368 CHAPTER 8
2005). The three types of patients had their brains scanned while they indicated
the color of various printed words. The trick was that some words were related to
OCD (e.g., “dirty,” “messy”), and other words were related to symptoms of panic
disorder (e.g., “crowd,” “faint”). The meanings of the words thus could be dis-
tracting, perhaps to different degrees, for the patients. One relevant result of this
study was that the amygdala was activated in the OCD patients when they viewed
OCD-related words, but it was not activated in the patients with hypochondriasis—
which shows that the two disorders are not the same. Moreover, in general the
brain activation pattern of patients with hypochondriasis more closely resembled
that of patients with panic disorder than patients with OCD. But even here, the
patterns of activation were not identical, which indicates that the disorders are
probably not precisely the same.Neural Communication Some researchers have suggested that the neurotransmitter
serotonin does not function properly in at least some cases of hypochondriasis
(King, 1990). As we’ll see in the section on treatment, there is some indirect support
for this hypothesis, based on the observation that SSRIs (which selectively affect
serotonin reuptake, as discussed in Chapter 4) appear to improve the disorder. That
is, the mere fact that SSRIs can improve the symptoms is evidence that the symp-
toms arise, at least in part, from disruption of the activity of serotonin.Genetics Results from one twin study suggest that genetic differences do contribute
to hypochondriasis (Gillespie et al., 2000). These researchers found that genetics
account for about a third of the variation in bodily symptoms that are not clearly
related to a medical disorder. In addition, researchers have used genetic studies to
examine the possible link between hypochondriasis and OCD; some studies fi nd
evidence for such a link (Bienvenu et al., 2000; Noyes, Happel & Yagla, 1999) and
others don’t (Fallon et al., 2000). One possible reason for these confl icting results is
that there may be different types of hypochondriasis, only one of which is related to
OCD (Barsky, 1992).Psychological Factors: Catastrophic Thinking About the Body
People with hypochondriasis have specifi c biases in their reasoning: Not surpris-
ingly, given their disorder, they not only tend to seek evidence of health threats
but also may fail to consider evidence that such threats are minimal or nonexis-
tent (Salkovskis, 1996; Smeets, de Jong, & Mayer, 2000). For instance, a man with
hypochondriasis who notices a bruise on his leg might interpret it as an indicator
of leukemia rather than trying to remember whether he had recently bumped into
something that could cause a black-and-blue mark.
In addition, people affl icted with hypochondriasis focus attention closely on
unpleasant sensations, even if those sensations are relatively weak or infrequent.
They commonly focus on the functioning of body parts (such as the stomach or the
heart), minor physical problems (such as a sore throat), and ambiguous physical
sensations (such as “aching veins”). Moreover, they interpret bodily sensations as
abnormal, pathological, and symptomatic of disease (Barsky, 1992; Barsky et al.,
2000). In fact, like patients with SD, patients with hypochondriasis may engage
incatastrophic thinking about their physical sensations or fears of illness, just as
the woman in Case 8.7 did when she interpreted physical sensations as signs of
“crippling illness.” Furthermore, perhaps as a result of these attentional biases,
people with hypochondriasis have better memory for health-related words than for
non–health-related words (Brown et al., 1999).
As is the case with many anxiety disorders, people with hypochondriasis may
engage in behaviors that temporarily reduce their anxiety. For example, they may
repeatedly take their blood pressure, perform urine dipstick tests, feel body parts for
cancerous lumps, or call their doctor about new symptoms. Such behaviors main-
tain their faulty beliefs and can, through negative reinforcement, sustain the anxiety
in the long term.Because of their particular cognitive biases
regarding health and illness, for people with
hypochondriasis, simply reading about an illness
or hearing about someone who is sick can lead to
becoming preoccupied with similar symptoms or
diseases in their own bodies.David Young-Wolff/PhotoEdit Inc.