Hypochondriasis, or hypochondria, is an overwhelming fear that you have a serious disease, even though health care providers can find no evidence of illness. People with hypochondriasis tend to misinterpret normal body sensations as signs of serious illness. Most people occasionally fear they have an illness, but people with hypochondriasis are preoccupied with their fear. This fear is severe and persistent and interferes with work, as well as relationships. Complaints tend to focus on the head, neck, and trunk, often in the form of pain. Hypochondriasis is somewhat similar to obsessive compulsive disorder, because of the obsession with illness and the compulsion to do something to lessen their anxiety. An estimated 75 - 85% of people who have hypochondriasis also have anxiety, depression, or another mental disorder.
No one knows what causes hypochondriasis, but there are several theories, including:
These factors increase the risk of developing hypochondriasis:
Your health care provider will perform a physical examination along with other tests to determine whether a physical disease may account for your reported symptoms. Your health care provider will also ask specific questions and use 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 having regular visits with a health care provider who will take the physical symptoms seriously, people with hypochondriasis may also benefit from psychotherapy. Group therapy, behavior modification, and cognitive therapy have been reported to work particularly well (see Surgical and Other Procedures section for more details). People with hypochondriasis often have other mental health conditions, such as anxiety and depression, and treatment of these conditions is important in treating symptoms of hypochondriasis.
For more information, see
Drugs are generally not used to treat hypochondriasis specifically, but for associated mental health conditions. They may improve symptoms of hypochondriasis. Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, fluvoxamine, or paroxetine, are sometimes prescribed. At least one study found that fluoxetine was well tolerated and moderately effective for hypochondriasis.
Several types of psychotherapy may help:
Cognitive behavioral therapy and stress management are the cornerstones of treatment for hypochondriasis. Acupuncture has also been shown to help. Beyond that, not many studies have been done on complementary and alternative therapies for hypochondriasis. Regular appointments with a CAM health care provider may help relieve health-related fears because of the regularity of the visits, the reassurance from a professional, and the focus on wellness and healthy behaviors. Work with someone who is licensed and reputable to develop a solid program of self care and health promotion.
No scientific studies have examined the effect of nutrition on hypochondriasis. However, people with hypochondriasis who also have anxiety or depression may benefit from avoiding alcohol and caffeine.
Following these nutritional tips may also help reduce risks and symptoms:
You may address nutritional deficiencies with the following supplements:
Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.
No herbs are specifically used to treat hypochondriasis, but certain herbs used to relieve stress or anxiety 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. Because many herbs interact with prescription antidepressants and anxiety medications, make sure your doctor is aware of all medications, herbs, and supplements you take.
Few studies have examined the effectiveness of specific homeopathic remedies. Some health care 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 -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.
Several studies indicate that acupuncture may be useful in treating hypochondriasis. Acupuncturists believe the procedure balances the flow of energy (qi) in the body. This balancing effect may be particularly helpful for people who have distorted perceptions of normal body sensations. Acupuncture may be useful for:
Some health care providers 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 for some people, having regular massages could draw attention to their physical complaints, and increase their symptoms.
Stress and anxiety may make the symptoms of hypochondriasis worse. Many people may also struggle with costly medical tests and develop a dependency on certain medications. Hypochondriasis is a chronic illness (it persists for a long time), but getting early psychiatric treatment and having a strong motivation to change may increase the chances of getting better. Some reports suggest that one third to one half of patients improve over time, and one tenth recover completely.
Try to maintain a healthy relationship with your primary health care provider. Your health care provider will want to schedule regular appointments to monitor your symptoms.
Adams RD, Victor M, Ropper AH. Principles of Neurology. 6th ed. New York, NY: McGraw-Hill; 1997:1523-1524.
Birdsall TC. 5-Hydroxytryptophan: a clinically-effective serotonin precursor. Altern Med Rev. 1998;3(4):271-280.
Clark DM, Salkovskis PM, Hackmann A, et al. Two psychological treatments for hypochondriasis. A randomised controlled trial. Br J Psychiatry. 1998;173:218-225.
Fallon BA, Petkova E, Skritskaya N, Sanchez-Lacay A, Schneier F, Vermes D, Cheng J, Liebowitz MR. A double-masked, placebo-controlled study of fluoxetine for hypochondriasis. J Clin Psychopharmacol. 2008;28(6):638-45.
Ferri: Ferri's Clinical Advisor 2011, 1st ed. Hypochondriasis. St. Louis, MO: Mosby. 2010.
Gramling SE, Clawson EP, McDonald MK. Perceptual and cognitive abnormality model of hypochondriasis: amplification and physiological reactivity in women. Psychosom Med. 1996;58(5):423-431.
Hales RE, Yudofsky SC, Talbott JA. Textbook of Psychiatry. 3rd ed. Washington, DC: American Psychiatric Press, Inc; 1999:683-686.
Jellin JM, Gregory P, Batz F, Hitchens K, et al. Pharmacist's Letter/Prescriber's Letter Natural Medicines Comprehensive Database. 3rd ed. Stockton, Calif: Therapeutic Research Facility; 2000.
Kochetkov VD, Mikhailova AA, Dallakian IG. Reflexotherapy of neurotic patients with depressive-hypochondriacal manifestations [in Russian]. Zh Nevropatol Psikhiatr Im S S Korsakova. 1983;83(12):1853-1855.
Marx: Rosen's Emergency Medicine, 7th ed. St. Louis, MO: Mosby. 2009.
Molin G. Probiotics in foods not containing milk or milk constituents, with special reference to Lactobacillus plantarum 299v. Am J Clin Nutr. 2001;73(2 Suppl):380S-385S.
Noyes R Jr, Kathol RG, Fisher MM, Phillips BM, Suelzer MT, Holt CS. The validity of DSM-III-R hypochondriasis. Arch Gen Psychiatry. 1993;50(12):961-970.
Ravindran AV, da Silva TL, Ravindran LN, Richeter MA, Rector NA. Obsessive-compulsive spectrum disorders: a review of the evidence-based treatments. Can J Psychiatry. 2009;54(5):331-43.
Romoli M, Giommi A. Ear acupuncture in psychosomatic medicine: the importance of the sanjiao (triple heater) area. Acupunct Electrother Res. 1993;18(3-4):185-194.
Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders-a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry. 1997;30(1):1-5.
© 2011 University of Maryland Medical Center (UMMC). All rights reserved.
UMMC is a member of the University of Maryland Medical System,
22 S. Greene Street, Baltimore, MD 21201. TDD: 1-800-735-2258 or 1.866.408.6885