0
November 20, 1987, Vol 258, No. 19 >
ARTICLE | November 20, 1987

Hypochondriasis and Somatization FREE

Robert Kellner, MD
[+] Author Affiliations

Reprint requests to Department of Psychiatry, 2400 Tucker NE, Albuquerque, NM 87131 (Dr Kellner).


JAMA. 1987;258(19):2718-2722. doi:10.1001/jama.1987.03400190100036
Text Size: A A A
Published online
Article
References

Between 60% and 80% of healthy individuals experience somatic symptoms in any one week. About 10% to 20% of a random sample of people worry intermittently about illness. A substantial proportion of patients present physicians with somatic complaints for which no organic cause can be found. Patients who are hypochondriacal do not understand the benign nature of functional somatic symptoms and interpret these as evidence of disease. Hypochondriacal concerns range from common short-lived worries to persistent and distressing fears or convictions of having a disease. Hypochondriasis can be secondary to other psychiatric disorders (eg, melancholia or panic disorder), and hypochondriacal attitudes remit when the primary disorder is successfully treated. Patients with primary hypochondriasis are also anxious or depressed, but the fear of disease, or the false belief of having a disease, persists and is the most important feature of their psychopathology. There are substantial differences among hypochondriacal patients in their personalities and psychopathologies. Psychotherapy as well as psychotropic drugs are effective in the treatment of functional somatic symptoms. There are no adequate controlled studies on the value of psychotherapy in hypochondriasis; the recommended guidelines are based on uncontrolled studies of hypochondriasis and on controlled studies of the psychotherapy in similar disorders. The prognosis of functional somatic symptoms as well as that of hypochondriasis is good in a substantial proportion of patients.

(JAMA 1987;258:2718-2722)

REFERENCES

1 +
Ladee GA: Hypochondriacal Syndromes . New York, North-Holland Publishing Co, 1966;.
2 +
Veith I:  On hysterical and hypochondriacal afflictions . Bull Hist Med 1956;;30:233-240.
3 +
Pilowsky I:  Dimensions of hypochondriasis . Br J Psychiatry 1967;;113:89-93.
4 +
Stenbäck A, Jalava V:  Hypochondria and depression . Acta Psychiatr Scand 1962;; 37( (suppl) ):162-240.
5 +
Kellner R: Somatization and Hypochondriasis . Westport, Conn, Praeger-Greenwood Press Inc, 1986;.
6 +
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3, Revised (DSM-III-R). Washington, DC, American Psychiatric Association, 1987;.
7 +
Kenyon FE:  Hypochondriasis: A survey of some historical, clinical and social aspects . Br J Med 1965;;38:117-133.
8 +
Barsky JA, Klerman L: Overview:  Hypochondriasis, bodily complaints, and somatic styles . Am J Psychiatry 1983;;140:273-281.
9 +
Ford CV: The Somatizing Disorders . New York, Elsevier Science Publishing Co Inc, 1983;.
10 +
Lichtstein PR:  Caring for the patient with multiple somatic complaints . South Med J 1986;;79:310-314.
11 +
Küchenhoff J:  Das hypochondrische Syndrom . Nervenarzt 1985;;56:225-236.
12 +
Lipowski ZJ:  Somatization: A borderland between medicine and psychiatry . Can Med Assoc J 1986;;135:609-614.
13 +
Kirmayer L:  Somatization and the social construction of illness experience , in McHugh S, Vallis TM (eds): Illness Behavior . New York, Plenum Press, 1986;, pp 111-133.
14 +
Kellner R, Sheffield BR:  The one-week prevalence of symptoms in neurotic patients and normals . Am J Psychiatry 1973;;130:102-105.
15 +
Reidenberg MM, Lowenthal DT:  Adverse nondrug reactions . N Engl J Med 1968;;279:678-679.
16 +
Agras S, Sylvester D, Oliveau D:  The epidemiology of common fears and phobia . Compr Psychiatry 1969;;10:151-156.
17 +
Kessel WIN:  Psychiatric morbidity in a London general practice . Br J Prev Soc Med 1960;; 14:16-22.
18 +
Christian P, Hase B, Kromer W:  Statistische Untersuchungen über die sogennannten 'Nervösen Herz- und Kreislaufstörungen.' Arch Kreislaufforsch 1954;;20:287-305.
19 +
Kellner R:  Neurosis in general practice . Br J Clin Pract 1965;;19:681-682.
