Geriatric hypochondriasis: situational factors

Health anxiety disorders in older adults: conceptualizing complex conditions in late life

Health anxiety disorders (e.g., hypochondriasis) are prevalent but understudied in older adults. Existing research suggests that severe health anxiety has a late age of onset, perhaps because of comorbidity with physical health conditions that are more likely to occur with aging. Despite being under diagnosed in later life due to a lack of age-appropriate diagnostic criteria, significant positive associations with age suggest that health anxiety disorders are more prevalent in older than younger adults. Preliminary research also highlights the complexity of these disorders in older adults and the potential importance of medical morbidity as a risk factor. This review explores the complexities of health anxiety disorders in later life with a focus on understanding defining features, prevalence rates, correlates, assessment, diagnosis, and treatment. We offer a theoretical model of the development of severe health anxiety among older adults to encourage further research on this important and under-studied topic.

The need for qualitative research on mental health of elder Hispanics

This article contends that purely quantitative measures of Hispanic aged mental health have been insufficiently sensitive to cultural factors. It describes the uses and limitations of qualitative methods, especially in-depth interviews and life histories, and suggests that researchers should include the use of psychometric tests in these interviews, in order to improve the interpretations of the data. In this article the Adlerian perspective is developed along with several relevant dimensions for evaluating cases. Finally, seven cases illustrating the diversity of Hispanic elders are presented.

The prevalence of hypochondriasis in medical outpatients

Forty-one DSM-III-R hypochondriacs were obtained by screening consecutive visitors to a general medical clinic and compared with 76 patients randomly chosen from the same setting. They completed a research battery consisting of a structured diagnostic interview (DIS) and self-report questionnaires to measure hypochondriacal symptoms and functional impairment. The criterion standard for diagnosing hypochondriasis was a structured interview of demonstrated reliability and validity. The six-month prevalence of DSM-III-R hypochondriasis was estimated to be between 4.2% and 6.3% of consecutive attenders who met the inclusion criterion of having visited the same physician before. This rate was somewhat lower than that found for generalized anxiety disorder and comparable to that of alcohol abuse. The hypochondriacal patients did not differ significantly from the comparison random sample in sociodemographic risk factors except that they were significantly more likely to be Black. Hypochondriacal symptomatology was similar in males and females; and in those over 65 and those under 65. Over a three-week interval, hypochondriacal symptoms remained stable, and hypochondriacal patients had significantly higher levels of long-term disability than did the comparison patients.

Hypochondriacal psychoses: a long-term follow-up

From a large series of delusional subjects 23 patients demonstrated hypochondriacal delusions as the main delusion during the long-term course of approximately 30 years. An extensive study of these cases reveals that the majority had abnormal premorbid personality, especially somatization, paranoid and/or avoidant traits. Previous and/or precipitating somatic illnesses, if present, were not very serious. The hypochondriacal preoccupation diminished in the long term, but the overall prognosis varied, as the patients did not belong to a uniform diagnostic category. Implications for the clinician in diagnosing and treating are discussed, and the importance of early detection of correct diagnostic category is stressed.