Hypochondriasis: conceptualization, treatment, and relationship to obsessive-compulsive disorder

Once considered exclusively as a problem secondary to other mental dis-orders (ie, mood disorders), HC is now known to occur quite often as a pri-mary diagnosis. A frequent drain on medical resources, patients who have HC can be viewed as suffering essentially from an anxiety disorder in which intense fear is focused on the possibility that they might be seriously physically ill or that such illness is imminent. The processes that contribute to the development and maintenance of such health anxiety consist largely of beliefs, assumptions, and behavioral responses that, although internally consistent with the perception of health-related threat, are erroneous and highly maladaptive in that they prevent the correction of erroneous perceptions of threat. There is growing evidence that this conceptualization leads to effective reduction in HC symptoms through cognitive-behavioral and pharmacologic treatments. By far the main obstacle to successful treatment of HC is the patient's reluctance to view the problem as anything other than physical. The authors have found, however, that patients appreciate their care providers showing a genuine understanding of their concerns and taking the time to offer a logical, coherent explanation and rationale for the need for psychological and psychiatric services.