20 +
Katon W:  Depression: Somatic symptoms and medical disorders in primary care . Compr Psychiatry 1982;;23:274-287.
21 +
Kellner R, Abbott P, Pathak D, et al:  Hypochondriacal beliefs and attitudes in family practice and psychiatric patients . Int J Psychiatry Med 1983;;13:127-139.
22 +
Bianchi GN:  The origins of disease phobia . Aust NZ J Psychiatry 1971;;5:241-257.
23 +
Kellner R, Abbott PJ, Winslow WW, et al:  Fears, beliefs and attitudes in hypochondriasis . J Nerv Ment Dis 1987;;175:20-25.
24 +
Mayou R:  The nature of bodily symptoms . Br J Psychiatry 1976;;129:55-60.
25 +
Kenyon FE:  Hypochondriasis: A clinical study . Br JPsychiatry 1964;:110;478-488.
26 +
Kellner R:  The prognosis of treated hypochondriasis: A clinical study . Acta Psychiatr Scand 1983;;67:69-79.
27 +
Barsky AJ, Wyshak G, Klerman GL:  Hypochondriasis: An evaluation of the DSM-III criteria in medical outpatients . Arch Gen Psychiatry 1986;;43:493-500.
28 +
Kellner R, Slocumb JC, Wiggins RG, et al:  The relationship of anxiety and depression to hypochondriacal fears and beliefs . Psychiatr Med , in press.
29 +
Kellner R:  Functional somatic symptoms and hypochondriasis . Arch Gen Psychiatry 1985;;42:821-833.
30 +
Cloninger CR, Sigvardsson S, von Knorring A-L, et al:  An adoption study of somatoform disorders: II. Identification of two discrete somatoform disorders . Arch Gen Psychiatry 1984;;41:863-871.
31 +
Sigvardsson S, Bohman M, von Knorring AL, et al:  Genetic causes of somatization in men . Epidemiology 1986;;3:153-185.
32 +
Shields J: Monozygotic Twins Brought up Apart and Brought up Together . New York, Oxford University Press Inc, 1962;.
33 +
Nielsen NJ:  Individual and environment . Acta Psychiatr Scand Suppl 1965;;40:1-292.
34 +
Apley T:  Common denominators in the recurrent pains of childhood . Proc R Soc Med 1958;;51:1023-1027.
35 +
Mechanic D:  The influence of mothers on their children's health attitudes and behavior . Pediatrics 1964;;33:444-453.
36 +
Parker G, Lipscombe P:  The relevance of early parental experiences to adult dependency, hypochondriasis and utilization of primary physicians . Br J Med Psychol 1980;;53:355-363.
37 +
Burns BH, Nichols MA:  Factors related to the localization of symptoms to the chest in depression . Br J Psychiatry 1972;;121:405-409.
38 +
Kreitman N, Sainsbury P, Pearce K, et al:  Hypochondriasis and depression in outpatients at a general hospital . Br J Psychiatry 1965;;111:607-615.
39 +
Zborovski M:  Cultural components in responses to pain . J Soc Issues 1952;;8:16-30.
40 +
Lerner J, Noy P:  Somatic complaints in psychiatric disorders: Social and cultural factors . Int J Soc Psychiatry 1968;;14:145-150.
41 +
Kirmayer LJ:  Culture, affect and somatization: Part 1 . Transcultural Psychiatric Res Rev 1984;;21:159-188.
42 +
Kirmayer LJ:  Culture, affect and somatization: Part 2 . Transcultural Psychiatric Res Rev 1984;;21:237-262.
43 +
Sternbach RA, Tursky B:  Ethnic differences among housewives in psychophysical and skin potential responses to electric shock . Psychophysiology 1965;;1:241-246.
44 +
Tursky B, Sternbach RA:  Further physiological correlates of ethnic differences in responses to shock . Psychophysiology 1967;;4:67-74.
45 +
Petrie A: Individuality in Pain and Suffering . Chicago, University of Chicago Press, 1967;.
46 +
Merskey HA, Evans PR:  Variations in pain complaint threshold in psychiatric and neurological patients with pain . Pain 1975;;1:59-72.
47 +
Tyrer P, Lee I, Alexander J:  Awareness of cardiac function in anxious, phobic and hypochondriacal patients . Psychol Med 1980;;10:171-174.
48 +
Sullivan MA, Cohen S, Snape WJ Jr:  Colonic myoelectrical activity in irritable-bowel syndrome . N Engl J Med 1978;;298:878-883.
