Hypochondriasis and severe health anxiety

(from the chapter) The essential feature of hypochondriasis (HC), according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000), is a preoccupation with the (inaccurate) belief that one has, or is in danger of developing, a serious illness. Whereas most people evince occasional passing health concerns, the disease conviction in HC is intense, frequent, and persistent. Moreover, it endures despite appropriate (even excessive) medical evaluations and reassurance of good health. Furthermore, the health preoccupation results in functional disability. Traditionally considered a somatoform disorder because of the focus on bodily symptoms, recent conceptualizations of HC have emphasized the role of health anxiety (e.g., Taylor & Asmundson, 2004). This approach has transformed what was once considered a treatment-refractory problem into one with a broader conceptualization and a wider range of treatment options and therapy response. We begin this chapter by introducing the reader to the cognitive-behavioral approach to HC (and other forms of health anxiety). We next describe the treatment based on this approach and evidence supporting the use of this treatment. An important obstacle to successful treatment of health anxiety is that many patients have poor insight into their condition and believe strongly that they require medical, as opposed to psychological, interventions. Using a case example, we illustrate the use of motivational interviewing principles (Miller & Rollnick, 2002) to help health anxious patients embrace and engage in effective psychological treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved) (chapter)