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Chapter 40. Hypochondriasis

Brian A. Fallon, M.D.; Arthur J. Barsky, M.D.
DOI: 10.1176/appi.books.9781585622986.260536

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Hypochondriasis, defined as a fear or conviction of having a disease despite medical reassurance, is a chronic, debilitating, and prevalent condition (Barsky et al. 1990; Escobar et al. 1998; Kellner 1986). It has three central features: disease conviction, disease fear, and bodily preoccupation (Pilowsky 1967). The relative balance of each of these features creates different profiles. For example, if disease conviction predominates, the patient's adamant determination to find a doctor who will make the "accurate" diagnosis will lead to doctor shopping and multiple doctor visits. This patient may also demonstrate a general distrust and disdain about the medical profession because its practitioners seem to be either incompetent or withholding regarding the true nature of the patient's disease. If disease fear predominates, the patient may learn to avoid anxiety-triggering disease-related environmental cues (e.g., visits to sick relatives, television shows with illness as a theme) and may also avoid going to doctors for evaluation because of the terror associated with facing confirmation of the disease that is so dreaded. If bodily preoccupation predominates, the patient's primary focus will be on one or more somatic symptoms, and only through probing will the underlying fear or belief of having a serious disease be revealed. Bodily preoccupation with a focus on multiple somatic symptoms is common among patients with hypochondriasis in the medical setting; in one study, 49% of patients with hypochondriasis also met criteria for abridged somatization (Escobar et al. 1998)—a provisional diagnosis characterized by four medically unexplained symptoms in men or six such symptoms in women.

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