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[Late Latin, abdomen, from Greek hupokhondria, pl. of hupokhondrion, abdomen (held to be the seat of melancholy), from neuter of hupokhondrios, under the cartilage of the breastbone : hupo-, hypo- + khondros, cartilage.]
Hypochondria is a condition in which a person believes that he or she is ill when no objective signs of illness can be observed. It has an obsessive as well as a delusional component. Sufferers from hypochondria, or, to use the clinical term, hypochondriasis, remain convinced that they are ill despite reassurances, and often present themselves to their doctors over a long period of time as suffering from a series of different symptoms and diseases. The onset of hypochondria is frequently in the 30s in men and 40s in women. Those in sedentary occupations are notoriously liable to it, and, whilst medical students usually suffer only a transient bout of hypochondria, some doctors remain hypochondriacal throughout their career. Depression and alcoholism exacerbate the condition.
Originally hypochondria meant an illness of the organs lying immediately under the ribs and on each side of the stomach: the liver, gall bladder, and spleen. By the sixteenth century hypochondria had become an aspect of melancholy and was associated especially with the humour of black bile and with the spleen, the organ that was supposed to clear black bile from the body. A variety of somatic and psychological states were subsumed under hypochondria, and its modern sense was prominent. As Robert Burton pointed out in the Anatomy of Melancholy (1621), the belief in imaginary illness was an important aspect of melancholy; he wrote that the imagination could produce real illness, to the extent that fear of plague might lead to actual plague and death. In the next century George Cheyne in his The English Malady (1733), or the ‘spleen’, wrote that the vapours and hysterical and hypochondriacal disorders (the last two had overlapping meanings) were characteristic of the English upper and middle classes, and were brought on by the nation's prosperity and peculiar climate. However, even though hypochondria was a fashionable disorder in the eighteenth century, it had a strong stigma attached to it, and this has continued up to the present day.
Hypochondria today lies in the domain of psychology and psychiatry. It is a label that is largely unproblematic to everyone except the sufferer. But in some instances it has been used to hide medical ignorance. In the nineteenth century many sufferers from multiple sclerosis were diagnosed as hypochondriacal, and it was not until the discovery of signs such as Babinski's sign, in which an abnormal reflex of the great toe is elicited, that objective evidence supported what in the early stages of the disease are often subjective sensations such as paraesthesia (sometimes described as ‘pins and needles’). It is possible that another instance of blaming the patient for medicine's lack of knowledge is chronic fatigue syndrome, which at present has few physical signs associated with it. The dispute between those clinicians who seek to give it organic causes and the psychologists who view it as a mix of depression and hypochondria is evidence that the diagnosis of hypochondria is not always unproblematic.
— A. Wear
Anxiety about disease; a type of neurosis characterized by fear of disease or by simulated disease.
Bibliography
See S. Baur Hypochondria (1988).
Hypochondria is a psychopathological formation whose locus of suffering, anxiety, or even (fantasized) erasure is the body or one of its parts or functions, even though the symptoms in most cases appear to have no material cause. Symptoms can range from minor, transient forms to massive, debilitating forms. Despite some strong lines of evidence pointing toward a link with various specific structural organizations of the psyche, hypochondria is currently seen as transnosographic, as present as an element in a neuropsychosis or preceding certain psychoses.
For centuries, hypochondria has challenged medicine, philosophy, and even religion. Some ancient lines of inquiry are echoed by modern investigations, notably on the enigmatic link between psyche and soma and on similarities between hypochondria and melancholia. The absence of any material organic cause has elicited a variety of hypotheses from psychoanalysts, including accounts of pathogenicity that extend to delusions in the subject.
Has the enigma of hypochondria been fully deciphered by contemporary psychoanalysis? Freud acknowledged this poorly understood disorder as an awkward gap in his theories. Later it was deemed surprising that hypochondriacs had been the object of so little psychoanalytic research, but in the 1990s there were a number of studies on the topic. One reason that psychoanalysis has paid little attention to hypochondria is that the autocratic attitude of hypochondriacs has made analysts unreceptive to types of transference unconducive to analytic listening. However, a broadening of treatment indications seems to have made psychoanalysis more receptive to hypochondriacs, and this has allowed psychoanalysis to draw conclusions from them that go beyond Freud's hypotheses. It is also true that hypochondriacal behavior can emerge in the course of any treatment, as a displacement or means of discharge when the patient's psyche is placed under stress.
