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Hypochondria

This entry provides a brief overview of the concept of hypochondria and its historical background; this disorder plays an important role in psychological and somatic health care systems. The entry also discusses recent theoretical models, which have led to an empirically supported series of psychological treatments, including those using a cognitive-behavioral frame of reference.

Nature and Origin of Hypochondriasis

Hypochondria (also written as hypochondriasis) is characterized by unjustified fears or convictions that one has a serious and often fatal disease, such as heart disease, cancer, or AIDS. The main component is health anxiety, and in contemporary writing this more neutral term is often preferred over hypochondria(sis). Patients frequently seek reassurance in medical consultation, check their bodies, and avoid illness-related triggers (such as bodily sensations and medical information). Merely informing the patient of the absence of a disease process or explaining the benign nature of the symptoms results in temporary reassurance followed by renewed worry over symptoms and continuing overuse of medical services. Hypochondria is thought to be quite common, and a number of studies estimate its prevalence in the general population as between 4% to 7%, with equal numbers for men and women. The course is often chronic, but remission (also known as transient hypochondriasis) also occurs, and it has been found that about one in three patients no longer meet criteria for hypochondriasis after a 5-year follow-up period.

Traditionally, hypochondriasis (an ancient Greek word meaning below the cartilage) was considered to be a special form of melancholia (i.e., depressed mood) resulting from an excess of black bile. In the 17th century, scientists argued that hypochondriasis occurred only in men and was equivalent to hysteria occurring in females. Around the turn of the 20th century, the Austrian psychoanalyst Sigmund Freud suggested that hypochondria was the consequence of an imbalance in sexual energy that would build up and result in physical symptoms. Other early psychological theories on hypochondriasis suggested that physical symptoms developed in individuals defending against low self-esteem because a sick body is attached to fewer stigmas than a sick mind. These early theories were overly speculative, lacking empirical support from research.

Theoretical Perspectives

At the end of the 20th century, more specific cognitive-behavioral models were formulated in which great emphasis was placed on the patient's misinterpretation of innocuous bodily sensations. A number of studies on the information processing features of hypochondria supported these models. It was shown that selective attention to illness information, risk perception, misinterpretation of benign symptoms, and cognitive responses to medical reassurance are maintaining factors. It has also been found that hypochondriacal individuals hold distinct (catastrophic) assumptions about health and illness. However, it has not been convincingly demonstrated that triggering these assumptions (e.g., by exposure to illness related stimuli) leads to increased hypochondriacal concerns. Several studies found a substantial positive correlation between hypochondria and the tendency to experience a broad range of bodily sensations as noxious, intense, and disturbing. Far less attention has been paid to specific conditioning models regarding the onset and maintenance of hypochondriasis, although theories of excessive health anxiety stipulate that internal cues (e.g., pain sensations or stomachache) perceived as predictors of threat and bodily harm (unconditioned stimuli—i.e., naturally threatening circumstances) can serve as conditioned stimuli (i.e., originally neutral stimuli that acquire the meaning of the naturally threatening stimuli). In the presence of these stimuli, individuals will exhibit so-called conditioned responses—that is, learned reactions. In hypochondriasis these responses are generally related to anxiety and its concomitant physiological sensations (e.g., muscle tension, palpitations).

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