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Risk of substance-related problems in hypochondriasis

Kayoko Isomura¹, Susanna Österman¹, Erik Hedman-Lagerlöf²

¹Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.

Psychological Medicine

|January 15, 2026

Abstract

Background:

Hypochondriasis, or health anxiety disorder, is associated with increased mortality, mainly from potentially preventable causes. Substance misuse is a well-known contributor to premature death, yet its relationship with hypochondriasis remains unclear. We assessed the risk of broadly defined substance-related problems in individuals diagnosed with hypochondriasis.

Methods:

This Swedish register-based matched cohort study included 4,129 individuals diagnosed with hypochondriasis in specialist services between 1997 and 2020 and 41,290 demographically matched unexposed individuals. Stratified Cox proportional hazards models were fitted to estimate hazard ratios (HRs) for the association between hypochondriasis and substance-related problems - defined as alcohol and drug use disorders, dispensed medications for alcohol dependence and opioid use disorders, and alcohol- and drug-related accidental poisonings, deaths, and suspected criminal offenses. Models were adjusted for sociodemographic variables, parental substance-related problems, and personal psychiatric history.

Results:

Substance-related problems were identified in 504 (12.2%) individuals with hypochondriasis and 1,924 (4.7%) matched unexposed individuals. After adjustment for sociodemographic and parental covariates, hypochondriasis was significantly associated with an increased risk of substance-related problems (HR, 2.55; 95% confidence interval [CI], 2.30-2.84). Similar results were observed in individuals without preexisting substance-related problems (HR, 2.85; 95% CI, 2.48-3.27). Further adjustment for psychiatric comorbidity, particularly anxiety and depression, reduced the risk estimates, but the associations remained statistically significant. In an additional analysis including primary care diagnoses of hypochondriasis (presumably reflecting less complex cases), the risk of substance-related problems remained elevated (HR, 1.61; 95% CI, 1.39-1.86).

Conclusion:

Improved recognition of, and clinical awareness of substance misuse may help reduce long-term adverse outcomes in individuals with hypochondriasis.

Keywords:

epidemiology health anxiety disorder hypochondriasis substance-related problems

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