Freud encountered hypochondria early on in his work. On the basis of the semantics and nosology of his era as well as his own theories, he placed hypochondria among the pure forms of "actual neurosis," alongside neurasthenia and anxiety neurosis, and thus outside of the realm of the defensive neuropsychoses. His description of the actual neuroses contains the same elements as hypochondria: the patient's representational contents have a basis in current reality and not in what has been repressed into the unconscious; the patient's meaningful contents or unconscious overdeterminations capable of being symbolized do not indicate an internal conflict with current reality.
In "On Narcissism: An Introduction" (1914c), Freud revised his account of hypochondria in light of his theory that the libido is divided into the object-libido and the (narcissistic) ego-libido. He placed (bodily) ego-libido, the realm of hypochondriacal anxiety, in opposition to object libido, the realm of neurotic anxiety. As a function of this opposition, the more one realm absorbs, the more the other is impoverished. Therefore, the idea of excessive, dammed-up narcissistic libido is essential to understanding hypochondria. The chosen organ of hypochondria, which has strong erotogenic potential, is nevertheless a source of unpleasure, suffering, and anxiety owing to this increase in tension, this damming up of libido. Many authors have viewed this account, a schematic model of dynamic energies, as problematic and fraught with questions.
During the same period, Freud tried to understand the possible relationship between hypochondria and paraphrenia. In "On Narcissism: An Introduction" (1914c) he wrote, "We may suspect that the relation of hypochondria to paraphrenia is similar to that of the other 'actual' neuroses to hysteria and obsessional neurosis: we may suspect, that is, that it is dependent on ego-libido just as the others are on object-libido, and that hypochondriacal anxiety is the counterpart, as coming from ego-libido, to neurotic anxiety" (p. 84). In this perspective he viewed hypochondria as the first stage in delusion and linked it to narcissistic pathologies affecting the body. Three years earlier he wondered about the connections between hypochondria and paranoia. For example, in "Psycho-Analytic Notes on an Autobiographical Account of a Case of Paranoia (Dementia Paranoides)" (1911c [1910]), his text on Daniel Paul Schreber, he wrote, "I shall not consider any theory of paranoia trustworthy unless it also covers the hypochondriacal symptoms by which that disorder is almost invariable accompanied" (pp. 56-57, n. 3). Freud thus viewed hypochondria as a precursor to psychosis and sometimes as an independent condition.
Some authors have interpreted hypochondria in terms of true projections that are no longer directed outward but instead are directed at the body, like an internal paranoia. In his subsequent writings Freud did not return to the comparison with melancholia, nor did he reexamine his hypotheses in light of his second theory of the instincts or in terms of the concept of primary masochism, as later authors did, thereby somewhat undermining Freud's classification of hypochondria as an actual neurosis.
Many others, notably followers of Melanie Klein, have emphasized the close relationship between hypochondria and melancholic depression. Others have inferred a masochistic dimension or a "locked-up" autoerotism. In the view of still others, the "hypochondriacal solution," despite its fragile and largely unstructured nature and despite being pregnant with the death instinct, is the subject's last bastion against madness.
Bibliography
Aisenstein, Marilia; Fine, Alain; & Pragier, Georges (Eds.). (1995). L'hypocondrie. Paris: Presses universitaires de France.
Freud, Sigmund. (1898a). Sexuality in the aetiology of the neuroses. SE, 3: 259-285.
——. (1911c [1910]). Psycho-analytic notes on an autobiographical account of a case of paranoia (dementia paranoides). SE, 12: 1-82.
——. (1914c). On narcissism: An introduction. SE, 14: 67-102.
Jeanneau, Augustin. (1990). L'hypocondrie, ou La mentalisation de l'impossible. Cahiers du Centre pour la psychanalyse et la psychothérapie, 21, 83-99.
