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What Is Hypochondria?

Hypochondria, or hypochondriasis, is a condition of extreme, preoccupying worry about having a medical disease or developing an illness. Patients experience not only distressing somatic concerns (bodily complaints) that are unexplained medically but abnormal thoughts, feelings, and behavior. For example, patients typically have persistent beliefs about the seriousness of normal bodily sensations and spend excessive amounts of time pursuing a diagnosis of their physical concerns. Their distress is real.

Although hypochondria is a term widely understood, it is not an officially designated term. Instead, the name Illness Anxiety Disorder is used when the symptoms are primarily generalized worries about health and normal body sensations are interpreted as troublesome or threatening illness; patients are preoccupied with the idea that they might be or get sick. Somatic Symptom Disorder obtains when the worry manifests in bodily symptoms that accompany the belief that a physical illness is present, if only the right doctor could find it. Patients are preoccupied with having a specific disorder.

In both cases, psychological distress seeks expression in physical symptoms and sensations, and both types of patients are frequent users the medical care system, although a subset of those with illness anxiety may avoid doctors altogether so that their worst fears remain unconfirmed. Approximately 5 percent of all general medical outpatient visits are attributed to hypochondria.

Signs and Symptoms of Hypochondria

Almost everyone worries intermittently about illness. People with hypochondria live in dread that they have a serious disease. The symptoms they worry over can manifest anywhere in the body. A headache is proof of a brain tumor. Stomach pain is a sign of pancreatic cancer. A sore muscle indicates multiple sclerosis. Hypochondriacs search for proof online or by going to doctors, often “doctor-shopping” from provider to provider.

Somewhere between 5 to 10 percent of people are thought to have hypochondria, but doctors find their practices disproportionately burdened by such patients, who may repeatedly call with every complaint and concern. More females than males have the disorder, and it generally begins in middle adulthood. In children, the disorder manifests in recurrent abdominal pain or headache.

How do you know if you’re a hypochondriac?

Patients with Illness Anxiety Disorder or Somatic Symptom Disorder spend a great deal of time monitoring body sensations and visiting doctors. They spend considerable time seeking health information online, feeling distressed after online health research, and then making appointments for doctor visits—a phenomenon sometimes dubbed cyberchondria. They specialize in self-diagnosis and frequently demand medical tests, even when their doctor considers such tests unnecessary. As a result, they may have medical bills 10 times the national average.

Nevertheless, they are not reassured when their doctor reports that no medical problem can be found, and they may be consistently disappointed or even angry with their physician for failing to find an illness. They are likely to consider their doctor unskilled and uncaring. They may go from doctor to doctor (“doctor-hopping”) seeking diagnosis of the illness they fear is eating away at them. Many researchers who have studied the condition believe that people with hypochondria are looking more for care and concern than for cure.

What are the signs of being a hypochondriac?

Do you repeatedly check yourself for signs of illness? Do you fear that your sore throat is a sign of throat cancer or that your cough is the sure sign you have pneumonia? Do you think a lot about your health and talk more than most people about it? Do you spend a lot of time online searching for the causes of your physical sensations and symptoms? Are you sure your doctor is overlooking something important? Do you worry that death is just around the bend? Do you go from doctor to doctor seeking medical tests? Or do you avoid going to doctors altogether, because you don’t want you worst fears confirmed?

Body vigilance is a hallmark of health anxiety, repeatedly scanning for abnormalities. There is evidence that people with illness anxiety, like people with generalized anxiety disorder, are overly attuned to normal body sensations and overinterpret them as signs of catastrophic medical disorders. Cognitively patients are convinced that a real disorder is developing, undetected by medical experts. In fact, medical reassurance is often counterproductive, prompting a renewed search for correct diagnosis.

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"My Distress Is Real"

Hypochondria exposes the weakness of a medical system that divides disorders by whether they are expressed in the body or the psyche, when most conditions are collaborative ventures between mind and body, only to differing degrees. The consequence is that conditions presented to the division of the healthcare system that looks only for somatic causes must, by definition, be deemed nonexistent—not real—when diagnostic search yields no objective evidence of illness. Referral to a psychiatrist is often seen by patients as a rejection of the validity of their suffering.

Do hypochondriacs feel real symptoms?

There is no question that the physical distress hypochondriacs experience is real, as is their emotional anguish. They want their pain and suffering to be acknowledged as real by physicians and those around them. They appear to have heightened perception of and sensitivity to the inner workings of their own bodies (interoception), so that what others experience as a little twinge for them has more power and staying power. As with other forms of anxiety, the very real physical and psychological components of the condition intensify each other.

What role do normal body sensations play?

Normal somatic sensations are thought to play a significant role in hypochondria, or health anxiety. Anxiety propels systems of awareness to go on high alert for danger. In health (or illness) anxiety, the vigilance that is a characteristic of all anxiety is focused on the body. Under extreme surveillance, given a mind on the lookout for and attuned to negative outcomes, every little twinge, no matter how benign, is mentally magnified and becomes a sign of impending medical disaster. That soreness in your chest? Must be a heart problem. Abdominal cramps? Colon cancer, no doubt.

