Hypochondriasis is an overwhelming fear that one has a serious disease, even
though healthcare providers can find no evidence of illness. It is based on
misinterpreting normal body sensations. Mild, occasional preoccupation with
disease is quite common. This is not the same as hypochondriasis, which is
severe and persistent and interferes with work as well as relationships. An
estimated 75% to 85% of those who have hypochondriasis also have anxiety,
depression, or another mental disorder.
Signs and Symptoms
Preoccupation with a serious illness for at least six months
Persistent fear of illness despite reassurance to the contrary from
Difficulty maintaining a job, keeping relationships, and performing
normal daily activities
What Causes It?
There are several theories about what causes hypochondriasis, including the
The belief that an illness may atone for past real or imagined
Having learned apparent benefits of being sick, such as receiving
attention; may occur in one who had a childhood illness or had a sibling with a
Hypochodriasis is sometimes considered a variant of another
psychiatric disorder such as anxiety or obsessive-compulsive disorder (OCD); in
other words, hypochondriasis may develop from or be a sign of one of these other
Who's Most At Risk?
These factors increase the risk of developing hypochondriasis:
witnessing or experiencing a prolonged childhood illness (learning the apparent
benefits of being sick)
Family history of hypochondriasis
Recent stressful event (for example, the death of a close friend or
What to Expect at Your Provider's Office
A healthcare provider will perform a physical exam along with other tests to
determine whether a physical disease may account for the reported symptoms. He
or she will also ask specific questions and administer psychological tests to
rule out the possibility of other related disorders such as anxiety or
obsessive-compulsive disorder. A trained specialist, such as a psychologist or a
psychiatrist, may be consulted to aid in the diagnosis and treatment.
In addition to regular visits with a healthcare provider, people with
hypochondriasis may also benefit from psychotherapy. Group therapy, behavior
modification, and cognitive therapy have been reported to work particularly well
(see section entitled Surgical and Other Procedures for more details).
Because people with hypochondriasis tend to have other mental health conditions,
such as anxiety and depression, treatment of these associated conditions is an
important step in resolving the symptoms of hypochondriasis.
Drugs are generally not used to treat hypochondriasis specifically, but
medication for associated mental health conditions may improve symptoms of
hypochondriasis. Selective serotonin reuptake inhibitors (SSRIs), such as
sertraline, fluoxetine, fluvoxamine, or paroxetine, are a class of medications
that your doctor may consider.
Surgical and Other Procedures
Several types of psychotherapy may help:
Cognitive-behavioral therapy is intended to identify psychological
factors that contribute to fears about illness and to correct misinterpretations
of body sensations. This model focuses on helping patients recognize that their
problem is health anxiety (worrying about illness) rather than having an actual
Behavioral-stress management therapy teaches stress management and
relaxation techniques to help patients avoid becoming focused on illness during
stressful situations. Comparatively, however, cognitive-behavioral therapy may
be longer lasting.
Complementary and Alternative Therapies
Cognitive-behavioral therapy and stress management are the cornerstones of
treatment for hypochondriasis. Good results have also been documented with the
use of acupuncture and music therapy. Little other formal research exists
regarding the use of complementary and alternative therapies for
hypochondriasis. Regular appointments with a supportive CAM provider, though,
may help to relieve health related fears because of the consistency of visits,
the reassurance from a professional, and the focus on wellness as well as
To date, no scientific studies have investigated the role of nutrition in
hypochondriasis. However, people with hypochondriasis who also have anxiety or
depression might benefit from using less alcohol and caffeine. In general, it
makes good sense for a person with hypochondriasis to follow healthy nutritional
guidelines and to make only one dietary change at a time. A registered dietitian
may also be helpful in creating a healthy eating plan. He or she may encourage
Maintain a whole-foods diet that includes plenty of fresh fruits,
vegetables, and whole grains.
Limit sugar, dairy, and refined, processed foods.
Drink at least eight glasses of water each day to reduce constipation
and other gastrointestinal complaints.
Eat small, frequent meals throughout the day. This helps stabilize
blood sugar (which can improve mood) and normalize digestion (which may reduce
awareness of normal body sensations as food passes through the intestines).