Perrier, François. (1994). Psychanalyse de l'hypocondriaque. In Jacques Sédat (Ed.), La Chaussée d'Antin (rev. ed.). Paris: Albin Michel. (Originally published 1959)
Further Reading
Rosenfeld, Herbert. (1958). Observations on the psycho-pathology of hypochondriacal states. International Journal of Psychoanalysis, 39, 121-124.
Stolorow, Robert D. (1977). Notes on the signal function of hypochondriacal anxiety. International Journal of Psychoanalysis, 58, 245-246.
—ALAIN FINE
Hypochondria (or hypochondriasis, sometimes referred to as health anxiety/health phobia) refers to an excessive preoccupation or worry about having a serious illness. Often, hypochondria persists even after a physician has evaluated a person and reassured him/her that his/her concerns about symptoms do not have an underlying medical basis or, if there is a medical illness, the concerns are far in excess of what is appropriate for the level of disease. Many people suffering from this disorder focus on a particular symptom as the catalyst of their worrying, such as gastro-intestinal problems, palpitations, or muscle fatigue. The DSM-IV-TR defines this disorder, “Hypochondriasis,” as a somatoform disorder and it is thought to plague about 1-5% of the general population.[1] Hypochondria is often characterized by fears that minor bodily symptoms may indicate a serious illness, constant self-examination and self-diagnosis, and a preoccupation with one's body. Many individuals with hypochondriasis express doubt and disbelief in the doctors' diagnosis, and report that doctors’ reassurance about an absence of a serious medical condition is unconvincing, or un-lasting. Many hypochondriacs require constant reassurance, either from doctors, family, or friends, and the disorder can become a disabling torment for the individual with hypochondriasis, as well as his or her family and friends. Some hypochondriacal individuals are completely avoidant of any reminder of illness, whereas others are frequent visitors of doctors’ offices. Other hypochondriacs will never speak about their terror, convinced that their fear of having a serious illness will not be taken seriously by those in whom they confide.
Hypochondria is often associated with obsessive-compulsive disorder (OCD), depression, and anxiety, and can also be brought on by stress. It is distinct from factitious disorders and malingering, in which an individual intentionally fakes, exaggerates, or induces mental or physical illnesses.
The term hypochondria comes from the Greek hypo- (below) and chondros (cartilage - of the breast bone), and is thought to have been originally coined by Hippocrates. It was thought by many Greek physicians of antiquity that many ailments were caused by the movement of the spleen, an organ located near the hypochondrium (the upper region of the abdomen just below the ribs on either side of the epigastrium). Later use in the 19th Century employed the term to mean, “illness without a specific cause,” and it is thought that around that time period the term evolved to be the male counterpart to female hysteria. In modern usage, the term hypochondriac is often used as a pejorative label for individuals who hold the belief that they have a serious illness despite repeated reassurance from physicians that they are perfectly healthy.
Hypochondriasis manifests in various ways. Some people have numerous intrusive thoughts and physical sensations that push them to check with family, friends and physicians. Other people are so afraid of any reminder of illness that they will avoid medical professionals for a seemingly minor problem, sometimes to the point of becoming neglectful of their health when a serious condition may exist and go undiagnosed. Yet, some others live in despair and depression, certain that they have a life-threatening disease and no physician can help them, considering the disease as a punishment for past misdeeds. [2]
Hypochondriasis is often accompanied by other psychological disorders. Clinical depression, obsessive-compulsive disorder (also known as OCD), phobias and somatization disorder are the most common accompanying conditions in people with hypochondriasis, as well as a generalized anxiety disorder diagnosis at some point in their life. [3]
Many people with hypochondriasis experience a cycle of intrusive thoughts followed by compulsive checking, which is very similar to the symptoms of obsessive-compulsive disorder. However, while people with hypochondriasis are afraid of having an illness, patients with OCD worry about getting an illness or of transmitting an illness to others. [2] Although some people might have both, these are distinct conditions.
Patients with hypochondriasis often are not aware that depression and anxiety produce their own physical symptoms that might be mistaken for signs of a serious medical disease. For example, people with depression often experience changes in appetite and weight fluctuation, fatigue, decreased interest in sex and motivation in life overall. Intense anxiety is associated with rapid heart beat, palpitations, sweating, muscle tension, stomach discomfort, and numbness or tingling in certain parts of the body (hands, forehead, etc.).
