochondriasis. Accessed April 18, 2019.
Hypochondriasis. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816015/all/Hypochondriasis
Hypochondriasis [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816015/all/Hypochondriasis.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hypochondriasis ID - 816015 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816015/all/Hypochondriasis PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -