Hypochondriasis (anxiety about illness): symptoms and treatment

By Cristiano Antonino On Mar 31, 2023

The essential feature of hypochondriasis is worry related to the fear of having, or the belief that one has, a serious illness

This is usually based on the misinterpretation of one or more physical signs or symptoms.

Illness anxiety (or fear of illnesses), of course, only exists if a thorough medical evaluation has ruled out any medical conditions that could fully explain the physical signs or symptoms.

However, excessive illness anxiety may exist even when non-serious organic disease is present.

The main feature of hypochondriasis is that the unwarranted fear or belief that you have a disease persists despite medical reassurances.

Symptoms of hypochondriasis

Symptoms of hypochondriasis can be related to concerns about:

bodily functions (e.g. heart rate, perspiration or peristalsis);
minor physical changes (e.g. a small wound or the occasional cold);
vague or ambiguous physical sensations (e.g. “tired heart”, “aching veins”).

The person attributes these symptoms or signs to the suspected disease and is very concerned about their meaning and cause.

In illness anxiety (also called disease phobia), worries can affect many systems, at different times or simultaneously.

Alternatively there may be concern about a specific organ or a single disease (eg fear of heart disease).

Repeated doctor visits, diagnostic tests, and reassurances from doctors do little to alleviate concern about illness or physical suffering.

For example, a person worried about having heart disease will not feel reassured by repeated negative findings from the doctor’s visits, EKG, or even cardiac angiography.

Hypochondriacs may become alarmed if they read or hear about an illness

But also if they learn that someone has fallen ill, or because of observations, sensations, or events affecting their body.

For those with hypochondriasis, the fear of illness often becomes a central element of the person’s self-image, a habitual topic of conversation, and a way of responding to life’s stressors.

Further clinical manifestations

Often in hypochondriasis the medical history is presented in great detail and at great length.

“Going to doctors” and the deterioration of the doctor-patient relationship, with mutual frustrations and resentment, are common.

People with fears of disease often feel that they are not getting the proper treatment.

They may strenuously oppose invitations to go to psychological services.

Complications can arise from repeated diagnostic procedures, which themselves may carry risks and which are costly.

However, precisely because these individuals have a history of multiple complaints without a clear physical basis, there is a risk that they will receive cursory evaluations.

As in the fairy tale “wolf to the wolf” the presence of a general medical condition when present can therefore be overlooked.

Social relationships are disrupted due to the fact that the person who has symptoms of hypochondriasis is concerned about his condition and often expects special consideration and treatment.

Family life may become disturbed as it becomes focused around the individual’s physical well-being.

There may be no effect on an individual’s occupational functioning if they can limit the expression of hypochondriacal concerns outside the occupational setting.

More often the worry interferes with performance and causes absences from work.

In severe cases, the hypochondriac can become a complete invalid due to his fears of disease.

Causes, onset and course of hypochondriasis and illness anxiety

Serious illnesses, especially in childhood, and a family member’s previous experience of illness are easily associated with the occurrence of symptoms of hypochondriasis.

It is believed that certain psychosocial stressors, in particular the death of a close person, may in some cases precipitate disease phobia.

The disorder is equally distributed between males and females.

The prevalence rate of hypochondriasis symptoms in the general population is unknown, but in general medical practice it ranges from 4 to 9%.

Fear of disease can begin at any age, but the most common age of onset is thought to be early adulthood.

The course is usually chronic, with symptoms coming and going, but complete remission of hypochondriasis sometimes occurs.

Because of its chronicity, some believe that hypochondriac disorder is primarily an expression of character traits (ie, long-standing preoccupations with physical problems and a focus on somatic symptoms).

It is important to distinguish illness anxiety from contamination obsessive-compulsive disorder

This is characterized not so much by the fear of having a disease, but by the excessive and irrational fear of getting sick or making someone else sick by contagion.

Generally, washing rituals and avoidances follow to ward off such fears.

Hypochondria care

Psychotherapy is a very inhomogeneous discipline; There are dozens of forms of individual, family, couple and group psychotherapy.

In the treatment of hypochondria, the form of psychotherapy that scientific research has shown to be most effective, in the shortest possible time, is the “cognitive-behavioral”.

It is a short psychotherapy, usually on a weekly basis, in which the patient plays an active role in solving his problem.

Together with the therapist, she focuses on learning more functional ways of thinking and behaving, with the aim of breaking the vicious circles of health anxiety.

In any case, the treatment of hypochondriasis can be particularly difficult, as the subjects are never entirely convinced that the cause of their ills is only of a psychological nature.

Psychotherapy is generally possible in those cases in which the person worries incessantly about having illnesses, but realizes, at least in part, that his worries are excessive and unfounded.

The pharmacological treatment of hypochondriasis, assuming that the person agrees to take drugs without fearing that they will cause damage to his body, is fundamentally based on antidepressants, both tricyclic and SSRIs.

The latter class has, compared to the previous ones, greater manageability and fewer side effects.

Given that hypochondriasis is often assimilated to obsessive-compulsive disorder, considering the patient’s worries as disease obsessions, drug therapy reflects the guidelines for this disorder.

Therefore, high doses of serotonergic antidepressants are used, taken for prolonged periods.

In mild forms, the prescription of benzodiazepines alone may be sufficient, but generally it does not constitute a form of therapy for hypochondriasis and only achieves short-term anxiety relief.

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