Clinical manifestations of hypochondriasis and related conditions

Hypochondriasis encompasses affective, cognitive, and behavioral features. Fear of illness is the affective manifestation of hypochondriasis and relates to the idea of being seriously ill. The object of this fear may remain constant or change over time. It may reach the intensity of a phobia. Hypochondriasis is characterized by alterations in both thought content and process. Disease conviction resistant to medical reassurance is the hallmark of hypochondriasis; it is this that differentiates hypochondriasis from less serious forms of health anxiety. Hypochondriasis encompasses several behavioral manifestations, which may be conceptualized as safety-seeking behaviors aimed at reducing fears of having a serious disease. Early observers described patients they labeled as having disease phobia or nosophobia. The term “thanatophobia” was introduced in 1928 by Ryle to refer to a sense of dying (angor animi). Preoccupation with the idea of having a physical disorder or dysfunction may reach delusional intensity. The term “hypochondriasis” has disappeared from the DSM-5 somatic symptom and related disorders, which replace the former groups of somatoform disorders, psychological factors affecting medical conditions, and factitious disorders.