The essential characteristic of hypochondria is the worry related to the fear of having, or the belief of having, a serious illness. This is usually based on the misinterpretation of one or more physical signs or symptoms. One can speak of illness anxiety (or fear of illness ), of course, only if a thorough medical evaluation has ruled out any medical conditions that could fully explain the physical signs or symptoms. However, there may be excessive disease anxiety even when a non-serious organic disease is present. The main aspect of hypochondria is that the unjustified fear or belief that you have an illness persists despite medical reassurance.

Symptoms of hypochondria

Symptoms of hypochondria can be traced back to concerns about:

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

The person attributes these symptoms or signs to the suspected disease and is very concerned about their significance and cause. In sickness 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 medical examinations, diagnostic tests, and reassurance from doctors do little to alleviate worries about illness or physical suffering. For example, a person worried about having heart disease will not feel reassured by the repeated negativity of medical examination findings, ECG, or even cardiac angiography.

People with hypochondriacs may be alarmed if they read or hear about a disease. M even if they learn that someone has fallen ill, or because of observations, sensations, or events that affect their body.

For those suffering from hypochondria , the fear of disease  often becomes a central element of self-image, a habitual topic of conversation, and a way of responding to the stresses of life.

Further clinical manifestations

Often in hypochondria the medical history is presented in great detail and very extensively. “Going for doctors” and the deterioration of the doctor-patient relationship, with mutual frustration and resentment, are common.

People with fear of disease often feel that they are not receiving appropriate treatment. They can strongly oppose invitations to go to psychological services. Complications can arise from repeated diagnostic procedures, which in themselves can 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 superficial evaluations. As in the fable “wolf to wolf”, the presence of a general medical condition when present can therefore be neglected.

Social relationships are disrupted by the fact that the person with symptoms of hypochondria is concerned about their condition and often expects special consideration and treatment.

Family life can become disturbed as it is focused around the individual’s physical well-being. There may be no effect on the individual’s work functioning if he or she manages to limit the expression of hypochondriacal concerns outside the work environment. More often, worry interferes with performance and causes absences from work. In severe cases, the hypochondriac subject can become a complete invalid due to his fears of disease.

Causes, onset and course of hypochondria and disease anxiety

Severe illness, especially in childhood, and a family member’s previous illness experiences are easily associated with the onset of hypochondria symptoms .

It is believed that certain stressful psycho-social factors, in particular the death of some close person, can in some cases precipitate the phobia of diseases .

The disorder is equally distributed between males and females. The prevalence of symptoms of hypochondria 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 hypochondria sometimes occurs.

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

It is important to distinguish sickness anxiety from obsessive-compulsive contamination disorder . This is characterized not so much by the fear of having an illness, but by the excessive and irrational fear of getting sick or making someone else sick through contagion. This generally results in washing rituals and avoidances aimed at averting such fears.

Hypochondria treatment

Psychotherapy is a very uneven 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 brief 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 hypochondria can be particularly difficult, as the subjects are never completely convinced that the cause of their illnesses is only of a psychological nature.

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

The pharmacological treatment of hypochondria , provided that the person agrees to take drugs without fear of causing damage to his body, is fundamentally based on antidepressants, both tricyclics and SSRIs .

The latter class presents, compared to the previous ones, greater handling and fewer side effects.

Because hypochondria is often equated with obsessive-compulsive disorder , considering the patient’s concerns as obsessions with disease, drug therapy mirrors the guidelines for this disorder. Therefore, high dosages of antidepressants with serotonergic action taken for prolonged periods are used.

In mild forms, the prescription of benzodiazepines alone may be sufficient, but generally it is not a form of therapy for hypochondria and only helps to allay short-term anxiety.