Hypochondriasis: Symptom and Treatment

Most of the patients develop a particular attention towards their bodily sensations, with an exaggerated sensitivity for minor and normal changes. The patient at first associates a number of somatic symptoms with the subjective experience of a panic attack, these symptoms thus acting as conditional stimuli. Later on, the occurrence of these symptoms, whatever their origin, then bring on by conditioning the subjective anxiety symptoms of the attack. This mechanism, termed ‘‘interoceptive conditioning’’, makes some subjects avoid activities that provoke physical sensations, which can be interpreted, as anxiety-like (e.g. physical efforts, drinking coffee, etc.). A similar phenomenon could also explain these patients’ intolerance to the side effects of antidepressants, the frequent worsening of their anxiety symptoms during somatic affections. Many patients (around 20%) develop a true hypochondriac elaboration, during which they are seriously afraid of being ill or even persuaded they are ill. The hypochondriac worries mainly concern the fear of cardiac illness or of the cerebral ictus.

Interoceptive conditioning could account for the anxiety ‘‘crescendo’’ which is often described by these patients during the premonitory phase of certain attacks. In fact, the sudden, brutal and unpredictable nature of the first panic attacks often disappears after a time progression of the disease, with subsequent attacks occurring when the patient is confronted with phobogenic situations or at the apex of a period of rapidly growing apprehension. These ‘‘provoked’’ patients often describe a ‘‘vicious circle’’: their apprehension brings on somatic symptoms which in turn increase their anxiety which gradually grows in intensity until the panic attack is triggered off in all its severity. Often patients are perfectly aware of this mechanism and some even describe this phenomenon as if they were capable of triggering it themselves.

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