Childhood environment

Several childhood factors appear important in the development of adult somatization and hypochondriasis. (55) Studies have consistently demonstrated adverse early environments among patients with unexplained somatic symptoms and, as Barsky et al. (56> recently showed, this pattern extends to hypochondriasis. Their hypochondriacal patients reported more traumatic sexual contacts, physical violence, and major parental upheavals before the age of 17. Likewise, in a non-clinical sample, greater somatization and hypochondriasis were observed among abused subjects.

Illness in childhood may contribute to hypochondriasis. For example, Mabe et al.(57> found that hypochondriacal symptoms correlated with reports of serious illness early in life, and Craig et al.(58) obtained reports of serious illness in childhood more often from adult somatizers than non-somatizers. Also, Barsky et al.(53 obtained reports of sickness in childhood and absence from school for health reasons more often from hypochondriacal than from non-hypochondriacal patients. Such early experience with illness may render a child vulnerable to the later development of hypochondriasis.

Parental attitudes toward illness may also contribute to adult hypochondriasis. Few studies have looked specifically at hypochondriasis, but some somatizing patients recall more parental attention and overprotection, as well as more special caring and rewards for ill health during childhood. (59)

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