Psychosomatics 43:433-434, October 2002
© 2002 The Academy of Psychosomatic Medicine
Hypochondriasis—Modern Perspectives on an Ancient Malady
Edited by Vladan Starcevic, M.S., and Don R. Lipsitt, M.D., New York, Oxford University Press, 2001, 416 pages, $65.00, ISBN 0-19-512676-9
Catherine M. Piontek, M.D.
Key Words: Books Reviewed
As the title of this book so aptly indicates, the illness of hypochondriasis has been recognized, in one form or another, throughout the ages. Likewise, it has perplexed, if not vexed, clinicians with respect to both its description and its treatment. In the introduction, the editors state that their goal was to "produce a text on this ancient disorder that will provide state-of-the-art knowledge on hypochondriasis for years to come." They have succeeded admirably, since this is likely to be considered the definitive text on this disorder.
The book is divided into three sections: "Clinical and Diagnostic Considerations," "Theoretical and Etiologic Aspects," and "Treatment Considerations." The editors have assembled a remarkable array of expert contributors. Because this is a comprehensive treatment of a wide range of issues regarding hypochondriasis, not all sections will be of interest to every reader. For this reason, a brief editorial summary at the beginning of each section might have been useful for those who might not choose to read every chapter. However, those who do read the entire book, whether in order or selectively, will be rewarded with a wealth of information and a variety of perspectives on this subject.
The highlight of the first section is Chapter 2, "Clinical Features and Diagnosis of Hypochondriasis." In this thorough yet lucid chapter, the nosologic difficulties inherent in the understanding of hypochondriasis, currently and historically, are addressed. There is also an excellent discussion of the differential diagnosis of hypochondriasis, with pertinent clinical examples to illustrate distinctions between disorders. The chapter concludes with a useful diagnostic decision tree. This chapter is complemented by Chapters 3 and 5. The former ("Assessment of Hypochondriasis") is an exhaustive review of available assessment instruments and would be of particular interest to those who wish to pursue research on this disorder. The latter ("Hypochondriasis and Personality Disturbance") attempts to delineate the complex relationship between hypochondriasis as a mental state disorder and hypochondriacal personality traits. Completing the discussion of diagnosis and assessment is a review of the as yet quite limited epidemiology of hypochondriasis that includes a thought-provoking model for the development of the disorder.
Section Two, "Theoretical and Etiologic Aspects," may as readily have been titled "Theoretical Aspects," since the etiology of hypochondriasis remains speculative. Nevertheless, the editors have included four thought-provoking chapters, each examining hypochondriasis from a unique perspective: psychodynamic, cognitive-behavioral, somatosensory, and sociocultural. In particular, the chapters discussing the psychodynamic and cognitive-behavioral viewpoints provide a solid foundation for understanding the therapeutic techniques discussed in the final section, "Treatment Considerations."
Regardless of theoretical approach, all those who diagnose and treat individuals with hypochondriasis would no doubt agree that those who suffer from this disorder are in considerable distress. Accordingly, the four chapters included in Section 3 are among the finest. The section begins with a superb discussion of the importance of the patient-physician relationship. The emphasis is on the unique ways in which hypochondriasis affects this relationship, including an incisive review of the potentially antitherapeutic (countertransferential) responses so readily provoked in the physician. While written from a psychodynamic perspective, these principles transcend theoretic allegiance and therefore inform the subsequent chapters on "Reassurance in the Treatment of Hypochondriasis," and "Cognitive-Behavioral Treatment of Hypochondriasis." Each of these chapters provides a concise and practical guide to the application of a technique demonstrated to be useful in the treatment of hypochondriasis. Last, while data on the use of pharmacotherapy are few, promising preliminary studies are included in the final chapter.
In summary, this book is a much-needed addition to the psychiatric literature. It should appeal to researcher and clinician alike and will be of interest to both psychiatrists and primary care physicians. I share the editors' hopeful enthusiasm that the dialogue resulting from this excellent volume will inspire others to further our understanding of hypochondriasis and its treatment.
FOOTNOTES
Dr. Piontek is assistant professor of psychiatry and human behavior at Thomas Jefferson University, Philadelphia
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