Clinical picture Essential features

The essential feature is a morbid preoccupation with, and sense of vulnerability concerning, one's body. Individuals are preoccupied with fears of having or developing serious disease, and find their minds filled with alarming thoughts and images of disabling or disfiguring illness, even death. Thoughts of this kind are intrusive and accompanied by a sense of conviction. They are overvalued, meaning they are strongly held despite lack of evidence, but make some sense in terms of the person's experience/19

These individuals find their attention narrowly focused on bodily functions (e.g. heartbeat, breathing), minor abnormalities (e.g. lump, cough), or vague diffuse sensations (e.g. fatigue, poor concentration). Patients attribute such symptoms or signs to suspected disease and are often more concerned about their meaning than the distress they cause. Their concerns may involve several body systems or they may be preoccupied with a specific organ or disease (e.g. bone cancer, heart disease). Persons with hypochondriasis are self-absorbed and others find them preoccupied with health concerns.

Thorough medical evaluation does not identify a medical condition to account for symptoms, yet the patient's preoccupation persists. Thus, repeated examinations, diagnostic tests, and reassurance by physicians have little lasting effect, although concern may temporarily lessen. When told there is little the matter, hypochondriacal patients often react angrily and press for further evaluation, and when treated their symptoms often worsen. (12) As a consequence, they grow distrustful of physicians, dissatisfied with care, and consult many practitioners (doctor-shopping).

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