Cyberchondria is a colloquial term for hypochondria in individuals who have researched medical conditions on the internet. The media and the internet often contribute to hypochondria, as articles, TV shows and advertisements regarding serious illnesses such as cancer and multiple sclerosis (some of the common diseases hypochondriacs think they have) often portray these diseases as being random, obscure and somewhat inevitable. Inaccurate portrayal of risk and the identification of non-specific symptoms as signs of serious illness contribute to exacerbating the hypochondriac’s fear that they actually have that illness.
Major disease outbreaks or predicted pandemics can also contribute to hypochondria. Statistics regarding certain illnesses, such as cancer, will give hypochondriacs the illusion that they are more likely to develop the disease. A simple suggestion of mental illness can often trigger one with hypochondria to obsess over the possibility.
It is common for serious illnesses or deaths of family members or friends to trigger hypochondria in certain individuals. Similarly, when approaching the age of a parent's premature death from disease, many otherwise healthy, happy individuals fall prey to hypochondria. These individuals believe they are suffering from the same disease that caused their parent's death, sometimes causing panic attacks with corresponding symptoms.
A majority of people who experience physical pains or anxieties over non-existent ailments are not actually "faking it", but rather, experience the natural results of other emotional issues, such as very high amounts of stress.
| “ | Grief that finds no vent in tears makes other organs weep | ” |
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—Dr. Henry Maudsley, British psychiatrist |
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Our emotions have cognitive, physiological and feeling components. For example, when one is sad, an individual may simultaneously experience muscle weakness and loss of energy. Whether it is an emotional memory, a vivid fantasy, or a present situation, the brain treats it the same. It is a real experience processed through neural paths.
Family studies of hypochondriasis do not show a genetic transmission of the disorder. Among relatives of people suffering from hypochondriasis only somatization disorder and generalized anxiety disorder were more common than in average families. [2] Other studies have shown that the first degree relatives of patients with OCD have a higher than expected frequency of a somatoform disorder (either hypochondriasis or body dysmorphic disorder). [4] Many people with hypochondriasis point out a pattern of paying close attention to bodily sensations, preventative investigations, and checking with physicians, that they have learned from family members, but there is no definitive scientific support for this notion.
Many people are aware that anxiety and depression are mediated by problems with brain chemicals such as serotonin and norepinephrine. The physical symptoms that people with anxiety or depression feel are indeed real bodily symptoms, and are in fact triggered by neurochemical changes. For example, too much norepinephrine will result in severe panic attacks with symptoms of increased heart rate and sweating, shortness of breath, and fear. Too little serotonin can result in severe depression, accompanied by an inability to sleep, severe fatigue, and needs fixing.
To treat hypochondriasis, one must acknowledge the interplay of body and mind. If a person is sick with a medical disease such as diabetes or arthritis, there will often be psychological consequences, such as depression. Some even report being suicidal. In the same way, someone with psychological issues such as depression or anxiety will sometimes experience physical manifestations of these affective fluctuations, often in the form of medically unexplained symptoms. Common symptoms include headaches, abdominal, back, joint, rectal, or urinary pain, nausea,itching, diarrhea, dizziness, or balance problems. Many people with hypochondriasis accompanied by medically unexplained symptoms feel they are not understood by their physicians, and are frustrated by their doctors’ repeated failure to provide symptom relief. Common to the different approaches to the treatment of hypochondriasis is the effort to help each patient find a better way to overcome the way his/her medically unexplained symptoms and illness concerns rule her/his life. Current research makes clear that this excessive worry can be helped by either appropriate medicine or targeted psychotherapy.
For a long time, hypochondriasis was considered untreatable. However, recent scientific studies show that cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs, e.g., fluoxetine and paroxetine) are effective treatment options for hypochondriasis as demonstrated in clinical trials [5] [6] [7] [8] [9]. CBT, a psycho-educational "talk" therapy, helps the worrier to address and cope with bothersome physical symptoms and illness worries and is found helpful in reducing the intensity and frequency of troubling bodily symptoms. SSRIs can reduce obsessional worry through readjusting neurotransmitter levels, have been shown to be effective as treatments for anxiety and depression, as well as for hypochondriasis.
