Persistent, excessive concern with one’s state of healthaccompanied by various bodily complaints even though no organic pathology can be found.The reaction may be focused on either physical or emotional health, but more often the former. Most hypochondriacs make numerous complaints about different organs, and many of them insist that they are incurably diseased. They are acutely aware of sensations which most people disregard, and exaggerate the effects of normal fatigue and the symptoms of ordinary illnesses such as colds and headaches. They are also overconcemed about the everyday functions of the body, particularly digestion and elimination. Physicians must be extremely careful not to suggest new disorders simply by the process of examining them or giving them medical tests. See IATROGENIC ILLNESS.The tendency to hypochondria increases with age and is aggravated by situations that produce physical or emotional stress. When faced with difficulties, the hypochondriac unconsciously resorts to the defense and escape mechanism of “flight into illness,” which often brings him “secondary gains” in the form of attention, sympathy, and control over others. In some cases these “gains” may lead to chronic invalidism.Although this type of reaction is neurotic in nature and was at one time classified as a neurosis in its own right, today it is regarded as a symptom rather than a disorder. The reason is that hypochondria is associated with a variety of syndromes, both neurotic and psychotic. It resembles a phobic reaction in that it involves fear of disease; and it has an obsessive-compulsive character since it involves persistent preoccupation with one idea and may lead to compulsive pill-taking, dieting, handwashing, or surgical operations. In many cases it seems to be a displacement of anxiety onto the body—that is, instead of being concerned about his emotional difficulties, the hypochondriac becomes concerned about his health. It is a common symptom in asthenic (neurasthenic) reactions, neurotic depressive reaction, involutional psychotic reaction, and the mental disorders of old age. As a symptom of these disorders, it tends to disappear or become less intense when they are successfully treated by psychological procedures.Illustrative Case: HYPOCHONDRIASIS Luther R., male, thirty-three, divorced. Complains of abdominal pains, low back pains, tightness in head. Fears he has “bad heart.” For past three years has refrained from doing any heavy physical work because he feared a heart attack. Unable to carry on with work (shipping clerk) because he is afraid of overexerting himself.Family History: Patient’s father died at thirty-five when the patient was six. He died suddenly, from an illness of five days’ duration (pneumonia). He was described as being sociable, intelligent, and well-liked. Had been practicing dentistry for five years at time of death. Mother fifty-seven, living and well, pictured as quiet, methodical, overly cautious. After father’s death she went to work as an office clerk in a department store. She never remarried, concentrated efforts on making good home for Luther and caring for his every need. Very devoted mother, took every precaution to safeguard son’s health. Sudden death of father seemed to have made her extremely healthconscious. Any slight symptom of a cold or fever meant a day or more in bed for Luther with mother at his side. Continuous inquiries on how he felt, was he warm enough, was he too cold, was he losing weight. As Luther grew older mother’s interest in his health did not diminish. At twelve, he was severely ill with influenza. Mother maintained constant vigil until he was out of danger. Lived with mother until married at twenty-four.Personal History: Considered self-centered child. Until five had to play by himself because no other children of his age in neighborhood. Not permitted to participate in sports because mother feared he might get injured. Had few friends, became more and more seclusive as he grew up. Always seemed more at ease with adults than with persons of his own age. In adolescence became extremely self-conscious and quite sensitive. Spent most of time at home reading and listening to radio. Always greatly attached to mother.(1) Medical history: In childhood measles, chicken pox, diphtheria—good recovery in each instance. At twelve, attack of in fluenza.At sixteen fell while running and fractured right arm. At twenty-one mild case of food poisoning. No significant illnesses since that time.4 (2) Educational history: Graduated from high school at eighteen. Repeated part of sixth grade because absent a great deal. During this semester was ill with “flu.” Mother did not permit him to go back until six weeks after he was out of bed. Average student in school, got along well with classmates and teachers. However, made very few friends in school.(3) Vocational history: First job at nineteen repairing books at public library; remained there four years; quit to take a civil service job with city as clerk, still employed. So preoccupied with state of his health that he asked for sick leave.(4) Social and marriage history: Never at ease with girls, had only a few “dates” in teen years. At twenty-one met girl he married, after six months’ acquaintance. Marriage lasted fifteen months, ended in divorce. Principal difficulty, according to patient, was sexual incompatibility. No children. Patient stated he had been given no sex education. Masturbated during adolescence and was once apprehended by mother. She told him that “it would lead to a diseased body and a diseased mind.” Engaged in no heterosexual relations before marriage.Summary: Hypochondriacal symptoms apparently developed as a result of mother’s overemphasis and overconcern about his physical health. Seems probable that complaints are in part a bid for attention based on inferiority feelings. (Thorpe, Katz and Lewis, 1961)