Although no scientific studies have examined the effect of supplements on
hypochondriasis, the following may support general health and
Multivitamin taken daily
Mineral supplements (including calcium and magnesium) (Note:
taking too much calcium may lead to constipation and too much magnesium to
gas, bloating, and diarrhea)
Vitamin B complex, including pantothenic acid (B5) and
pyridoxine (B6); (Note: taking too much niacin (vitamin
B3), may cause flushing of the skin and perspiration)
Lactobacillus acidophilus helps to decrease bowel
Certain herbs that are used to energize people during times of stress may
also help a person with hypochondriasis become less preoccupied with disease
(which tends to worsen during stressful times). Other herbs may help lessen
symptoms of hypochondriasis. An herbalist may recommend a combination of two to
four of the following dried herbs for the stated purposes:
Echinacea (Echinacea angustifolia, E. purpurea, E. pallida) to
reduce frequency and duration of colds
Kava kava (Piper methysticum) for anxiety with restlessness.
This herb should not be used along with any prescription psychotropic
medications (used to treat anxiety and certain mental illnesses).
Lemon balm (Melissa officinalis) for calming stress reactions,
particularly with associated gastrointestinal symptoms (such as constipation,
gas, bloating, nausea) or insomnia
Oat straw (Avena sativa) to assist recovery from cold or other
illnesses and strengthen a weakened constitution
Passionflower (Passiflora incarnata) for restlessness, nervous
stress, anxiety, rapid heartbeat related to anxiety, and sleep
St. John's wort (Hypericum perforatum) for symptoms of
depression, anxiety and nervous unrest. This herbal medicine should not be used
with other medications for depression or with a class of medications called
protease inhibitors such as indinavir. In addition, women who use St. John's
wort while on oral contraceptives may experience spotting between periods. This
herb may also make your skin more sensitive to the sun.
Skullcap (Scutellaria lateriflora) for nervous
There have been few studies examining the effectiveness of specific
homeopathic remedies. Some healthcare professionals, however, believe that
homeopathy promotes a sense of well-being and may relieve feelings of anxiety
and depression often associated with hypochondriasis. Before prescribing a
remedy, homeopaths take into account a person's constitutional type. In
homeopathic terms, a person's constitution is his or her physical, emotional,
and intellectual makeup. An experienced homeopath assesses all of these factors
when determining the most appropriate remedy for a particular individual.
Aconitum — for a sense of panic and
fear; this remedy is most appropriate for individuals who believe that they are
so sick they are going to die
Arsenicum album — for anxiety and fear
of dying; this remedy is most appropriate for individuals who call the doctor
often and are difficult to reassure; children may be worried about everything
and tend to act more sick than they actually are
Lycopodium — for general fear and
anxiety about health; this remedy is most appropriate for stressed individuals
who complain often of stomach problems
Phosphorus — for general anxiety about
health; this remedy is most appropriate for individuals who have a fear that
something bad will happen (sense of impending doom) and may latch onto the fears
of others, but tend to be easily
Several studies indicate that acupuncture may be a promising treatment for
hypochondriasis. Acupuncture is believed to balance the flow of energy (qi) in
the body and this balancing effect may be particularly helpful for people with
distorted perceptions of body sensations. The studies suggest that acupuncture
may be useful for:
Relieving ongoing fear and apprehension
Reducing symptoms of emotional stress
Diminishing perceptions of stress and pain
Regulating sleep patterns
Improving work capacity
Some healthcare practitioners believe that regular visits to a massage
therapist (which include techniques to relieve stress) may help reduce symptoms
of hypochondriasis. It is possible, however, that massage could draw attention
to physical complaints, thereby increasing symptoms. For these reasons, more
research is needed before definitive conclusions can be drawn about the value of
massage for hypochondriasis.
Stress and anxiety may worsen the symptoms of hypochondriasis. Many patients
will also struggle with costly medical evaluations and develop addictions to
certain medications. Although hypochondriasis is a chronic illness, early
psychiatric treatment combined with a strong motivation to change may increase
the chances of a healthy prognosis. Some reports suggest that one-third to
one-half of patients improve over time, and one-tenth recover completely from
Try to maintain a healthy relationship with your primary healthcare provider.
He or she will want to schedule regular appointments to monitor your
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Review Date: December 2000
Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Ruth Marlin, MD, Medical Director and Director
of Medical Education, Preventive Medicine Research Institute, Sausalito,
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