NIH-funded studies are now underway to compare different treatment approaches for hypochondriasis: a study in the NYC area and a study in the Boston area. In these studies, patients will be given one of four treatments: supportive therapy with fluoxetine, supportive therapy with placebo, cognitive behavior therapy, or cognitive behavior therapy with fluoxetine. For more information you can also visit external links.
In Norway a clinic specializing in the treatment of hypochondria has been opened.
If one is worried about having a serious medical illness despite receiving reassurance to the contrary by a physician during a comprehensive evaluation, it might be beneficial to put these techniques into practice:
The following self-help books might be helpful as well.
In the 2005 DreamWorks Animation film Madagascar, a giraffe (Melman) is portrayed as a hypochondriac.
On the show South Park, Stan Marsh's father, Randy Marsh, is described by his son as a hypochondriac in the episode "Bloody Mary".
In the film My Girl the leading character Vada is a hypochondriac most likely due to her being raised in a funeral home.
In the film, Bandits, one of the bank robbers (portrayed by Billy Bob Thornton), Terry, is a hypochondriac. The other bank robber, Joe, used this to an advantage once, and claimed that his brother received a brain tumor from smelling burning feathers as a joke to get Terry to worry.
In the TV series, Scrubs, recurring character Harvey Korman, portrayed by actor Richard Kind, is a hypochondriac that appears in several episodes. His most notable appearance being in the episode, "My New Old Friend".
In the 1986 hit film Ferris Bueller's Day Off, Ferris' friend Cameron Frye (portrayed by Alan Ruck) was displaying some symptoms of hypochondria throughout the movie, notably when he is lying in bed thinking he is sick, until Ferris convinces him that it's all in his head.
In the TV series, Boy Meets World Cory is diagnosed with hypochondria and sees it as a real illness.
This entry is from Wikipedia, the leading user-contributed encyclopedia. It may not have been reviewed by professional editors (see full disclaimer)
Dansk (Danish)
n. - hypokonder
Nederlands (Dutch)
hypochondrie, het overmatig zorgen maken om eigen gezondheid
Français (French)
n. - hypocondrie
Deutsch (German)
n. - Hypochondrie, Einbildung, krank zu sein, Schwermut
Ελληνική (Greek)
n. - (ψυχολ.) υποχονδρία
Português (Portuguese)
n. - hipocondria (f) (Patol.)
Español (Spanish)
n. - hipocondría
Svenska (Swedish)
n. - hypokondri (inbillningssjuka)
中文（简体） (Chinese (Simplified))
忧郁症, 臆想病
中文（繁體） (Chinese (Traditional))
n. - 憂鬱症, 臆想病
한국어 (Korean)
n. - 저혈당증, 심기증, 우울증
日本語 (Japanese)
n. - 心気症, 憂鬱症, ヒポコンデリー
العربيه (Arabic)
(الاسم) وسواس, المرض, توسوس, المرء على صحته وبخاصه حين يكون مصحوبا بتوهم وجود مرض جسماني
עברית (Hebrew)
n. - היפוכונדריה, דאגה לא-נורמלית של אדם לבריאותו, דיכאון חולני ללא סיבה אמיתית
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 | Dictionary. The American Heritage® Dictionary of the English Language, Fourth Edition Copyright © 2007, 2000 by Houghton Mifflin Company. Updated in 2007. Published by Houghton Mifflin Company. All rights reserved. Read more |
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| World of the Body. The Oxford Companion to the Body. Copyright © 2001, 2003 by Oxford University Press. All rights reserved. Read more |
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| Dental Dictionary. Mosby's Dental Dictionary. Copyright © 2004 by Elsevier, Inc. All rights reserved. Read more |
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| Columbia Encyclopedia. The Columbia Electronic Encyclopedia, Sixth Edition Copyright © 2003, Columbia University Press. Licensed from Columbia University Press. All rights reserved. www.cc.columbia.edu/cu/cup/ Read more |
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| Psychoanalysis. International Dictionary of Psychoanalysis. Copyright © 2005 by The Gale Group, Inc. All rights reserved. Read more |
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| Wikipedia. This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Hypochondria". Read more |
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