Hypochondriasis between health and psychosis

Abstract

Considering the lack of clarity in the conceptualisation of hypochondriasis, it is not surprising that the concept is quite heterogeneous and that there are dilemmas in terms of what is encompassed by hypochondriasis and where its boundaries are. Therefore, the aim of this review paper was to contribute towards a more coherent view on hypochondriasis, which would also allow its more adequate classification. The essential features of hypochondriasis were identified as an overvalued idea about the presence of disease, fear that the person has already become seriously ill, reassurance-seeking and other forms of health checking, and disturbances in the perception of bodily sensations and symptoms. These four aspects of hypochondriasis can be assessed dimensionally to ascertain to what extent they characterise each patient. Suggestions have been made to delineate more precisely hypochondriasis from health anxiety, anxiety disorders, obsessive-compulsive disorder, other somatoform disorders, personality disorders, depression, and delusional disorder with disease-related delusions. In the absence of better alternatives, hypochondriasis should continue to be classified among the somatoform disorders. In order to improve communication between clinicians and reduce conceptual heterogeneity, the term "hypochondriasis" should be used to refer only to primary hypochondriasis. The pressure to abandon this term should be resisted until an adequate substitution for it has been found.