Delusional disorder somatic subtype monosymptomatic hypochondriacal psychosis

Modern society, especially in developed countries, is preoccupied with health concerns. While much of this is positive, there is no doubt that many people worry excessively about health matters and a proportion of these show pathological self-concern. This can shade into hypochondriasis, in which there is a persistent conviction of illness in the absence of objective evidence of its existence, with misinterpretation of bodily sensations as disease and with inability to accept reassurances. In many cases the individual shows some degree of body image disturbance, sometimes of extreme degree.(5 55> Usually we think of hypochondriasis as referring to physical complaints, but nowadays it seems that an increasing number of affected people are also prepared to complain in psychological terms.

Hypochondriasis is common and may be a personality trait, but it can also be an accompaniment to many psychiatric illnesses, both non-delusional and delusional. It is the presenting feature of the somatic subtype of delusional disorder and in different patients we see many varieties of alteration of body image expressed in delusional terms. Certain themes of delusional content tend to predominate and this has meant an unfortunate proliferation of descriptive names scattered across a fragmented literature, leading to many difficulties in conceptualizing the subtype and in separating it from other psychiatric disorders with prominent hypochondriasis.

As with all subtypes of delusional disorder, the clinician must bear in mind the advice already given that, for the diagnosis of delusional disorder, it is the characteristic form of the illness that is of prime importance, not the content of the delusional beliefs. The hypochondriasis in delusional disorder may superficially resemble that of somatoform disorder, psychotic depression, or obsessive-compulsive disorder, but careful examination will reveal very different underlying illnesses.

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