Hypocondria with absent insight – a variant for the development of depression with somatic symptoms

Abstract

Hypochondria is a psychiatric disorder that, even though it has been known since the antiquity, it has always been difficult to conceptualize it from a nosologic point of view. In ICD 11, hypochondria was included in a category made of „Obsessive compulsive disorder and other relational diseases”, being excluded this way from the category of „Somatoform disorders” as in ICD 10. The patient C.T., 54 years old, from Sibiu, came to our Psychiatric Department presenting anxious-depressive symptoms and somatic symptoms triggered by a medical check-up that determined at first a state of anxiety, that later evolved into a „major depressive disorder, major depressive episode with somatic features”. From a therapeutic perspective, the patient followed an antidepressant treatment; psychotherapy has been indicated too, but the patient didn’t undergo it. The symptoms have progressed, until attaining a delusional intensity, and the diagnosis was then changed to „hypochondria with absent insight”. An antipsychotic treatment was introduced; the patient then had significant progress once some changes appeared in his family environment. Switching the diagnosis from the neurotic to psychotic register (“Hypocondria with absent insight”) happened as a result of a follow-up for the later installed signs of delusion, guilt, sin, shame and a loss of self-esteem, which persisted for a long period, while also having traits of obsessive-compulsive personality, and the perception of an insufficient social support.