Follow-up studies show that, despite improvement, the majority of general medical patients with hypochondriasis continue to meet criteria for the disorder a year or more later. Both Noyes et alkD and Barsky et al.'(72) found that two-thirds of their patients continued to qualify for the diagnosis up to 5 years later, with the remaining one-third having persisting symptoms. Hypochondriacal patients in both studies showed significant improvement during the follow-up interval, but continued to be substantially more hypochondriacal, more functionally impaired, and more psychiatrically disordered than the comparison patients.

The improvement may have resulted from a natural fluctuation in the course of hypochondriacal symptoms or non-specific factors associated with physician contact. Some patients, who were improved at follow-up, claimed they had responded to reassurance and, in a few cases, to symptomatic treatment. However, others claimed benefit from fortuitous changes in life circumstances or from self-treatment regimens. And, in a few instances, serious medical illness appeared to relieve hypochondriasis by legitimizing symptoms and sanctioning the sick role. (72)

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