Hypochondriasis and Somatization Disorder

  • Don R. Lipsitt

On a busy day in a general physician’s office, perhaps 50% or more of the patients with physical complaints will have no definitive explanation for their ailment (Kroenke and Mangelsdorff, 1989). The patients present with distress from fatigue, chest pain, cough, back pain, shortness of breath, and a host of other painful or worrisome bodily concerns. For most, the physician’s expressing interest, taking a thorough history, doing a physical examination, and offering reassurance, a modest intervention, or a pharmacologic prescription suffices to assuage the patient’s pain, anxiety, and physical distress. But for some, these simple measures fall short of their expected result, marking the beginning of what may become a chronic search for relief, including frequent anxiety-filled visits to more than one physician, and in extreme cases even multiple hospitalizations and possibly surgery.


Irritable Bowel Syndrome Chronic Fatigue Syndrome Physician Relationship Somatization Disorder Whitely Index 
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  1. Allen LA, Woolfolk RL, Lehrer PM, Gara MA, Escobar JI. Cognitive behavior therapy for somatization disorder: a preliminary investigation. J Behav Ther Exp Psychiatry 2002;32:53–62.CrossRefGoogle Scholar
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 1952.Google Scholar
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd ed. Washington, DC: American Psychiatric Association, 1980.Google Scholar
  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.Google Scholar
  5. Avia MD, Ruiz MA. Recommendations for the treatment of hypochondriac patients. J Contemp Psychotherapy 2005;35:301–313.CrossRefGoogle Scholar
  6. Barsky AJ, Ahern DK. Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004;291:1464–1470.PubMedCrossRefGoogle Scholar
  7. Barsky AJ, Cleary PD, Wyshak G, Spitzer RL, Williams JBW, Klerman GL. A structured diagnostic interview for hypochondriasis: a proposed criterion standard. J Nerv Ment Dis 1992;180:20–27.PubMedCrossRefGoogle Scholar
  8. Barsky AJ, Wyshak G, Klerman GL. The somatosensory amplification scale and its relationship to hypochondriasis. J Psychosom Res 1990;24:323–334.CrossRefGoogle Scholar
  9. Bass C. Somatization: Physical Symptoms and Psychological Illness. Oxford: Blackwell, 1990.Google Scholar
  10. Bass C, Benjamin S. The management of chronic somatisation. Br J Psychiatry 1993;162:472–480.PubMedCrossRefGoogle Scholar
  11. Burton R. The Anatomy of Melancholy. London: Thomas Tegg, 1621. Reprinted by Gryphon Editions, 1988.Google Scholar
  12. Escobar JI, Rubio-Stipec M, Canino G, Karno M. Somatic symptom index (SSI): a new and abridged somatization construct. Prevalence and epidemiological correlates in two large community samples. J Nerv Ment Dis 1989;177:140–146.PubMedCrossRefGoogle Scholar
  13. Fallon BA. Pharmacologic strategies for hypochondriasis. In: Starcevic V, Lipsitt DR, eds. Hypochondriasis: New Perspectives on an Ancient Malady. New York: Oxford University Press, 2001:329–351.Google Scholar
  14. Freud S. Fragment of an analysis of a case of hysteria (1905). In: Strachey J, ed. The Standard Edition of the Complete Works of Sigmund Freud, vol 7. London: Hogarth Press, 1986:7–63.Google Scholar
  15. Goldberg D, Gask L, O’Dowd T. Treatment of somatization: teaching techniques of reattribution. J Psychosom Res 1989;33:689–695.PubMedCrossRefGoogle Scholar
  16. Gureje O, Utsun TB, Simon GE. The syndrome of hypochondriasis: a cross-national study in primary care. Med Psychol 1997;27:1001–1010.CrossRefGoogle Scholar
  17. Guze SB. Genetics of Briquet’s syndrome and somatization disorder: a review of family, adoption, and twin studies. Ann Clin Psychiatry 1983;5:225–230.CrossRefGoogle Scholar
