Functional somatic symptoms and hypochondriasis. A survey of empirical studies

Empirical studies suggest the following main conclusions: functional somatic symptoms are extremely common; a large proportion appear to be caused by physiologic activity and tend to be aggravated by emotion. Hypochondriacal patients misunderstand the nature and significance of these symptoms and believe that they are evidence of serious disease. Hypochondriasis can be a part of another syndrome, usually an affective one, or it can be a primary disorder. The prevalence differs between cultures and social classes. Constitutional factors, disease in the family in childhood, and previous disease predispose to hypochondriasis. Various stressors can be precipitating events. Selective perception of symptoms, motivated by fear of disease, and subsequent increase in anxiety with more somatic symptoms appear to be links in the vicious cycle of the hypochondriacal reaction. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies of psychotherapy in hypochondriasis, and the recommended treatments are based on studies with similar disorders. The prognosis of treated hypochondriasis is good in a substantial proportion of patients.