The worried patient: Clinical management of the patient with hypochondriasis

The author discusses the importance of accurately identifying patients with hypochondriasis, especially in the current cost-conscious healthcare environment. Such patients frequently overuse clinical and laboratory services, especially when not correctly diagnosed. The author discusses three different approaches to the diagnosis and management of the somatizing patient: naive realism; categorical labeling (i.e., the DSM-IV approach) which includes a summary of the DSM-IV diagnostic criteria, prevalence, onset, predisposing factors, and differential diagnosis; and dimensional understanding of illness worry. The second half of the article focuses on evaluation and treatment considerations and includes a discussion of both psychotherapeutic and psychopharmacologic treatment strategies for the patient with hypochondriasis. Clinical case examples are given throughout to illustrate the points being made. Copyright