The syndrome of hypochondriasis: a cross-national study in primary care

Psychol Med. 1997 Sep;27(5):1001-10. doi: 10.1017/s0033291797005345.


Background: The nature and correlates of hypochondriasis are still poorly understood, especially in settings other than those in North America and Western Europe.

Methods: A total of 25,916 consecutive patients making ambulatory visits to primary care clinics at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Based on the screen-score performance, a stratified sample of 5447 of respondents was evaluated at the second-stage (response rate: 62%). Evaluation consisted of physician-rated physical and psychological health status and self-ratings of overall health, physical disability and GHQ-28. Interviewers conducted assessment of psychiatric status, using the Composite International Diagnostic Interview (CIDI) and occupational disability.

Results: Across the sites, the occurrence of ICD-10 hypochondriasis was 0.8% (95% Confidence Interval, 0.5-1.0%) and over 1.5% at only two sites. A less restrictively-defined form of the disorder had a pooled frequency of 2.2% (95% Confidence Interval, 1.8-2.6%) across the sites. Patients with this abridged hypochondriasis were more likely than those without to have co-morbid major depression and generalized anxiety disorder. They had a poorer perception of their health, were more physically disabled, were more impaired in the performance of occupational role, and were above-average utilizers of health service. Patients with ICD-10 hypochondriasis were no more impaired than those with abridged hypochondriasis.

Conclusion: Even though the ICD-10-defined hypochondriasis is rare, a form consisting of the triad of disease conviction, associated distress and medical help-seeking is present in primary-care settings in different cultures. This syndrome is associated with considerable psychiatric ill-health and functional disability.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anxiety Disorders / complications
  • Attitude to Health
  • Chi-Square Distribution
  • Confidence Intervals
  • Cross-Cultural Comparison
  • Cross-Sectional Studies
  • Disabled Persons / statistics & numerical data
  • Female
  • Global Health*
  • Health Status
  • Health Surveys
  • Humans
  • Hypochondriasis / diagnosis
  • Hypochondriasis / epidemiology*
  • Logistic Models
  • Male
  • Middle Aged
  • Odds Ratio
  • Patient Acceptance of Health Care
  • Prevalence
  • Primary Health Care / statistics & numerical data*
  • Reproducibility of Results
  • Sick Role
  • Terminology as Topic*