Hypochondria: a tentative approach

The author begins his investigation of hypochondria by defining the condition and distinguishing between hypochondriacal symptoms and hypochondriacal crises, the latter being stated to arise when the defensive function of the former fails. After an enumeration of the main psychogenetic elements observed in the psychoanalytic psychotherapy of a sample population of eight patients, he concentrates on the psychodynamic and psychostructural aspects and demonstrates by means of clinical examples how conflicts of separation and dependence give rise to oral-sadistic, anal-sadistic and progressive-perverse defensive structures. Although regressive and progressive psychodynamic processes established between these structures may temporarily stabilise the psychic system to some extent, splits cause them to loom large in a hypochondriacal world full of disintegrative anxiety that is accompanied by an aggressive excitation pervaded with threatening confusion and sexual perversion, where the patient flees into quasi autistic withdrawal and tormenting self-observation. Catastrophic states resulting from earlier traumas are here fused with more mature psychic elements owing to earlier traumas. The author shows how instability in these structures, together with the failure of important ego and superego functions, may lead to a malignant regression and the consequent pathogenic reintrojection of projections. When the psyche is threatened by a dynamic of this kind, hypochondriacal symptoms may ensue as a last-ditch attempt by the patient to defend against psychic decompensation.