49 +
Clouse RE, Lustman PJ:  Psychiatric illness and contraction abnormalities of the esophagus . N Engl J Med 1983;;309:1337-1342.
50 +
Chaudhary NA, Truelove SC:  Human colonic motility: A comparative study of normal subjects, patients with ulcerative colitis, and patients with the irritable colon syndrome . Gastroenterology 1961;;40:1-36.
51 +
Wangel AG, Deller DJ:  Intestinal motility in man: III. Mechanisms of constipation and diarrhea with particular reference to the irritable colon syndrome . Gastroenterology 1965;;48:69-84.
52 +
Malmo RB, Shagass C:  Physiologic study of symptom mechanisms in psychiatric patients under stress . Psychosom Med 1949;;11:25-29.
53 +
Sainsbury P, Gibson JG:  Symptoms of anxiety and tension and the accompanying physiological changes in the muscular system . J Neurol Neurosurg Psychiatry 1954;;17:216-224.
54 +
Lewis BI:  Hyperventilation syndrome: A clinical and physiological evaluation . Calif Med 1959;;3:121-129.
55 +
Tyrer P: The Role of Bodily Feelings in Anxiety . New York, Oxford University Press Inc, 1976;.
56 +
Lacey JI:  The evaluation of autonomic responses: Toward a general solution . Ann NY Acad Sci 1956;;67:123-164.
57 +
Grings WW, Dawson ME: Emotions and Bodily Responses: A Psychophysiological Approach . Orlando, Fla, Academic Press Inc, 1978;.
58 +
Barsky AJ:  Patients who amplify bodily symptoms . Ann Intern Med 1979;;91:63-70.
59 +
Mechanic D:  Social psychologic factors affecting the presentation of bodily complaints . N Engl J Med 1972;;286:1132-1139.
60 +
Braütigam VW:  Analyse der hypochondrischen Selbstbeobachtung . Nervenarzt 1956;;27:409-418.
61 +
Feldmann H:  Symptomwahrnehmung und Überbewertung bei der Hypochondrie . Arch Psychiatrie Nervenkrankheiten 1977;;224:235-245.
62 +
Kellner R, Pathak D, Romanik R, et al:  Life events and hypochondriacal concerns . Psychiatr Med 1983;;1:133-141.
63 +
Adám G: Interception and Behaviour . Budapest, Akademiai Kiado, 1967;.
64 +
Ruesch J: Chronic Disease and Psychological Invalidism: A Psychosomatic Study . Los Angeles, University of California Press, 1951;.
65 +
Cope RL:  The psychogenic factor in chest pain . Tex Med 1969;;65:78-81.
66 +
Chappell MN, Stevenson TI:  Group psychological training in some organic conditions . Mental Hygiene 1936;;20:588-597.
67 +
Stenbäck A:  Hypochondria in duodenal ulcer . Adv Psychosom Med 1960;;1:307-312.
68 +
Kellner R, Samet J, Pathak D:  Fears, beliefs and attitudes in patients with chronic airflow obstruction . JPsychosom Res , in press.
69 +
Kenyon FE:  Hypochondriacal states . Br J Psychiatry 1976;;129:1-14.
70 +
Pisztora F:  The determining part of personality pattern in the pathogenesis of cenestepathic hypochondriasis . Pszichologiai Tanulmányok 1967;;10:575-579.
71 +
Katon W, Kleinman A, Rosen G:  Depression and somatization: I. A review . Am J Med 1982;;72:127-135.
72 +
Kellner R, Fava GA, Lisansky J, et al:  Hypochondriacal fears and beliefs in DSM-III melancholia: Changes with amitriptyline . J Affective Disord 1986;;10:21-26.
73 +
Noyes R Jr, Reich J, Clancy J, et al:  Reduction of hypochondriasis with treatment of panic disorder . Br J Psychiatry 1986;;149:631-635.
74 +
Astrup C, Noreik K, Elkes J: Functional Psychoses: Diagnostic and Prognosis Models . Springfield, Ill, Charles C Thomas Publisher, 1966;, pp 45-53.
75 +
Munroe A, Chmara J:  Monosymptomatic hypochondriacal psychosis: A diagnosis checklist based on 50 cases of the disorder . Can J Psychiatry 1982;;77:374-376.
76 +
Pilowsky I:  Primary and secondary hypochondriasis . Acta Psychiatr Scand 1970;;46:273-285.
