The British Journal of Psychiatry (1965) 111: 607-615. doi: 10.1192/bjp.111.476.607
© 1965 The Royal College of Psychiatrists
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Hypochondriasis and Depression in Out-patients at a General Hospital

NORMAN KREITMAN M.D., D.P.M.1, PETER SAINSBURY M.D., D.P.M.1, K. PEARCE M.D.1, and W. R. COSTAIN M.B., B.S., D.P.H., D.P.M.1

1 Medical Research Council Clinical Psychiatry Research Unit, Graylingwell Hospital, Chichester, Sussex

1. Some clinical features of patients with depressive disorders referred to a special hypochondriasis clinic after prolonged general medical investigation are briefly described. Twenty-one such patients were compared with a matched control group of patients with the same diagnosis but with no somatic symptoms, and the differences between the groups analysed in an attempt to ascertain the factors responsible for the "somatizing" process.

2. Four hypotheses were tested. It was postulated that the hypochondriacal patients would show, (i) a higher degree of social isolation, (ii) a lower socio-economic status, and families of origin in which much importance was attached to physical illness, (iii) a greater likelihood of psychosomatic disorders, (iv) poorer interpersonal relationships, especially in marriage. The first two hypotheses were not substantiated, though the mechanisms implied appeared operative in some individuals. The other hypotheses were confirmed.

3. The remaining (statistically significant) differences between the "somatizing" and "non-somatizing" patients were that the former showed (a) a greater similarity between their pattern of symptoms and those of their mothers': this was not true for fathers; (b) poorer marriage relationships and sexual adjustment; (c) a greater likelihood for the current illness to be precipitated by stressful external events, often relating to death or illness, and to fluctuate markedly with environmental change; (d) a much greater chronicity of the present illness; (e) less disruption of social, family and occupational activities; (f) a relative lack of depressive affect, despite an equal intensity of depressive mood, and less evidence of subjective or objective anxiety.

4. Some observations on the phenomenology of hypochondriasis are presented.

5. Some comments are offered on the prophylaxis, management and treatment of hypochondriacal depression.

Submitted on November 9, 1964




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