What is more, there is evidence that those prone to anxiety are especially sensitive to body sensations—they are especially aware of and pay more attention to bodily sensations than others. The phenomenon is called interoceptive sensitivity. Further, those normal body sensations are deemed intolerable, a conduit to catastrophe ahead. That is a misinterpretation, a cognitive distortion, but it nevertheless plays a role in creating the real terror that hypochondriacs experience.

Causes of Hypochondria
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Hypochondria is a baffling disorder. No one knows for sure what makes some people especially prone to express distress exclusively through physical complaints. Or why people persist in believing that they have a medical disorder after being repeatedly reassured by physicians that they are fine. But it is well-documented that many people with illness anxiety refuse referral to mental health specialists, resisting seeing their symptoms as having a psychological origin.

What triggers hypochondria?

If the tendency to focus on somatic complaints is a prerequisite for hypochondria, then stress is often a catalyst. In particular, one identified catalyst is personal tragedy, such as the death of a loved one. Or it could be the death of a friend who has succumbed to a common, or uncommon, disease. Even news reports about a disorder have been known to trigger hypochondria. Another trigger may be the personal experience of a symptom—a memory lapse, a shooting pain in the chest—well-identified with a disorder considered a  major threat to longevity. An online search for information may convert curiosity to conviction that something is wrong.

Is hypochondria genetic?

There is no gene for hypochondria, just as there is gene for general anxiety. There is, however, some evidence that hypochondria is more common in those with a parent who has the disorder. But familial transmission does not necessarily implicate genes. There are many ways families develop their own codes of behavior and pass them on to the next generation. Ways of expressing emotions in general and distress in particular are often among them. Parents who tell children such things as “they’ll be no anger [or sadness] in this house," are laying the groundwork for alternate pathways of expressing emotional distress. Parents who worry about their children’s health and take elaborate precautions to ward off every sniffle may, through their acts of overprotection, be directly demonstrating to their children how to worry about their own health.

Treatment of Hypochondria

Until recently, hypochondria—the conviction some people have that they are suffering a serious undiagnosed illness— was considered a disorder beyond the reach of treatment. But in the past decade or so, the components of the condition have come into clearer focus— belief in the presence of an undiagnosed disease, health-related anxiety, bodily preoccupation. The misperception of benign body sensations and the distorted thinking that magnifies and misattributes them have led researchers and clinicians to see the value of psychological treatments.

Nevertheless, physicians report that hypochondria remains a difficult disorder to treat, in part because it is difficult to orient patients to the right treatment. Patients with illness anxiety spend a great deal of time in the medical system. They overutilize medical services and remain anxious even when diagnostic procedures turn up no evidence of illness. They literally don’t take no for an answer; it does not give them reassurance. Many resist seeing their problem as inherently psychological, because they believe it means their suffering is not “real.”

Is there a treatment for hypochondria?

The challenge for any treatment of hypochondria is to educate patients about the nature of their disorder and what triggers it. Beyond that, the treatment of choice for hypochondria, or Illness (health) Anxiety Disorder, is psychotherapy, because it specifically targets the perceptual and cognitive mechanism thought to underlie the disorder—and in particular, cognitive behavioral therapy (CBT). There is a mountain of evidence documenting the effectiveness of CBT for generalized anxiety and other anxiety disorders. And as with other anxiety disorders, the antidepressant drug fluoxetine (Prozac) is sometimes al so used to treat health anxiety.

Can psychotherapy relieve hypochondria?

Research has shown that CBT successfully teaches hypochondriacs to identify what triggers their behavior and gives them coping skills to help them manage it. In one well-regarded, randomized, and controlled study, patients assigned to CBT received treatment in six 90-minute sessions at weekly intervals. At both 6-month and 12-month follow-up, CBT patients logged significant reductions in hypochondriacal thought frequency, health anxiety, and amplification of body sensations. They also were better able to participate in the normal activities of daily living.

The treatment didn’t necessarily eliminate somatic symptoms. But it does help patients reduce their fears and bolster the ways they cope with them. Still, there’s a rub: The treatment is effective only if people undergo it—and only 30 percent of patients offered any form of psychosocial treatment accepted it. The majority of those with hypochondria believe in a physical solution to their somatic symptoms.

CBT takes aim at several facets of hypochondria at once. At its heart, CBT targets distorted thoughts, such as the expectation of disastrous outcomes. Patients are taught, for example, to examine the evidence for and to challenge their automatic thoughts, rather than to accept them at face value. They learn to identify all-or-nothing thinking, jumping to conclusions (That pain in my arm means I’m having a heart attack), catastrophizing from tiny bits of evidence, ignoring or discounting positive evidence, and other thought distortions that incline the mind negatively. Patients also learn alternative ways of dealing with uncomfortable physical symptoms, such as diaphragmatic breathing and muscle relaxation.

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