77 +
Baker B, Merskey H:  Classification and associations of hypochondriasis in patients from a psychiatric hospital . Can J Psychiatry 1983;;28:629-634.
78 +
Cohen ME, White PD:  Life situations, emotions and neurocirculatory asthenia . Psychosom Med 1951;;13:335-357.
79 +
Cope RL:  The psychogenic factor in chest pain . Tex Med 1969;;65:78-81.
80 +
Sarno JE:  Psychosomatic backache . J Fam Pract 1977;;5:353-357.
81 +
Sapira JD:  Reassurance therapy . Ann Intern Med 1972;;77:603-604.
82 +
Draspa LJ:  Psychological factors in muscular pain . Br J Med Psychol 1959;;32:106-116.
83 +
Svedlund J, Ottosson J, Sjödin I, et al:  Controlled study of psychotherapy in irritable bowel syndrome . Lancet 1983;;1:589-592.
84 +
Nemiah JC:  Hypochondriasis (hypochondriacal neurosis) , in Freedman AM, Kaplan HI, Sadock BJ (eds): Comprehensive Textbook of Psychiatry . Baltimore, Williams & Wilkins, 1980;, vol 2, pp 1538-1543.
85 +
Laughlin HP: The Neuroses . Washington, DC, Butterworths, 1967;.
86 +
Wahl CW:  Psychodynamics of the hypochondriacal patient , in Wahl CW (ed): New Dimension in Psychosomatic Medicine . Boston, Little Brown & Co Inc, 1964;, pp 201-213.
87 +
Lowy FH:  Management of the persistent somatizer . Int J Psychiatry Med 1975;;6:227-239.
88 +
Galatzer-Levy RM:  The opening phase of psychotherapy of hypochondriacal states . Int J Psychoanal Psychother 1982;-1983;9:389-413.
89 +
Busse EW:  The treatment of the chronic complainer . Med Rec Annals 1956;;50:196-200.
90 +
Brown HN, Vaillant GE:  Hypochondriasis . Arch Intern Med 1981;;141:723-726.
91 +
Cooper CD, Dickinson JB, Adams HB, et al:  Interviewer's role-playing and responses to sensory deprivation: A clinical demonstration . Percept Mot Skills 1975;;40:291-303.
92 +
Kellner R, Sheffield BF:  The relief of distress following attendance at a clinic . Br J Psychiatry 1971;;118:195-198.
93 +
Kellner R:  Psychotherapeutic strategies in hypochondriasis: A clinical study . Am J Psychotherapy 1982;;36:146-157.
94 +
Katzenelbogen S:  Hypochondriacal complaints with special reference to personality and environment . Am J Psychiatry 1942;;98:815-822.
95 +
Pilowsky I:  The response to treatment in hypochondriacal disorders . Aust NZ J Psychiatry 1968;;2:88-94.
96 +
Bursztajn H, Barsky AJ:  Facilitating patient acceptance of a psychiatric referral . Arch Intern Med 1985;;145:73-75.
97 +
Mendel E: Hypochondrie beim Weiblichen Geschlecht. Dtsh Med Wochenschr, 1889, pp 205-209.
98 +
Kellner R:  Hypochondriasis , in Karasu T (ed): Treatment of Mental Disorders . Washington, DC, American Psychiatric Association, in press.
99 +
Kessel N:  Reassurance . Lancet 1979;;1:1128-1133.
100 +
Ley P, Spellman MS: Communicating With the Patient . Worchester, Mass, Staples Press, 1967;.
101 +
Floru L:  Verhaltenstherapeutische Versuche durch systematische Desensibilisierung . Psychiatr Clin 1973;;6:300-318.
102 +
Sulk SKD:  Verhaltenstherapie der Herzphobie: Ein klinischer Erfahrungsbericht über ein Training kognitiver Angstbewältigung . Psychiat Prax 1986;;13:10-16.
103 +
O'Donnell JM:  Implosive therapy with hypnosis in the treatment of cancer phobia: A case report . Psychother Theory Res Prac 1978;;15:8-12.
104 +
Ford CV, Long KD:  Group psychotherapy of somatizing patients . Psychother Psychosom 1977;;28:294-304.
105 +
Wooley SC, Blackwell B, Winget C:  A learning theory model of chronic illness behavior: Theory, treatment and research . Psychosom Med 1978;;40:379-401.
106 +
Blackwell B, Gutman M:  The management of chronic illness behavior , in McHugh S, Vallis TM (eds): Illness Behavior . New York, Plenum Press, 1986;, pp 401-408.
