Hypochondriasis: Modern Perspectives on an Ancient Malady

Hypochondriasis has been a term used by physicians as well as the general population for centuries. Kenyon’s classic review of hypochondriasis (1) offered little except to emphasize that hypochondriasis is commonly comorbid with depression (secondary hypochondriasis) but is rare as a primary entity. He was correct in that the DSM-IV categorical diagnosis of hypochondriasis is rare within psychiatric settings; however, it is often found within general medical clinics.

Over the past 25 years our knowledge base of this phenomenon has greatly expanded because of careful empirical research. The major contributors to this renaissance of research are the chapter authors in this superb volume. The research has focused on hypochondriasis as both a noun (categorical classification) and as an adjective (a dimensional construct). Thus, terms such as the “medically unexplained complaint,” “illness worry,” “illness phobia,” “somatization,” “illness attitudes,” and “illness behaviors” all have similarities with hypochondriasis. Understanding these concepts further elucidates the nature of hypochondriasis. This outstanding book joins other volumes that address the complicated problem of hypochondriasis and its related problem of somatization (2–4). The editors, Drs. Starcevic and Lipsitt, are well-known for their work in somatization. Contributors to the volume represent an outstanding array of international scholars in this area.

The book begins with a chapter on the history of hypochondriasis by German E. Berrios, the great medical historian from Cambridge University. Dr. Starcevic contributes a chapter on the clinical phenomenology of hypochondriasis as well as a chapter on the role of reassurance in the treatment of hypochondriasis. The latter chapter, itself, is reason enough to purchase the book. Not all individuals respond to reassurance, and Dr. Starcevic reviews how reassurance should be provided. Dr. Lipsitt contributes two chapters, one on the psychodynamics of hypochondriasis and one on the importance of the physician-patient relationship. The chapter on psychometric assessment of hypochondriasis by Anne E.M. Speckens should be required reading for anyone who wishes to study this disorder. Chapters on hypochondriasis and anxiety disorders by Giovanni A. Fava and Lara Mangelli and the relation of hypochondriasis to personality disturbances by Michael Hollifield complement the clinical consideration section of the book. Russell Noyes, Jr., reviews the epidemiology of categorical hypochondriasis, illness worry, and illness phobia. Laurence J. Kirmayer and Karl J. Looper review the role of hypochondriasis in primary care settings by focusing on the different roles of disease conviction, illness worry, and vulnerability as factors within hypochondriasis.

A chapter on mechanisms such as somatosensory amplification by Arthur J. Barsky is included, as well as a chapter on the constructs of abnormal illness behavior by Issy Pilowsky. The treatment section of the book is outstanding. The cognitive behavior treatment of hypochondriasis is discussed by Hilary M.C. Warwick and Paul M. Salkovskis, who have been pioneers in this field. The book closes with a chapter on pharmacological strategies for hypochondriasis by Brian A. Fallon, who has made important contributions in this area.

Nice additions to the volume are copies of questionnaires for hypochondriasis, including the Structured Diagnostic Interview for Hypochondriasis, the Whiteley Index, the Illness Behavior Questionnaire, the Illness Attitude Scales, and the Somatosensory Amplification Scales. This allows the reader to review the actual instruments that were used in so many of the studies cited. The book is beautifully produced, with many helpful tables. The cover features a wonderful reproduction of a print titled “The Hypochondriac” by H. Daumier that encapsulates much of what the hypochondriacal patient experiences.

Difficult somatizing patients who cannot be managed in primary care are increasingly being referred to psychiatrists. This book will offer not only understanding of what fosters hypochondriacal complaints but also treatment options. It is for this reason that this book should be part of any clinician’s library. The editors have brought together an extraordinary collection of authors. Their careful editing makes this volume a great gift to our field.