The term hypochondria refers to a preoccupation with one’s own body and its functions, which arises spontaneously or through mechanisms that produce an unnecessary or unwarranted degree of anxiety.
The term does not indicate a specific illness and may refer to mental states occurring in different disorders. The most frequent cases will be examined here: panic, obsessive disorder, depression, and psychosis.
The preoccupation may, for example, develop as a reaction to panic attacks and may concern the type of symptoms that are central to the attacks. It is a concern about the possibility of having something that could suddenly lead to death during the next attack. People who continue to experience attacks may free themselves from this concern and limit themselves to “bringing it out” only during the attack, when the fright is so intense that they want reassurance that there is no imminent risk of death.
People suffering from panic may also develop a second type of hypochondria: the fear that, even though the panic attack itself is not a sign of a lethal illness, repeated attacks might place excessive strain on the heart or other organs—typically the heart—so that the stress of the attack could accidentally prove fatal. This assumption is unfounded. Moreover, people suffering from panic often confuse “symptoms” with objective parameters. For example, they typically describe palpitations—the sensation of an accelerated heartbeat or of a heartbeat that is beating forcefully—as “tachycardia,” whereas tachycardia actually means an increased heart rate.
The same thing happens when the sensation of fainting or profound weakness during an attack, causing the person to collapse or lie down, is described as “fainting,” “low blood pressure,” or “low blood sugar,” even though there has never actually been a loss of consciousness accompanied by a fall, or the blood pressure has never actually been measured and found to be low.
Reassurance is effective in hypochondria that is closely linked to panic, although the reassurance that occurs during attacks is essentially unavoidable when the attack is very severe. Some people control their fear of “dying” from a heart problem or having a heart attack during an attack by using anxiolytics or beta-blockers. In some cases, antihypertensive treatments have been started without an actual diagnosis of hypertension, on the assumption that they might help limit blood-pressure increases during an attack.
Hypochondria as an Obsession
Hypochondria can be a type of obsession. In this case, it originates as an unwarranted concern. The person is tormented by a thought about the possibility of having an illness and instinctively tries to find a rational answer, naturally hoping to find a reassuring one.
This mechanism normally works, but in obsessive disorder it goes around in circles because, at a rational level, absolute certainty never exists. Therefore, if a person has a specific concern about a problem, they will usually arrive at an answer that is not completely certain but is sufficient to make a decision or conclude that there is no reason to worry.
If, instead, the concern arises “incorrectly” as an obsession demanding a “certain” answer, no possible answer will ever be sufficient. On the contrary, every answer will introduce further details that open up new questions or new points of uncertainty requiring clarification.
Eventually, the person finds themselves besieged by a thousand questions that multiply their fear of having the illness. Instead of a thousand “probable” explanations leading to the conclusion that they are not ill, they have a thousand “possible” explanations leading to the conclusion that they are.
Worse still, the person often finds ways of arranging medical tests on their own, without going through a physician’s diagnostic hypotheses, or insists until the doctor prescribes investigations that are not actually based on the doctor’s diagnostic suspicion but are intended to reassure the patient.
This is a procedural error because the investigation does not follow the clinically dominant symptom—the hypochondriacal preoccupation—but rather the content of those preoccupations, as though that content itself were a clinically significant symptom or sign.
In other words, a person may undergo a brain CT scan because they are afraid of having a tumor, rather than because the doctor has found evidence suggesting one.
A hypochondriacal patient who has already undergone examinations in this way will often report distress caused by the obsession, but then demand to be reassured “as well” through further investigations.
In these cases, reassurance is harmful because it feeds the obsessive cycle and “desensitizes” the brain to reassurance—that is, it makes every uncertainty unacceptable and every doubt sufficient to justify anxiety and requests for clarification.
Rather than patiently allowing the obsession to pass, the patient may insist that the psychiatrist provide an answer concerning their fear of having one illness or another.
The illnesses “feared” in this form of hypochondria are usually nonspecific illnesses—that is, illnesses that can manifest through different and common symptoms, initially mild but potentially concealing serious disease in its early stages—and insidious illnesses, meaning illnesses that one might have without realizing it until it is already too late. Neurodegenerative diseases, tumors, and others are common examples.
