Hypochondria

Hypochondria (from the Greek hypo- meaning below and chondron meaning cartilage), according to ancient views, originated from diseases of organs located in the regio hypochondriaca - the area beneath the cartilages of the ribs, such as the stomach, liver, etc. Hypochondria is a pathological state characterized by a one-sided fixation of attention on various, even insignificant, unpleasant sensations in the body; in connection with exaggerated, sometimes delusional interpretation of these sensations, hypochondriacal states are accompanied by distressing fears of the patient regarding their health and life. Older authors - Esquirol, Griesinger, and others - described hypochondria as a distinct form of psychosis. Magnan showed that the tendency toward hypochondriacal thoughts and fears often takes on the character of obsession, characteristic of psychic degeneration, thereby emphasizing the importance of the constitutional factor in the origin of hypochondria. Later researchers associated hypochondria sometimes with neurasthenia, when it concerned the perception of distressing, painful sensations; sometimes with melancholy, when there was a depressed mood and fear - so-called hypochondriacal melancholy; finally, hypochondria received new interpretation in cases where exaggerated and delusional interpretations of sensations experienced by the patient predominated - so-called hypochondriacal paranoia. The spread of Kraepelin's ideas led to the complete rejection of the concept of hypochondria as a distinct form of mental illness; in modern psychiatric language, the term hypochondria has retained only a limited meaning, characterizing the content of delusional ideas and certain obsessive states. The mildest form of hypochondria is represented by so-called mistrustfulness, characteristic of certain asthenic states: the patient is extremely sensitive to their slightest sensations, attributing to them extremely exaggerated significance, ascribes non-existent diseases to themselves; an innocent skin rash is taken for syphilis; a minor intestinal disorder causes strict and prolonged dieting; the patient constantly counts their pulse, examines their tongue in the mirror, etc.; an example is the mistrustfulness that often develops in medical students beginning the study of clinical medicine and diagnosing in themselves signs of all the diseases they study. In more severe forms, the patient's attention is completely absorbed in observing their sensations; the patient is able to think and talk only about their imaginary diseases; carefully analyzes every detail of their functions, writes long notes to the doctor for fear that they might miss some detail that seems to the patient extremely important. The patient loses the ability to work regularly, goes from doctor to doctor, undergoes numerous, useless blood tests, secretions, etc., finds no peace or confidence in the possibility of recovery anywhere. Such states are observed in psychasthenia, in constitutional nervousness, in phenomena of nervous exhaustion (post-infectious asthenia). In morbid states already associated with weakening of mental activity (feeble-mindedness), hypochondriacal ideas can take on an absurd form, when the patient claims that they are decomposing alive, that they have no stomach, nothing to breathe with, etc. Hypochondriacal states taking the form of true delusions can be observed in various psychoses. They are often found in schizophrenia, reflecting the various somatic sensations characteristic of this disease. They are also observed in depressive states of manic-depressive psychosis, in progressive paralysis, in cerebral arteriosclerosis, in presenile psychoses. Experience has shown that hypochondriacal states are usually based on sensations, although exaggerated and falsely interpreted by the patient, but actually caused by improper functioning of one organ or another. Cases have been observed where hypochondriacal complaints found confirmation at the autopsy table. Therefore, the physician's attitude toward the hypochondriacal complaints expressed by the patient should be attentive and cautious; simple denial of hypochondriacal ideas does not give the desired result, since the sensations experienced by the patient remain real for them. On the other hand, every careless word of the physician, every medical term is perceived and fixed by the patient with heightened sensitivity and can easily give rise to further development of hypochondriacal ideas. Cautious psychotherapy - rational, and in some cases also suggestive - often gives favorable results, if, of course, there is no delirium in the proper sense and no feeble-mindedness. Local treatment, directed at the organ causing the patient's anxiety (sexual apparatus, heart, etc.), is useful only on the condition that it is possible to avoid fixation of the patient's attention on the painful sensations.