  18. Kashner TM, Rost K, Cohen B, Anderson M, Smith GR Jr. Enhancing the health of somatization disorder patients. Effectiveness of short-term group therapy. Psychosom 1995;36:462–470.Google Scholar
  19. Katon W, Kleinman A, Rosen G. The prevalence of somatization in primary care. Compr Psychiatry 1984;25:127–135.CrossRefGoogle Scholar
  20. Kellner R, Abbott P, Pathak D, Winslow WW, Umland BE. Hypochondriacal beliefs and attitudes in family practice and psychiatric patients. Int J Psychiatry Med 1983–1984;13:127–139.PubMedGoogle Scholar
  21. Kellner R. Psychosomatic Syndromes and Somatic Symptoms. Washington, DC: American Psychiatric Press, 1991.Google Scholar
  22. Kroenke K, Mangelsdorff D. Common symptoms in ambulatory care: incidence, evaluation, therapy and outcome. Am J Med 1989;86:262–266.PubMedCrossRefGoogle Scholar
  23. Lipowski ZJ. Somatization: the concept and its clinical application. Am J Psychiatry 1988;145:1358–1368.PubMedGoogle Scholar
  24. Lipsitt DR. Challenges of somatization: diagnostic, therapeutic and economic. Psychiatr Med 1992;10:1–12.PubMedGoogle Scholar
  25. Lipsitt DR. Commerce between the mind and the body. Adv Mind-Body Med 1998;14:107–113.Google Scholar
  26. Lipsitt DR. Medical and psychological characteristics of “crocks”. Psychiatr Med 1970;1:15–25.Google Scholar
  27. Lipsitt DR. Primary care of the somatizing patient: a collaborative model. Hosp Pract 1996;31:77–88.Google Scholar
  28. Lipsitt DR. Psyche and soma in postwar psychiatry: struggles to close the gap. In: Menninger RW, Nemiah JC, eds. American Psychiatry After World War II (1944–1994). Washington, DC: American Psychiatric Press, 2000:152–186.Google Scholar
  29. Lipsitt DR. Psychodynamic perspectives on hypochondriasis. In: Starcevic V, Lipsitt DR, eds. Hypochondriasis: Modern Perspectives on an Ancient Malady. New York: Oxford University Press, 2001a:265–290.Google Scholar
  30. Lipsitt DR. Psychotherapy. In: Wise MG, Rundell JR, eds. Textbook of Consultation-Liaison Psychiatry, 2nd ed. Washington, DC: American Psychiatric Press, 2002:1027–1051.Google Scholar
  31. Lipsitt DR. The difficult doctor-patient relationship. In: Branch WT Jr, ed. Office Practice of Medicine, 2nd ed. Philadelphia: WB Saunders, 1987:1348–1356.Google Scholar
  32. Lipsitt DR. The physician-patient relationship in the treatment of hypochondriasis. In: Starcevic V, Lipsitt DR, eds. Hypochondriasis: Modern Perspectives on an Ancient Malady. New York: Oxford University Press, 2001b:183–201.Google Scholar
  33. Marin C, Carron R. The origin of the concept of somatization [letter]. Psychosom 2002;43:249–250.CrossRefGoogle Scholar
  34. Martin RL. The somatoform conundrum: a question of nosological values. Gen Hosp Psychiatry 1999;19:177–186.CrossRefGoogle Scholar
  35. McLeod CC, Budd MA, McClelland DC. Treatment of somatization in primary care. Gen Hosp Psychiatry 1997;19:251–258.PubMedCrossRefGoogle Scholar
  36. Menza M, Lauritano M, Allen L, et al. Treatment of somatization disorder with nefazodone: a prospective, open-label study. Ann Clin Psychiatry 2001;13:153–158.PubMedGoogle Scholar
  37. Okugawa G, Yagi, Kusaka H, Kinoshita T. Paroxetine for treatment of somatization disorder. J Neuropsych Clin Neurosci 2002;14:464–465.Google Scholar
  38. Othmer E, DeSouza C. A screening test for somatization disorder (hysteria). Am J Psychiatry 1985;142:1146–1149.PubMedGoogle Scholar
  39. Perley MJ, Guze SB. Hysteria—the stability and usefulness of clinical criteria. A quantitative study based on a follow-up period of six to eight years in 39 patients. N Engl J Med 1962;266:421–426.PubMedGoogle Scholar
  40. Pilowsky I. Abnormal illness behavior. Br J Med Psychol 1969;42:347–351.PubMedGoogle Scholar
