Boundaries and Overlap between Hypochondriasis and Other Disorders: Differential Diagnosis and Patterns of Co-occurrence
Affiliation: Nepean Hospital, Department of Psychiatry, PO Box 63, Penrith NSW 2751, Australia.
Hypochondriasis has common features with a number of other mental disorders, its boundaries are not always
easy to draw and it occurs frequently with several psychiatric conditions. This review examines the relationships between
hypochondriasis and other psychopathology in two ways. First, it discusses the differential diagnosis of hypochondriasis
by identifying both the similarities and differences between hypochondriasis and organic diseases, psychotic disorders,
depression, panic disorder, obsessive-compulsive disorder, generalized anxiety disorder, specific phobia of illness and
somatization disorder. The greatest overlap seems to exist between hypochondriasis and panic disorder, but
hypochondriasis can still be distinguished from it, as well as from other disorders. The diagnosis of hypochondriasis is not
warranted in the presence of psychotic features, but it can be made alongside diagnoses of most other disorders, provided
that hypochondriacal features are not better explained by them. In the second part, the article reviews studies of the cooccurrence
of hypochondriasis and other disorders. The literature reveals some inconsistencies and discrepant findings,
which is largely due to different settings in which studies have been conducted and various other methodological issues.
Still, it appears that hypochondriasis is more likely to co-occur with depression, panic disorder and somatization disorder
than with other psychiatric conditions, suggesting a closer relationship with them. The implications of these findings for
the conceptualization of hypochondriasis, its diagnostic status and classification are briefly considered.
Keywords: Comorbidity, depression, diagnosis, hypochondriasis, obsessive-compulsive disorder, panic disorder, somatization
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