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Hypochondriasis: common presentations and treatment strategies in primary care and specialty settings

Glen L Xiong, James A Bourgeois, Celia H Chang, Dandan Liu and Donald M Hilty

Hypochondriasis is a somatoform disorder marked by recurrent preoccupation with fears of having a life-threatening disease despite appropriate work-up and medical reassurance. The etiological explanations for hypochondriasis have evolved over time from a psychoanalytic stance (as an unconscious manifestation of instinctual drives) to social learning, cognitive–behavioral, and biological models that focus on functional values of hypochondriasis and parallels to anxiety disorders. We review recent therapeutic developments while emphasizing the importance of the therapeutic alliance. Although reassurance, psychotherapy, psychopharmacology and mental health referral are clearly indicated, we caution against using them prematurely. Since primary care and nonpsychiatric specialty physicians care for the majority of patients with hypochondriasis, we review the clinical presentations and treatment nuances specific to several different settings.