  41. Pilowsky I. Dimensions of hypochondriasis. Br J Psychiatry 1967;113:89–93.PubMedCrossRefGoogle Scholar
  42. Pilowsky I, Spence N, Cobb J, Katsikitis M. The illness behavior questionnaire as an aid to clinical assessment. Gen Hosp Psychiatry 1984;6:123–130.PubMedCrossRefGoogle Scholar
  43. Rost K, Kashner TM, Smith GR. Effectiveness of psychiatric intervention with somatization disorder patients: improved outcomes at reduced costs. Gen Hosp Psychiatry 1994;16:381–387.PubMedCrossRefGoogle Scholar
  44. Salkovskis PM, Warwick HMC. Morbid preoccupation, health anxiety and reassurance: a cognitive-behavioural approach to hypochondriasis. Beh Res Therapy 1986;24:597–602.CrossRefGoogle Scholar
  45. Schur M. Comments on the metapsychology of somatization. Psychoanalytic Study of the Child 1955;10:119–164.Google Scholar
  46. Shorter E. From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press, 1992.Google Scholar
  47. Simon G, Gater R, Kisly S, Piccinelli M. Somatic symptoms of distress: an international primary care study. Psychosom Med 1996;58:481–488.PubMedGoogle Scholar
  48. Simon GE. Treatment of somatoform and factitious disorders. In: Nathan PE, Gorman JM, eds. A Guide to Treatments that Work. New York: Oxford University Press, 2002:408–422.Google Scholar
  49. Smith GR Jr, Monson RA, Kay DC. Psychiatric consultation in somatization disorder: a randomized controlled study. N Engl J Med 1986;314:1407–1413.PubMedCrossRefGoogle Scholar
  50. Smith GR Jr. Somatization disorder and undifferentiated somatoform disorder. In: Gabbard GO, ed. Treatments of Psychiatric Disorders, vol 2, 2nd ed. Washington, DC: American Psychiatric Press, 1995:1716–1733.Google Scholar
  51. Speckens AEM. Assessment of hypochondriasis. In: Starcevic V, Lipsitt DR, eds. Hypochondriasis: Modern Perspectives on an Ancient Malady. New York: Oxford University Press, 2001:61–88.Google Scholar
  52. Starcevic V. Reassurance in the treatment of hypochondriasis. In: Starcevic V, Lipsitt DR, eds. Hypochondriasis: New Perspectives on an Ancient Malady. New York, Oxford University Press, 2001:291–313.Google Scholar
  53. Stekel W. The Interpretation of Dreams. New York: Liveright, 1943.Google Scholar
  54. Stuart S, Noyes R Jr. Interpersonal psychotherapy for somatizing patients. Psychother Psychosom 2006;75:209–219.PubMedCrossRefGoogle Scholar
  55. Swartz M, Landerman R, George L, Blazer D, Escobar J. Somatization disorder. In: Robins LN, Regier D, eds. Psychiatric Disorders in America: The Epidemiologic Catchment Area Study. New York: Free Press, 1990:220–257.Google Scholar
  56. Swartz MS, Hughes D, George L, Blazer D, Landerman R, Bucholz K. Developing a screening index for community studies of somatization disorder. J Psychiat Res 1986;20:335–343.PubMedCrossRefGoogle Scholar
  57. Tyrer P, Fowler-Dixon R, Ferguson B, Keleman A. A plea for the diagnosis of hypochondriacal personality disorder. J Psychosom Res 1990;34:637–642.PubMedCrossRefGoogle Scholar
  58. Viswanathan R, Paradis C. Treatment of cancer phobia with fluoxetine. Am J Psychiatry 1991;148:1090.PubMedGoogle Scholar
  59. Waller B, Scheidt CE, Hartmann A. Attachment representation and illness behavior in somatoform disorders. J Nerv Ment Dis 2002;192:200–209.Google Scholar
  60. Wessely S, Nimnuan C, Sharpe M. Functional somatic syndromes: one or many? Lancet 1999;354:936–939.PubMedCrossRefGoogle Scholar
  61. Wickramasekera I. Somatizers, the health care system, and collapsing the psychological distance that the somatizer has to travel for help. Professional Psychol Res Pract 1989;20:105–111.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Don R. Lipsitt
    • 1
  1. 1.Harvard UniversityCambridgeUSA

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