Fear of Medications
Hypochondria can obviously also involve medications as a potential source of harm to the body.
A person with “panic-based” hypochondria will fear an acute and violent reaction that could cause death.
An obsessive person, on the other hand, may fear causing irreversible damage even with a single dose, or triggering uncontrollable processes that can never be reversed.
“Psychic” Hypochondria
A relatively little-known form of hypochondria is “psychic” hypochondria, meaning the fear of losing control over one’s mental functions.
A common example is the fear of having a poor memory, which produces an obsession with checking it, with the obvious result that the person concludes that it is functioning badly or imperfectly.
The “imperfectly” functioning memory becomes, with each successive check, increasingly defective, so that the patient eventually presents by saying, “I don’t remember anything,” “I have no memory,” or “I can’t memorize anything.”
When memory is tested under conditions that demand that it function “on command,” it will obviously appear defective.
This hypochondriacal pseudo-amnesia is widespread, and patients have limited critical capacity regarding it because, unlike hypochondria concerning other organs, here the brain is both the source and the object of the concern.
Another common form is the fear of becoming “mad,” for example the fear of deteriorating until one becomes “schizophrenic” or “demented,” according to the paradoxical reasoning typical of obsessions: if one is not in control, the situation could deteriorate without one’s being able to do anything about it.
The fear of having “psychosis,” for example, is a common form of obsessive hypochondria. Instead of being concerned—and seriously concerned—with treating the obsession itself, the patient becomes concerned with discussing the content of the obsession, namely the illness that frightens them and that they fear they may develop.
Explaining to the patient why there is no risk of becoming “mad” or demented is actually counterproductive, because it reinforces the patient’s conviction that there is a risk that must be explained and discussed in order to obtain reassurance.
Hypochondria in Depression
There is also the hypochondriacal theme of depression, which consists of a complaint, eventually becoming a conviction, that one’s body is functioning badly or is deteriorating.
Patients amplify their limitations and regard them as signs of aging or decline, and as the cause of their depression.
A depressed patient typically amplifies symptoms in a negative direction, saying, for example, that they “do not sleep” when in fact their sleep is fragmented and superficial, or that they “cannot have a bowel movement” when in fact they do, although with difficulty or irregularly.
In this respect, the attitude resembles that of obsessive hypochondria, with one important difference: the depressed person does not seek an explanation or reassurance. On the contrary, they seem to reject reassuring comments—not because reassurance fails to satisfy them, but because they believe that things are getting worse and cannot accept alternative points of view.
In depressive delusion, patients may go so far as to claim that parts of their body no longer exist, that those parts no longer function, or even that they are already dead.
The hypochondriacal depressed patient does not tend to correct the supposed dysfunction or undergo investigations. Instead, they passively adapt to the presumed disability—for example, eating liquid foods because they claim they cannot digest anything else, not walking because they claim they have no strength in their legs, having enemas administered because they claim they cannot empty their bowels on their own, and so on.
Some people, following this delusional belief, may plan suicide in order to anticipate what they imagine will be a painful death, or to spare others the distress of witnessing their decline.
Essentially, from complaint to delusion, the depressed person appears intent on confirming and justifying their symptoms and presumed illness, with little interest either in clarifying the condition or in treating it.
Hypochondriacal Delusion in Psychosis
A rarer, but nevertheless possible, form is hypochondriacal delusion as a component of other psychoses.
In these cases, the patient is convinced that they have an illness and, without undergoing many investigations—in fact, often tending not to undergo them at all—they seek treatment or surgery while asserting unmistakable symptoms.
Their concern is to resolve an illness that they are convinced, without justification, that they have, but their goal is understandable within the framework of the delusion.
The fact that doctors have never made the diagnosis, or deny that the diagnosis exists, does not persuade the patient, who will behave according to their conviction.
In some cases, however, these people operate on a “dual track,” which is not unusual in psychosis. On the one hand, they are convinced that they have “an incurable disease,” or simply an illness that makes them disabled; on the other hand, they continue to live in ways that are plainly inconsistent with this supposed disability or “condemnation.”
The idea of illness therefore loses any real-world meaning and becomes a completely autonomous and isolated conviction.