Book Book

Health Anxiety: Clinical and Research Perspectives on Hypochondriasis and Related Conditions

BMJ 2002; 324 doi: (Published 23 March 2002) Cite this as: BMJ 2002;324:742
  1. Richard Mayou, professor of psychiatry
  1. University of Oxford

    Eds Gordon J G Asmundson, Steven Taylor, Brian J Cox

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    Wiley, £27.50, pp 415 ISBN 0 471 49104 7

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    Fear of serious illness is responsible for a high proportion of consultations with doctors. In most cases there is no confirmation of a serious cause and most patients can be easily reassured. Others continue to worry, to experience symptoms, and to limit their lives. Such persistent health anxiety is often difficult to treat and can be made worse by inconsistencies and ambiguities in medical care and by the lack of an acceptable explanation. While “unexplained” symptoms are often seen as an inappropriate use of health care, they are in fact genuine, often disabling, medical problems. They deserve to be taken seriously rather than abandoned to alternative medicine. Better and more informed care would result in better outcomes and would cut the heavy cost of treatment that is often ineffective and may reinforce disability.

    There is now encouraging evidence about how to minimise and treat health anxiety; unfortunately it mostly relates to highly specialised treatments by a small number of clinical psychologists and psychiatrists working largely in specialised settings. There has been rather little progress in improving treatment in primary care and outpatient clinics.

    The continuing lack of understanding within medicine is reflected in confused lay beliefs and an increasing number of controversial alleged syndromes. These conceptual difficulties are evident in the subtitle of the book, which refers to the historically old and controversial term hypochondriasis. Our Western separation of body and mind has made understanding of aetiology and treatment remarkably difficult. It results in medical specialties continuing to look for occult physical causes for symptoms with arbitrary descriptive names such as irritable bowel, chronic headache, and fibromyalgia, whereas psychiatrists use terms such as hypochondriasis, medically unexplained symptoms, and somatisation. However, patients find psychological causation unacceptable. A major reason why they are unhappy about their treatment is that their doctors are similarly bewildered.

    There is a need to stand back and look at the whole problem of symptoms without obvious pathology—what might best be referred to as functional symptomsand functional syndromes. While some will turn out to arise from major physical pathology, the majority are likely to result from how individuals perceive and interpret minor pathology or abnormal physiological processes—symptoms cannot be seen as “body” or “mind” but as an interaction of both. An understanding of this interactive aetiology has clear implications for treatment.

    Health anxiety is an important clinical topic, which is beginning to attract greater medical attention. It deserves wide discussion within medicine as a basis for greatly improved medical care and also for a wider public understanding of the ever increasing list of controversial syndromes. Unfortunately, this book, intended for a wide readership, is considerably dominated by difficult and, for most potential readers, arcane arguments about psychiatric classification and specialist experience. However, it does bring together a number of general chapters on aetiology and treatment which, even if not radically new, are not as well known as they deserve to be.

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