Hypochondriacal States

Abstract

A brief historical introduction traces the evolution of the concept of hypochondriasis. It is suggested that the term should now be used only as a descriptive adjective when there is a morbid preoccupation with health or body. Social and cultural factors are outlined, as well as problems of measurement. The psychopathology, as formulated by Freud and others, is also described. Clinical aspects are discussed under the headings of general symptoms, pain, smell, bodily appearance, sexual, gastro-intestinal, cardio-respiratory, eyes, and ears, nose and throat. Psychiatric syndromes mentioned are: hypochondria as a possible primary state, personality disorders, phobic-anxiety state, neurashthenia, obsessional neurosis, hysteria, depression, paranoid psychosis and organic. In general, hypochondriacal symptoms seem to make the prognosis rather worse. Treatment is to be aimed at the primary condition, which is most commonly depression, anxiety state or conversion reaction.

Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum

“…The essential part of any definition of hypochondriasis is a morbid preoccupation with one"s body or state of health, either mental or physical [28]. Although DSM-IV [29] hypochondriasis has been replaced as official diagnosis in DSM-5 by illness anxiety disorder, we shall use the term hypochondriasis throughout this review, as the latter term has uniformly been used in literature.…”

“…The disorder neither remits spontaneously nor progresses to further delusional elaboration. Although the disorder can begin at any age, its most common age at onset allegedly is in early adulthood, with male and lower social classes being more prone than others [28]. As in adolescent cenesthopathy, there seems to be a predominance of shy and sensitive individuals with disturbed narcissistic regulation among hypochondriac individuals [28].…”

“…These include progressive somatopsychosis [48], hypochondriacal hebephrenia [49], hypochondriac paraphrenia [50], or hypochondriacal psychosis [51]. In schizophrenia, it is not unusual for bodily complaints to be considered first as simple hypochondriacal complaints, only to be later assessed as cenesthopathic disturbances, particularly when the bodily complaints consist of bizarre or delusional alterations in bodily perceptions [28,43,52,53]. Bleuler may have been the first to emphasize the clinical importance of bodily complaints among schizophrenics.…”

“…Similarly, hypochondriasis is commonly associated with a high degree of affect that impact negatively on social and vocational functioning [28]. Impaired functioning has been described both in adolescent cenesthopathy [18] as well as in the majority of cenesthetic schizophrenia [15,33].…”

“…DSM-5 also provides a specifier, distinguishing between frequently versus rarely used medical care [3]. In general, hypochondriasis carries a poor prognosis, the duration usually being measured in decades rather than years, and the response to treatments is uniformly unsatisfactory [28]. The disorder neither remits spontaneously nor progresses to further delusional elaboration.…”