Diagnosis and clinical features
According to the Diagnostic and Statistical Manual of Mental Disorders,
fourth edition, text revised (DSM-IV-TR) [1], the essential feature of hypochondriasis (HC) is a preoccupation with the (inaccurate) belief that one has,
or is in danger of developing, a serious medical illness. In many instances,
the fear of illness disrupts social, occupational, and family functioning.
Moreover, it persists despite appropriate medical evaluation and reassurance
of good health. Patients’ preoccupation may be symptom based, with a focus
on (1) certain specific bodily functions (eg, swollen lymph nodes, vestibular
sensations), (2) actual physical abnormalities that are not typically dangerous (eg, a small sore, postural orthostatic tachycardia syndrome), or (3) vague and ambiguous physical sensations (eg, ‘‘tired lungs,’’ ‘‘foggy brain’’). The person ascribes these generally innocuous signs and sensations to
a feared malignant disease (eg, cancer, an unexplained heart condition)
and becomes highly engrossed with determining their meaning, authenticity,
and underlying etiology. The case of Greg illustrates the features of HC:
Greg, a 28-year-old student, was referred to the Mayo Clinic by his primary
care doctor for psychologic assessment and treatment because of Greg’s unrelenting fear that his recent episodes of tachycardia, dizziness, and chest pain meant that he was suffering from a serious heart condition. A comprehensive medical evaluation, including a complete cardiac work-up, revealed no evidence of a medical condition that might account for his complaints. Despite these results, Greg was intent on determining the exact nature and cause of his symptoms, believing that a serious undetected medical illness was present.
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