hypochondria

1. The persistent conviction that one is or is likely to become ill, often involving symptoms when illness is neither present nor likely, and persisting despite reassurance and medical evidence to the contrary. Also called hypochondriasis.
2. Plural of hypochondrium.

[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.

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

For the anatomical term, see hypochondrium.

This article needs additional citations for verification. Please help improve this article by adding reliable references. See talk page for details. Unsourced material may be challenged and removed. (June 2009)

Hypochondriasis
Classification and external resources
ICD-10	F45.2
ICD-9	300.7
MeSH	D006998

Hypochondriasis (or hypochondria, often referred to as health phobia) refers to an excessive preoccupation or worry about having a serious illness.^[1] Often, hypochondria persists even after a physician has evaluated a person and reassured them that their 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^[2] and one study has shown it to affect about 3% of the visitors to primary care settings.^[3]

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.

Contents 1 Etymology and colloquial use 2 Manifestation and comorbidity 3 Factors contributing to hypochondria 4 Treatment 5 See also 6 References 7 External links

Etymology and colloquial use

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. Hypochondria is sometimes confused with malingering, an intentional falsification of illness for external gains such as avoiding work or school, or factitious disorder, an intentional falsification of illness to assume the sick role.

Manifestation and comorbidity

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. Again, some people are afraid of getting a disease because they have a disease. 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. ^[4]

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. ^[5]

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. ^[4] 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.)^{[citation needed]}

Factors contributing to hypochondria

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 diseases hypochondriacs commonly 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.	”
—Dr. Henry Maudsley, British psychiatrist

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. ^[4] 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).^[6]

Some anxieties and depressions are believed to be 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 believed to be 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 a sleep disturbance, severe fatigue, and typically is treatable with medical intervention.^{[citation needed]}

Treatment

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.

Recent scientific studies have shown 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.^{[7][8][9][10][11]} 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 obsessive worry through readjusting neurotransmitter levels and have been shown to be effective as treatments for anxiety and depression as well as for hypochondriasis.

In the United States, NIH-funded studies are now underway to compare different treatment approaches for hypochondriasis: a study in the New York City area^[12] and a study in the Boston area.^[13] 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, visit the external links cited below.

See also

• Cyberchondria
• Munchausen syndrome
• Somatosensory amplification
• Medical students' disease

References

1. ^ "Hypochondriasis". University of Maryland Medical Center. http://www.umm.edu/altmed/articles/hypochondriasis-000089.htm. 
2. ^ American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised, Washington, DC, APA, 2000.
3. ^ Escobar JI, Gara M, Waitzkin H, Silver RC, Holman A, Compton W (1998). "DSM-IV hypochondriasis in primary care". Gen Hosp Psychiatry 20 (3): 155–9. doi:10.1016/S0163-8343(98)00018-8. PMID 9650033. http://linkinghub.elsevier.com/retrieve/pii/S0163-8343(98)00018-8. 
4. ^ ^{a b c} Fallon BA, Qureshi, AI, Laje G, Klein B: Hypochondriasis and its relationship to obsessive-compulsive disorder. Psychiatr Clin North Am 2000; 23:605-616.
5. ^ Barsky AJ: Hypochondriasis and obsessive-compulsive disorder. Psychiatr Clin North Am 1992; 15:791-801.
6. ^ Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BAM, Grados, MA, Nestadt G: The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biological Psychiatry 2000, 48:287-293.
7. ^ Barsky AJ, Ahern DK: Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 2004; 291:1464-1470.
8. ^ Clark DM, Salkovskis PM, Hackman A, Wells A, Fennell M, Ludgate J, Ahmand S, Richards HC, Gelder M: Two psychological treatments for hypochondriasis, a randomized controlled trial. Br J Psychiatry 1998; 173:218-225.
9. ^ Fallon BA, Schneier FR, Marshall R, Campeas R, Vermes D, Goetz D, Liebowitz MR: The pharmacotherapy of hypochondriasis. Psychopharmacol Bull 1996; 32:607-611.
10. ^ Fallon BA, Qureshi AI, Schneiner FR, Sanchez-Lacay A, Vermes D, Feinstein R, Connelly J, Liebowitz MR: An open trial of fluvoxamine for hypochondriasis. Psychosomatics 2003; 44:298-303.
11. ^ Greeven A, Van Balkom AJ, Visser S, Merkelbach JW, Van Rood YR, Van Dyck R, Van der Does AJ, Zitman FG, Spinhoven P: Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. Am J Psychiatry 2007; 164:91-99.
12. ^ "cumc.columbia.edu". http://www.illnessworry.cumc.columbia.edu. Retrieved 2007-12-20. 
13. ^ "The Health Study - Home". http://www.thehealthstudy.com/index.html. Retrieved 2007-12-20. 

External links

Look up hypochondriasis in Wiktionary, the free dictionary.

• Hypochondriasis at the Open Directory Project

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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

Italiano (Italian)
ipocondria

Português (Portuguese)
n. - hipocondria (f) (Patol.)

Русский (Russian)
ипохондрия

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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