-  Fear of having a serious disease

-  Episodic somatoform disorder lasting months to years with quiescent periods

-  One of most difficult & complex psychiatric disorder

-  Female = Male


Associated S/S

-  Medically unexplained complaint

-  Frequent medical visits (ED, GP..) w extensive Ix

-  Common presents w GAD, major depression, somatisation disorder, panic disorder, substance abuse



-  Preoccupying fear of having a serious disease

-  Persistance despite approprite medical evaluation & reassurance

-  Not of delusional intensity (Delusional Disorder) & not restricted to body appearance (DDx Body Dysmorphic Disorder)

-  Clinically significant distress or impairment

-  Duration > 6 months

-  Not explained better by mood, anxiety or somatoform disorder



-  MSE

-  Mood: anxious, worried, depressed, futile

-  Affect: restricted, shallow, fearful, anxious, fluctuant, limited depth

-  Catastrophising tendency

-  Health Anxiety Inventory (HIA)



-  Educate & reassure

-  Emphasis coping with symptoms

-  Beware countertransference

-  Single primary care physician

-  CBT

-  Fluoxatine (Prozac, SSRI)

-  Not specifically indicated for (off label use)