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Epidemiology and Treatment of Hypochondriasis

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Abstract

Although hypochondriasis has been one of the most durable disease concepts in psychopathology, little is known about its epidemiology and treatment. In this article, we review the last three decades of research into these two aspects of hypochondriasis.

According to DSM-IV, hypochondriasis is a distressing preoccupation with the fear or thought, based on physical sensations, that one has a serious disease. The prevalence of hypochondriasis in the general population is unknown; however, studies in primary care suggest that the prevalence in this setting is between 0.8 and 4.5%. There are, at present, no conclusive data about specific risk factors for hypochondriasis, although patients with hypochondriasis have higher rates of anxiety, depressive and other somatoform disorders than patients without the disorder. To date, there have been no studies documenting a genetic or familial predisposition for hypochondriasis, or for somatoform disorders in general.

Cognitive behavioural therapy has been shown in controlled studies to be efficacious in the treatment of hypochondriasis. Although the evidence is stronger for individual therapy, group cognitive-behavioural therapy may also be useful. Other therapies such as supportive or psychoanalytical psychotherapy may be efficacious for certain patients, but the lack of standardised treatments and controlled studies makes them a less preferable treatment option at present.

Little is known about the pharmacological treatment of primary hypochondriasis. The limited number of published studies and the absence of controlled trials make it impossible to be certain of the efficacy of existing medications. On the basis of the available information, however, it appears that the selective serotonin reuptake inhibitors hold promise for the treatment of this disorder. However, more information is needed for their efficacy to be clearly established.

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References

  1. 1.

    Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry 1967; 113:89–93

  2. 2.

    Barsky A, Wychak G, Klerman GL. Hypochondriasis: an evaluation of the DSM-III-R criteria in medical outpatients. Arch Gen Psychiatry 1986; 43: 443–500

  3. 3.

    Escobar JI, Gara M, Waitzkin H, et al. DSM-IV hypochondriasis in primary care. Gen Hosp Psychiatry 1998; 20: 155–9

  4. 4.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

  5. 5.

    Pilowsky I, Spence ND. Manual for the Illness Behavior Questionnaire (IBQ). 2nd ed. Adelaide: Department of Psychiatry, University of Adelaide, 1983

  6. 6.

    Barsky AJ, Cleary PD, Wyshak G, et al. A structural diagnostic interview for hypochondriasis: a proposed criterion standard. J Nerv Ment Dis 1992; 180: 20–7

  7. 7.

    Noyes R, Kathol RG, Fisher M, et al. The validity of DSM-III-R hypochondriasis. Arch Gen Psychiatry 1993; 50: 961–70

  8. 8.

    Robbins JM, Kirmayer LJ, Kapusta MA. Illness worry and disability in fibromialgia syndrome. Int J Psychiatry Med 1990; 20: 49–63

  9. 9.

    Robbins JM, Kirmayer LJ. Transient and persistent hypochondriacal worry in primary care. Psychol Med 1996; 26: 49–63

  10. 10.

    Kellner R. Abridged manual for the illness attitude scales. Albuquerque (NM): University of New Mexico, 1981

  11. 11.

    Kellner R, Abbott HP, Pathak D, et al. Hypochondriacal beliefs and attitudes in family practice and psychiatric patients. Int J Psychiatry Med 1983-84; 13: 127–39

  12. 12.

    Kellner R. Somatization and hypochondriasis. New York: Praeger Publishers, 1986: 15–120

  13. 13.

    Leighton AH. My name is legion. New York: Basic Books, 1959

  14. 14.

    Langner TS, Michael ST. Life stress and mental health. New York: Free Press, 1963

  15. 15.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1980

  16. 16.

    Gureje O, Ustun TB, Simon GE. The syndrome of hypochondriasis: a cross-national study in primary care. Psychol Med 1997; 27: 1001–10

  17. 17.

    Goldberg D, Williams P. A user’s guide to the general health questionnaire. Windsor: NFER/Nelson, 1988

  18. 18.

    Kellner R, Sheffield BE One week prevalence of symptoms in neurotic patients and normal. Am J Psychiatry 1970; 130: 102–5

  19. 19.

    Kellner R, Wiggins RG, Pathak D. Hypochondriasis fears in medical and law students. Arch Gen Psychiatry 1986; 43: 487–9

  20. 20.

    Faravelli C, Salvatori S, Galassi F, et al. Epidemiology of somatoform disorders: a community survey in Florence. Soc Psychiatry Psychiatr Epidemiol 1997; 32: 24–9

  21. 21.

    Saz P, Copeland JRM, de la Camara C, et al. Cross-national comparison of prevalence of symptoms of neurotic disorders in older people in live community sample. Acta Psychiatr Scand 1995; 91: 18–22

  22. 22.

