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What Is It?

Hypochondriasis is a persistent fear of having a serious medical illness. A person with this disorder tends to interpret normal sensations, bodily functions and mild symptoms as a sign of an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be a sign of a serious disease.

A person with hypochondriasis may be especially concerned about a particular organ system, such as the cardiac or digestive systems. A doctor's reassurance and even a complete medical evaluation often will not calm the person's fears. Or, if it does calm them, other worries may emerge days later.

Generally, people with this disorder do not develop "somatic delusions" (ideas about health that are completely divorced from reality). One common perspective on this disorder is that health anxiety is so great that reassurance is only temporarily helpful at best. Patients may admit the possibility that their fears are exaggerated. However, they may not accept being told that there is "nothing wrong."

The research about the prevalence of hypochondriasis is less thorough than the research on other mental disorders. The best estimate is that up to 4% or 5% of patients in general medical practices may have hypochondriasis. Another 10% may have some hypochondriacal symptoms without having the full disorder.

In severe forms, there is a tendency to go from doctor to doctor, looking for one that will confirm the presumed illness. The patient and the doctors may become frustrated or angry. The intensive search for illnesses that cannot be found sometimes interferes with the person getting proper care if he or she develops a medical illness for which there is an effective treatment.

Hypochondriasis is in some ways similar to obsessive-compulsive disorder. In fact, some researchers see it as a related disorder. The person is obsessively preoccupied with thoughts of illness and feels compelled to do things (feel lumps, browse for medical information, visit the doctor) to quell the anxiety they feel.

Some people with this disorder have had a serious illness in the past, commonly during childhood. Often hypochondriasis starts in young adulthood and can last many years. But it can occur at any age and in both men and women. Symptoms may become more intense after a stressful event, for example, the death of a loved one.

Although medical illnesses are uncomfortable, they can bring benefits, such as relief from responsibilities along with the attention and care of family members, friends and doctors. Sometimes, hypochondriasis is motivated by these advantages, although the individual is often not aware of that motivation.

Less often, a person may feign illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. In cases where someone is consciously seeking such advantages, the condition is called malingering. But hypochondriasis is not malingering. In hypochondriasis, the patient isn't pretending. He or she believes the illness is real and truly feels ill.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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