366 CHAPTER 8
kind of preoccupation with a perceived health problem must cause signifi cant dis-
tress or impair the person’s functioning in some way and must have continued for
at least 6 months (see Table 8.14). Additional facts about hypochondriasis are pre-
sented in Table 8.15.
Like people with SD, those with hypochondriasis don’t appreciate that even
healthy people sometimes have aches and pains and other bodily discomforts.
Instead, they unrealistically believe that having “good health” implies not hav-
ing any unpleasant bodily symptoms (Barsky, Coeytaux, et al., 1993), as does the
woman in Case 8.7.Table 8.14 • DSM-IV-TR Diagnostic Criteria for Hypochondriasis
A. Preoccupation with fears of having, or the idea that one has, a serious disease based on the
person’s misinterpretation of bodily symptoms.B. The preoccupation persists despite appropriate medical evaluation and reassurance.C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type
[discussed in Chapter 12]) and is not restricted to a circumscribed concern about appearance
(as in Body Dysmorphic Disorder [discussed later in this chapter]).D. The preoccupation causes clinically signifi cant distress or impairment in social, occupational,
or other important areas of functioning.E. The duration of the disturbance is at least 6 months.F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-
Compulsive Disorder, Panic Disorder [all discussed in Chapter 7], a Major Depressive Episode
[Chapter 6], Separation Anxiety [Chapter 14], or another Somatoform Disorder.
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Text Revision,
Fourth Edition, (Copyright 2000) American Psychiatric Association.CASE 8.7 • FROM THE INSIDE: Hypochondriasis
I attended graduate school, held jobs, was married, had children. But my existence was
peppered with episodes of illness. When the going got tough, I’d get sick. Or just the opposite:
when things seemed to be going well, I’d come down with a symptom, or at least what I inter-
preted as one. It might be stomach pain, dizziness, black and blue marks, swollen glands, an
achy heel. Anything. Whatever the symptoms, I always interpreted it as a precursor of some
crippling illness: leukemia, Lou Gehrig’s disease, scleroderma. I knew just enough about
most diseases to cause trouble. Eventually I’d get past each episode, but it always took time—
the cure a mysterious concoction of enough negative tests, a lessening of symptoms, some
positive change in my life. And when the event was over, the realization that I was healthy and
wasn’t going to die, at least not immediately, was like a high, a reprieve, a new lease on life.
That is, until the next time.
(Cantor, 1996, pp. 9–10)Hypochondriasis and Anxiety Disorders: Shared Features
Hypochondriasis has many features in common with anxiety disorders. In fact, hypo-
chondriasis and anxiety disorders are so similar that some researchers have advocated
moving hypochondriasis from the category of somatoform disorders to the category
of anxiety disorders, and renaming it health anxiety disorder (Mayou et al., 2005).
Let’s compare hypochondriasis with some anxiety disorders.
Hypochondriasis, phobias, and panic disorder are all characterized by high
levels of fear and anxiety, as well as a faulty belief of harm or danger. However,
with hypochrondriasis and panic disorder, the perceived danger is from an internal
event that is thought to be producing a bodily sensation, whereas with phobias, it
is from an external object (such as a snake) or a situation (such as giving a speech;