    Noyes R. Epidemiology of hypochondriasis. In: Storcevic V, Lipsitt DR, editors. Hypochodriasis: modern perspectives on an ancient malady. New York: Oxford University Press, 2001: 127–154

  23. 23.

    Slavney PR, Teitelbaum ML. Patients with multiple unexplained symptoms: DSM-III diagnosis and demographic characteristics. Gen Hosp Psychiatry 1985; 7: 21–5

  24. 24.

    Barsky AJ, Klerman GL, Wyshak G, et al. The prevalence of hypochondriasis in medical outpatients. Soc Psychiatry Psychiatr Epidemiol 1990; 14: 89–94

  25. 25.

    Barsky AJ, Frank CB, Cleary PD, et al. The relation between hypochondriasis and age. Am J Psychiatry 1991; 148: 923–8

  26. 26.

    Kirmayer LJ, Robbins JM. Three forms of somatization in primary care: prevalence, cooccurrence and sociodemographic characteristics. J Nerv Ment Dis 1991; 179: 647–55

  27. 27.

    Gerdes TT, Noyes R, Kathol RG, et al. Physician recognition of hypochondriacal patients. Gen Hosp Psychiatry 1996; 18: 106–12

  28. 28.

    Barsky AJ, Wyshak G, Latham KS. The relationship between hypochondriasis and medical illness. Arch Intern Med 1991; 151:84–8

  29. 29.

    Barsky AJ, Wool C, Barnett MC, et al. Histories of childhood trauma in adult hypochondriacal patients. Am J Psychiatry 1994; 151: 397–401

  30. 30.

    Mabe PA, Hobson DP, Jones LR, et al. Hypochondriacal traits in medical patients. Gen Hosp Psychiatry 1988; 10: 236–44

  31. 31.

    Noyes R, Holt CS, Happel RL, et al. A family study of hypochondriasis. J Nerv Ment Dis 1997; 185: 223–32

  32. 32.

    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. rev. Washington, DC: American Psychiatric Association, 1987

  33. 33.

    Shields J. Monozygotic twins brought up apart and brought up together. New York: Oxford University Press, 1962

  34. 34.

    Gottesman II. Differential inheritance of the psychoneuroses. Eugen Q 1962; 9: 223–7

  35. 35.

    Torgersen S. Genetics of somatoform disorders. Arch Gen Psychiatry 1986; 3: 502–5

  36. 36.

    Kellner R, Slocumb JC, Wiggins RJ. The relationship of hypochondriacal fears and beliefs to anxiety and depression. Psychiatr Med 1987; 4: 15–24

  37. 37.

    Barsky AJ, Wyshak G, Klerman GL. Psychiatric comorbidity in DSM-III-R hypochondriasis. Arch Gen Psychiatry 1992; 49: 101–8

  38. 38.

    Noyes R, Kathol RG, Fisher M, et al. Psychiatric comorbidity among patients with hypochondriasis. Gen Hosp Psychiatry 1994; 15: 78–87

  39. 39.

    Barsky AJ, Wyshak G, Klerman GL. Transient hypochondriasis. Arch Gen Psychiatry 1990; 47: 746–52

  40. 40.

    Barsky AJ, Cleary PD, Sarnie MK, et al. The course of transient hypochondriasis. Am J Psychiatry 1993; 150: 484–8

  41. 41.

    Noyes R, Kathol RG, Fisher MM, et al. One year follow-up of medical outpatients with hypochondriasis. Psychosomatics 1994; 35: 533–45

  42. 42.

    Barsky AJ, Fama JM, Bailey ED, et al. A prospective four-five year study of DSM-III-R hypochondriasis. Arch Gen Psychiatry 1998; 55: 737–44

  43. 43.

    Beck AT, Rush AJ, Shaw BF, et al. Cognitive therapy of depression. New York: Guilford Press, 1979

  44. 44.

    Barsky AJ, Geringer E, Wool CA. A cognitive-educational treatment for hypochondriasis. Gen Hosp Psychiatry 1988; 10: 322–7

  45. 45.

    Salkovskis PM, Warwick HMC. Morbid preoccupations, health anxiety and reassurance: a cognitive behavioural approach to hypochondriasis. Behav Res Ther 1986; 24: 597–602

  46. 46.

    Warwick HMC, Salkovskis PM. Hypochondriasis. Behav Res Ther 1990; 28: 105–17

  47. 47.

    Clark DM, Salkovskis PM, Hackmann A, et al. Two psychological treatments for hypochondriasis: a randomised controlled trial. Br J Psychiatry 1998; 173: 218–25

  48. 48.

    Kellner R. Prognosis of treated hypochondriasis: a clinical study. Acta Psychiatr Scand 1983; 67: 69–79

  49. 49.

