Description

• Hypochondriasis can be described as a preoccupation with or fear of having a serious disease. This preoccupation or fear persists for at least 6 months despite appropriate medical evaluation and reassurance. Level of patient’s insight can vary.
• In DSM-5, hypochondriasis has been removed and replaced with two new diagnostic categories, somatic symptom and illness anxiety disorder. The former represents health anxiety with one or more distressing or disruptive somatic symptoms, whereas the latter denotes health anxiety without such symptoms (1). 75% of patients with hypochondriasis are classified as having somatic symptom disorder (300.82), and 25% of patients with hypochondriasis are now classified as having illness anxiety disorder (300.7) (2).
• Synonym(s): somatic symptom disorder; illness anxiety disorder; hypochondriacal neurosis; hypochondria; health anxiety; cyberchondria; Briquet syndrome

Epidemiology

Incidence

• Predominant sex: Some studies reveal the female to male ratio may be as high as 10:1; however, women tend to seek help more frequently than men, so the disparity between sexes may be lower (3).
• Predominant age: Most common onset is in the 3rd to 4th decade of life.

Prevalence

• In the general population, approximately 0.26–8.5% have hypochondriasis.
• 4–6% of medical outpatients meet criteria for hypochondriasis, suggesting that a large percentage of those affected present for medical evaluation.

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 psychological 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
• Adverse childhood experiences

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