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PubMed1991

The work of hypochondria. A contribution to the study of the specificity of hypochondria, in particular in relation to hysterical conversion and organic disease.

The authors present a metapsychological conception of hypochondria. Following Freud, they contrast the complaints of the hypochondriac with the belle indifférence of the hysteric, and they then inquire into the heuristic value of hypochondria as an actual neurosis; this leads them to a consideration of psychosomatic illness and the importance of the object cathexis in hypochondriacal anxiety. In the development of Freud's theory of the drives, the explanatory concept of the damming up of ego libido proves insufficient and has to be coupled with the notion of primary erotogenic masochism: from this point of view, hypochondria can be seen as a form of binding which thus distinguishes it from other somatic outcomes. On the basis of three case histories, the authors endeavour to show hypochondriacal anxiety not only as a pathological process but also as a type of necessary minimum cathexis of the body; this leads to the idea of hypochondria as psychical work.

Adult↗

PubMed1956

[Body in hypochondria and in depersonalization; psychopathological structure of hypochondria].

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Depersonalization↗

PubMed1984

Hypochondrias, somatic delusion and body scheme in psychoanalytic practice.

One of the objectives of this paper is to differentiate between various types of hypochondria. Phenomenic, dynamic and clinical aspects are specially emphasized and a case of somatic delusion is presented. The author attempts to explain the dynamic mechanism on which each type of the different hypochondrias is based in order to facilitate the technical work. The different fantasies about the body scheme underlying each type of hypochondria are described. Hypochondria related to a primitive conception of Body Image, where ego disorganization-fragmentation or ego liquefaction can be expressed as spilt of vital liquids or blood. The conceptualization of hypochondria based on autistic mechanisms can help to explain certain clinical presentations of encapsulated hypochondrias which have been silent for a long time. We therefore consider it is useful to widen the spectrum of hypochondria: every type of hypochondria has a different fantasy about the Body Image.

Adult↗

PubMed1995

[Psychoanalytic theories of hypochondria].

Although hypochondria is one of the earliest psychic conditions to be described, its nosological status is still uncertain and it has been largely neglected in theories of psychosomatics and neurosis. The authors undertake a detailed review of the literature and examine the psychodynamic concepts and theoretical approaches to the hypochondria phenomenon, from Freud, Ferenczi and Levy, through Klein and the ego psychologists, object-relation theories and the psychology of the self, all the way up to the present day. The authors trace the differences between hypochondria and other body-related disturbances and indicate the consequences for diagnosis and therapy.

Freudian Theory↗

PubMed1987

[Dyskinesia of the abdominal musculature in hypochondria].

A 73-year-old woman with a history of chronic hypochondria, depression and abdominal symptoms, such as colics, flatulence and changing fecal consistency, was diagnosed as having an "irritable colon" syndrome and "hypochondria". Over a period of ten years she had been taking regularly various psychoactive drugs, especially diazepins and amitryptiline. Three years ago she began to have wave-like movements of the abdominal wall, interpreted as intestinal hyperperistalsis with chronic subileus. Radiological and endoscopic examinations were normal, but wave-like contractions of the abdominal musculature were demonstrated on electromyography. The most likely cause is the chronic abuse of psychoactive drugs over many years. In case of abdominal symptoms attention should be paid to the abdominal wall, not only the gastrointestinal tract.

Abdominal Muscles↗

PubMed2006

[Hypochondria circumscripta (to the problem of coenesthesiopathic paranoia)].

Hypochondria circumscripta manifests in patients with paranoial personality and signs of somatopsychic accentuation. A sample included 11 patients (6 men, 5 women, mean age 54 years) who referred to dermatologists or had been admitted to gastroenterological and psychiatric units. Pathokinesis of hypochondria circumscripta comprises three stages: idiopathic algias, overmastering sensations and possession of pain. In the latter stage, delusional behavior targeted to the elimination of a part of the body, which is perceived as the source of pain, develops. Psychopathological disorders are realized in limits of coenesthesiopathic spectrum without tendency to interpretive delusion manifestation as well as transformation to systematic delusion of persecution during the disease course. As a consequence of above mentioned peculiarities of psychopathological structure, the stage of possession of pain may be designated as coenesthesiopathic paranoia. Because of the small sample, the findings can be considered as preliminary ones.

Aged↗

PubMed1997

Hypochondria versus the relation to the object.

In the context of ideas of Freud, Klein, Bion, Rosenfeld and others on hypochondria, psychic development and object relations, the author presents the case history of a female patient who anxiously takes flight from the analyst's interpretations into somatic pains. The experience of separateness and of the 'facts of life' is so unbearable to her that she prefers a dialogue with her body to one with the analyst. Cathexis is withdrawn from the frustrating external object and transferred to an organ of the body, which, however, also proves inadequate and is hated, because, as the author shows, the processes of projection and introjection are inescapable. Clinical material is given to demonstrate how the patient uses hypochondriacal states to ward off a psychotic breakdown. Progress ensues when the analyst realizes that the patient's hypochondria is a form of communication in body language. In a particularly telling sequence, the patient physically averts her eyes from the unbearable reality of a rose in the consulting room because it stands for the separateness of the analyst. But interpretation gradually ushers in processes of symbolization, whereby the concrete physical injury felt by the patient to have been inflicted on her by the sight of the rose is turned into a symbolic 'allergic' reaction and the allergy becomes metaphorical.

Female↗

PubMed2000

Hypochondria: a tentative approach.

The author begins his investigation of hypochondria by defining the condition and distinguishing between hypochondriacal symptoms and hypochondriacal crises, the latter being stated to arise when the defensive function of the former fails. After an enumeration of the main psychogenetic elements observed in the psychoanalytic psychotherapy of a sample population of eight patients, he concentrates on the psychodynamic and psychostructural aspects and demonstrates by means of clinical examples how conflicts of separation and dependence give rise to oral-sadistic, anal-sadistic and progressive-perverse defensive structures. Although regressive and progressive psychodynamic processes established between these structures may temporarily stabilise the psychic system to some extent, splits cause them to loom large in a hypochondriacal world full of disintegrative anxiety that is accompanied by an aggressive excitation pervaded with threatening confusion and sexual perversion, where the patient flees into quasi autistic withdrawal and tormenting self-observation. Catastrophic states resulting from earlier traumas are here fused with more mature psychic elements owing to earlier traumas. The author shows how instability in these structures, together with the failure of important ego and superego functions, may lead to a malignant regression and the consequent pathogenic reintrojection of projections. When the psyche is threatened by a dynamic of this kind, hypochondriacal symptoms may ensue as a last-ditch attempt by the patient to defend against psychic decompensation.

Conflict, Psychological↗

PubMed1997

Hypochondria in women as a function of birth order.

The hypothesis that firstborn women would score higher than later-born women on a measure of hypochondria was supported. This result is explained in terms of parental treatment, specifically, the modeling of greater concern about the health of their girls by inexperienced parents.

Adolescent↗

PubMed1994

[The comorbidity of hyperthymia and hypochondria].

The authors examined 88 patients with hyperthymic-hypochondriac disturbances. Their typological differentiation is presented. Clinical and prognostic heterogeneity of euphoria and dysphoric-maniacal hypochondria is conditioned by relationships between different comorbid elements within complicated affective-hypochondriac syndrome.

Adult↗

PubMed1958