What Is Hypochondria and How Can It Be Treated?

“People with so-called hypochondria, or hypochondriacal symptoms, tend to misinterpret harmless physical sensations as signs of a serious or imminent illness, often self-diagnosing themselves with severe diseases,” explains Dr. Cavallini.

This leads to persistent distress marked by anxiety and fear that negatively affects family life, work, and social relationships. Patients with hypochondriacal symptoms remain deeply concerned about their health regardless of objective evidence and repeated medical reassurance through diagnostic tests, clinical analyses, or specialist evaluations.

“In fact,” she adds, “such patients often seek multiple medical consultations. They are either dissatisfied if no organic disease is found or become alarmed by any perceived ambiguity in the doctor’s findings. In other cases, fear of receiving a serious diagnosis can lead to complete avoidance of medical consultations altogether.”

The causes of hypochondriacal symptoms are varied and may include:

• Biological factors, such as genetic predisposition or family history of psychiatric conditions;
• Cultural or educational factors;
• Life experiences, including trauma or significant emotional events;
• Personality traits, such as anxious, over-controlling, or emotionally dysregulated tendencies.

Notably, traumatic life events (bereavement, serious illness in a loved one, abandonment, personal trauma, or job loss) can contribute to the development of hypochondriacal symptoms.

“Traumatic experiences,” explains the psychiatrist, “may lead predisposed individuals to express their psychological distress through physical symptoms, a process known as somatization. In some people, experiencing physical pain may be more tolerable than dealing with psychological suffering. Individuals with dysfunctional personality traits, such as excessive anxiety, hypercontrol, or a formerly termed ‘neurotic’ profile are often more likely to develop these symptoms.”

Hypochondriacal symptoms are frequently associated with generalized anxiety disorder (GAD), mood disorders, or post-traumatic stress disorder (PTSD).

“People with a biological and familial predisposition to anxiety or mood disorders (including major depression) are more vulnerable to developing these symptoms. Growing up in an environment where physical health is a constant concern may foster a tendency to misinterpret bodily sensations even normal ones,” she adds.

Clinical treatment of hypochondriacal symptoms typically involves multiple approaches and interdisciplinary collaboration. In hospital settings in Italy, the main available treatments include:

• Psychotherapy

“The recommended treatment according to Italian clinical guidelines is Cognitive Behavioral Therapy (CBT), which has proven efficacy in managing hypochondriacal symptoms,” notes Dr. Cavallini.

The goal of CBT is to help the patient develop functional behavioral strategies to counter exaggerated or inappropriate alarm responses to bodily sensations, reducing or eliminating the associated emotional and physical distress (somatization). In some cases, and with patient consent, family members or partners may be invited to participate in joint sessions. This can help the patient address dysfunctional relational patterns and hypochondriacal behaviors within the family context.

• Pharmacological Therapies

“Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed, but every diagnosis is unique, and the psychiatrist will determine the most appropriate treatment,” explains Dr. Cavallini.

• Complementary Psychological Support Therapies

“CBT can be complemented with Mindfulness-based therapy, which is increasingly validated in scientific literature.”

Other supportive techniques such as conscious breathing or yoga may also be recommended. These are never a substitute for clinical therapy or medication but can be offered as complementary treatments.

Challenges in Treatment

Treating hypochondriacal symptoms poses several challenges, as Dr. Cavallini shares from her experience at IRCCS Ospedale San Raffaele Turro:

“Often, once a specialist rules out an organic cause, the patient is referred to a psychiatrist or psychotherapist. However, it’s important to note that a hypochondriacal patient is not necessarily imagining everything.”

In fact, classical psychopathology distinguishes hypochondria cum materia—a situation where an actual medical condition is present, but the patient grossly exaggerates its meaning or threat.

“Even if the condition is treatable,” she says, “the patient may believe it’s incurable. The psychiatrist and psychologist work to contextualize and reframe the patient’s concerns appropriately.”

However, many patients are resistant to starting psychological care:

1. They are convinced they suffer from a physical illness, and reject the idea that their symptoms may have a psychological origin.
2. They are highly sensitive to perceived side effects of medication, often experiencing paradoxical reactions even to very low doses.

“The most effective approach is to explain that treatment whether pharmacological or psychological aims to restore a satisfactory quality of life,” concludes the psychiatrist.

Only a psychiatrist can diagnose hypochondriacal symptoms. Warning signs may include behavioral changes and life routine modifications aimed at avoiding illness, such as avoidant behavior toward perceived sources of contamination or risk.

How does a person with hypochondriacal symptoms feel?

• Physically: fatigued, drained, and weak;
• Emotionally: overwhelmed, out of control, confused, moody, sad, irritable, apathetic;
• They fear illness and obsess over the possibility of getting sick;
• Their perception of reality can evolve into an anxiety disorder or obsessive-compulsive disorder (OCD) marked by hypervigilance;
• They may worry excessively about the health of loved ones and exert control over them;
• In severe cases, patients experience a constant state of alertness, obsessive thoughts, and disabling fears (e.g., control mania, phobias) along with somatic symptoms such as muscle tension or abdominal cramps.

Common Hypochondriacal Behaviors

• Frequent self-checking and self-diagnosis;
• Compulsive internet research on symptoms and diseases;
• Avoidance of doctors, tests, and hospitals in some cases;
• Or, on the contrary, frequent and unnecessary medical consultations;
• Rejection of medical opinions or therapies;
• Suspicion or distrust of healthcare professionals—sometimes exhibiting paranoid or conspiratorial thinking;
• Poor or maladaptive compliance with treatment plans.

As noted earlier, the term hypochondria has been replaced by more precise terminology in contemporary psychiatric manuals used in medical schools and clinical practice. According to the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), what was once labeled as hypochondria now falls under two clinical categories:

1. Illness Anxiety Disorder (IAD)
2. Somatic Symptom Disorder, which encompasses former classifications like somatization disorder, undifferentiated somatoform disorder, and pain disorder.