Relationship between Hypochondriasis and Obsessive-Compulsive Personality Disorder: Close Relatives Separated by Nosological Schemes?

Abstract

It has been proposed that the relationship between obsessive-compulsive personality disorder and hypochondriasis can basically be conceptualized along the severity continuum, so that hypochondriasis would be conceived of as a more pervasive and more incapacitating form of the same or closely related underlying psychopathology. Clinically, this relationship is manifested through emergence of hypochondriasis as a complication of the obsessive-compulsive personality disorder. The principal components of the psychopathology common to both disorders, are perception of excessive threat to oneself with the consequent experience of vulnerability and insecurity, mistrust in oneself and others, greatly increased need for control, inordinate search for security, poor tolerance and fear of uncertainty and ambiguity, and specific cognitive style, mainly developed to support a struggle for control. In view of the most striking phenomenological characteristic of both disorders being an excessive need for control, displayed in a repetitious manner, the essence of hypochondriasis and obsessive-compulsive personality disorder could be captured by the term "chronic disorders of the measure of control." The main phenomenological differences between hypochondriasis and obsessive-compulsive personality disorder have been interpreted as expressive of the lower and higher levels of intrapsychic integration respectively. In this regard, the manner in which the bodily self has been formed and the degree to which it has been incorporated into the self as a whole have been considered particularly important.