Hypochondria, also known as illness anxiety disorder or health anxiety, refers to an excessive preoccupation or worry about having a serious illness. People with hypochondria tend to misinterpret minor bodily symptoms as signs of a serious underlying medical condition, even when there is no evidence to support their beliefs. On the other hand, psychosis refers to a mental state characterized by a detachment from reality. People experiencing psychosis may have false beliefs (delusions) or see, hear, feel, taste, or smell things that are not really there (hallucinations). So is hypochondria a form of psychosis?
Difference Between Hypochondria and Psychosis
While both hypochondria and psychosis involve some disconnect from reality, there are important differences between the two conditions:
- Delusions vs. excessive worries – In psychosis, the false beliefs (delusions) are held with strong conviction despite lack of evidence. In hypochondria, the individual has excessive worries about illness that may seem unreasonable, but some self-doubt is usually present.
- Hallucinations – Hallucinations are a key feature of psychosis but do not occur in hypochondria.
- Insight – Individuals with psychosis often lack insight that their beliefs are false. Those with hypochondria tend to recognize their concerns are excessive, although they still struggle to control their worry.
- Functioning – Psychosis typically has a greater negative impact on a person’s ability to function in daily life compared to hypochondria.
Based on these differences, most mental health experts agree that hypochondria is distinct from psychosis. The worries associated with hypochondria, while excessive, do not reflect the same complete loss of touch with reality seen in psychotic disorders.
Overlap with Anxiety Disorders
While hypochondria is not considered a psychotic disorder, research indicates there is significant overlap between hypochondria and anxiety disorders like generalized anxiety disorder, obsessive-compulsive disorder, and panic disorder:
- Generalized anxiety – Approximately 25-33% of people with hypochondria also have generalized anxiety disorder, which involves persistent, excessive worry about many areas of life.
- Obsessions – The intrusive fears about illness in hypochondria have similarities to the obsessions experienced in obsessive-compulsive disorder.
- Panic attacks – People with hypochondria often misinterpret panic attack symptoms like chest pain as evidence of physical illness.
The prevalence of anxiety disorders among people with hypochondria supports conceptualizing it as a type of anxiety disorder rather than a form of psychosis. The worries associated with hypochondria may reach delusional proportions in some cases, but anxiety appears to be the driving force behind this behavior.
Causes and Risk Factors
Research into the potential causes and risk factors for hypochondria provides further evidence that it is distinct from psychosis:
Family and twin studies suggest genetics may play a role in hypochondria:
- First-degree relatives of people with hypochondria are 2-3 times more likely to develop the disorder.
- Identical twins have higher rates of concordance for hypochondria compared to non-identical twins.
In contrast, psychotic disorders like schizophrenia are believed to have a more complex interaction between genetic and environmental factors.
Various environmental factors have been associated with hypochondria, including:
- Childhood experiences of illness
- Exposure to illness in family members or others
- Stressful life events
- Reinforcement of sick role behaviors
These types of experiences can predispose individuals to develop excessive health anxieties, while psychosis more commonly arises from factors like childhood trauma.
Differences are also seen when looking at the neurobiology of hypochondria compared to psychotic disorders:
|Overactivity in brain areas controlling perception of bodily sensations (ex. insula cortex)||Changes in dopamine function and other neurotransmitters|
|Hypervigilance for physical symptoms||Impaired reality testing|
This evidence further demonstrates the different mechanisms underlying hypochondria and psychotic disorders.
The most effective treatments for hypochondria and psychotic disorders also tend to differ:
- Cognitive behavioral therapy focusing on identifying and modifying inaccurate beliefs and maladaptive behaviors surrounding health concerns.
- Exposure therapy to reduce avoidance behaviors.
- Antidepressant or anti-anxiety medications in some cases.
- Antipsychotic medications to reduce delusions, hallucinations, and disordered thinking.
- Psychotherapy to help cope with symptoms.
- Cognitive remediation to improve cognitive deficits.
The differences in effective interventions provides further evidence that hypochondria and psychosis, while involving distortions in thinking, arise from distinct underlying causes.
Based on an analysis of the symptoms, development, neurobiology, and treatment of hypochondria compared to psychotic disorders like schizophrenia, the majority of mental health experts believe hypochondria falls under the category of anxiety disorders rather than being a form of psychosis. While hypochondria involves excessive worries and fears about illness that may reach delusional levels, true detachment from reality caused by biological changes in the brain is not present. The evidence instead supports conceptualizing hypochondria as an anxiety disorder characterized by somatic obsessions and hypervigilance to physical symptoms. Treatment focused on cognitive restructuring and exposure therapy is usually preferred over antipsychotic medications used for psychotic disorders. However, some overlap is seen between hypochondria and other mental illnesses like OCD and panic disorder. Overall, classifying hypochondria as a unique type of anxiety disorder appears to be the best categorization based on our current understanding.