    Visser S, Bouman TK. Cognitive-behavioral approaches in the treatment of hypochondriasis: six single case cross-over studies. Behav Res Ther 1992; 30: 301–6

  50. 50.

    Warwick HMC, Marks IM. Behavioral treatment of illness phobia and hypochondriasis: a pilot study of 17 cases. Br J Psychiatry 1988; 152: 239–41

  51. 51.

    Miller D, Acton TMG, Hedge B. The worried well: their identification and management. J R Coll Physicians Lond 1988; 22: 158–65

  52. 52.

    Logsdail S, Lovell K, Warwick H, et al. Behavioral treatment of AIDS-focused illness phobia. Br J Psychiatry 1991; 159: 422–5

  53. 53.

    Avia MD, Ruiz MA, Olivares ME, et al. The meaning of psychological symptoms: effectiveness of a group intervention with hypochondriacal patients. Behav Res Ther 1996; 34: 23–31

  54. 54.

    Stern R, Fernández M. Group cognitive and behavioral treatment for hypochondriasis. BMJ 1991; 303: 1229–31

  55. 55.

    Kenyon FE. Hypochondriasis: a clinical study. Br J Psychiatry 1964; 110:478–88

  56. 56.

    Ladeé GA. Hypochondriacal syndromes. New York: Elsevier, 1966

  57. 57.

    Goldstein SE, Birnbom F. Hypochondriasis and the elderly. J Am Geriatr Soc 1976; 24: 150–4

  58. 58.

    Kellner R, Fava GA, Lisansky J, et al. Hypochondriacal fears and beliefs in DSM-III melancholia: changes with amitriptyline. J Affect Disord 1986; 10(1): 21–6

  59. 59.

    Noyes R, Reich J, Clancy J, et al. Reduction in hypochondriasis with treatment of panic disorder. Br J Psychiatry 1986; 149: 631–5

  60. 60.

    Fallon BA, Qureshi AI, Laje G, et al. Hypochondriasis and its relationship with obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23: 605–616

  61. 61.

    Fallon BA, Javitch JA, Hollander E, et al. Hypochondriasis and obsessive-compulsive disorder: overlaps in diagnosis and treatment. J Clin Psychiatry 1991; 52: 457–60

  62. 62.

    Lesse S. Hypochondriasis and psychosomatic disorders masking depression. Am J Psychother 1967; 21: 607–20

  63. 63.

    Bodkin JA, White K. Clonazepam in the treatment of obsessive compulsive disorder associated with panic disorder in one patient. J Clin Psychiatry 1989; 50: 265–6

  64. 64.

    Fishbain DA, Barsky S, Goldberg M. Monosymptomatic hypochondriacal psychosis: belief of contracting rabies. Int J Psychiatry Med 1992; 22: 3–9

  65. 65.

    Lippert GP. Excesive concern about AIDS in two bisexual men. Can J Psychiatry 1986; 31: 63–5

  66. 66.

    Scarone S, Gambini S. Delusional hypochondriasis: nosographic evaluation, clinical course and therapeutic outcome of 5 cases. Psychopathology 1991; 24: 179–84

  67. 67.

    Fallon BA, Liebowitz MR, Salman E, et al. Fluoxetine for hypochondriacal patients without major depression. J Clin Psychopharmacol 1993; 13: 438–41

  68. 68.

    Wesner RB, Noyes R. Imipramine: an effective treatment for illness phobia. J Affect Disord 1991; 22: 43–8

  69. 69.

    Pilowsky I. The response to treatment in hypochondriacal disorders. Aust N Z J Psychiatry 1968; 2: 88–92

  70. 70.

    Kamlana SH, Gray P. Fear of AIDS [letter]. Br J Psychiatry 1988; 15: 1291

  71. 71.

    Stone AB. Treatment of hypochondriasis with clomipramine [letter]. J Clin Psychiatry 1993; 54: 5

  72. 72.

    Viswanathan R, Paradis C. Treatment of cancer phobia with fluoxetine [abstract]. Am J Psychiatry 1991; 148: 1090

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Acknowledgements

Dr Blanco is supported in part by grants MH-15144, DA-00482 and a grant from the National Alliance for Research on Schizophrenia and Depression.

The authors have no potential conflicts of interest that are directly relevant to the contents of this article.

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Correspondence to Dr Carlos Blanco.

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Magariños, M., Zafar, U., Nissenson, K. et al. Epidemiology and Treatment of Hypochondriasis. Mol Diag Ther 16, 9–22 (2002). https://doi.org/10.2165/00023210-200216010-00002

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Keywords

  • Fluoxetine
  • Wait List Control
  • Hypochondriasis
  • Delusional Disorder
  • Medical Morbidity