107 +
Turnbull JM:  The hypochondriacal patient , in Bowden CL, Burstein AG (eds): Psychosocial Basis of Medical Practice . Baltimore, Williams & Wilkins, 1974;, pp 73-80.
108 +
Thomas KB:  The consultation and the therapeutic illusion . Br Med J 1978;;1:1327-1328.
109 +
Uhlenhuth EH, Glass RM, Haberman SJ, et al:  Relative sensitivity of clinical measures in trials of antianxiety agents , in Burdock EF, Sudilorsky A, Gershon S (eds): Quantitative Techniques for the Evaluation of Behavior of Psychiatric Patients . New York, Marcel Dekker Inc, 1982;, pp 393-409.
110 +
Covi L, Lipman RS, Derogatis LR, et al:  Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 1974;;131:191-198.
111 +
Kahn RJ, McNair DM, Lipman RS, et al:  Imipramine and chlordiazepoxide in depressive and anxiety disorders: II. Efficacy in anxious outpatients . Arch Gen Psychiatry 1986;;43:79-85.
112 +
Sheehan DV, Ballenger J, Jacobsen G:  Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms . Arch Gen Psychiatry 1980;;37:51-59.
113 +
Robinson DS, Nies A, Ravaris CL, et al:  The monoamine oxidase inhibitor, phenelzine, in the treatment of depressive-anxiety states . Arch Gen Psychiatry 1973;;29:407-413.
114 +
Goldenberg DL, Felson DT, Dinerman H:  A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia . Arthritis Rheum 1986;;29:1371-1377.
115 +
Okasha A, Ghaleb HA, Sadek A:  A double-blind trial for the clinical management of psychogenic headache . Br J Psychiatry 1973;;122:181-183.
116 +
Lewis A:  Melancholia: A clinical survey of depressive states . J Ment Sci 1934;;80:277-378.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Ladee GA: Hypochondriacal Syndromes . New York, North-Holland Publishing Co, 1966;.
2 +
Veith I:  On hysterical and hypochondriacal afflictions . Bull Hist Med 1956;;30:233-240.
3 +
Pilowsky I:  Dimensions of hypochondriasis . Br J Psychiatry 1967;;113:89-93.
4 +
Stenbäck A, Jalava V:  Hypochondria and depression . Acta Psychiatr Scand 1962;; 37( (suppl) ):162-240.
5 +
Kellner R: Somatization and Hypochondriasis . Westport, Conn, Praeger-Greenwood Press Inc, 1986;.
6 +
American Psychiatric Association Committee on Nomenclature and Statistics: Diagnostic and Statistical Manual of Mental Disorders , ed 3, Revised (DSM-III-R). Washington, DC, American Psychiatric Association, 1987;.
7 +
Kenyon FE:  Hypochondriasis: A survey of some historical, clinical and social aspects . Br J Med 1965;;38:117-133.
8 +
Barsky JA, Klerman L: Overview:  Hypochondriasis, bodily complaints, and somatic styles . Am J Psychiatry 1983;;140:273-281.
9 +
Ford CV: The Somatizing Disorders . New York, Elsevier Science Publishing Co Inc, 1983;.
10 +
Lichtstein PR:  Caring for the patient with multiple somatic complaints . South Med J 1986;;79:310-314.
11 +
Küchenhoff J:  Das hypochondrische Syndrom . Nervenarzt 1985;;56:225-236.
12 +
Lipowski ZJ:  Somatization: A borderland between medicine and psychiatry . Can Med Assoc J 1986;;135:609-614.
13 +
Kirmayer L:  Somatization and the social construction of illness experience , in McHugh S, Vallis TM (eds): Illness Behavior . New York, Plenum Press, 1986;, pp 111-133.
14 +
Kellner R, Sheffield BR:  The one-week prevalence of symptoms in neurotic patients and normals . Am J Psychiatry 1973;;130:102-105.
15 +
Reidenberg MM, Lowenthal DT:  Adverse nondrug reactions . N Engl J Med 1968;;279:678-679.
16 +
Agras S, Sylvester D, Oliveau D:  The epidemiology of common fears and phobia . Compr Psychiatry 1969;;10:151-156.
17 +
Kessel WIN:  Psychiatric morbidity in a London general practice . Br J Prev Soc Med 1960;; 14:16-22.
18 +
Christian P, Hase B, Kromer W:  Statistische Untersuchungen über die sogennannten 'Nervösen Herz- und Kreislaufstörungen.' Arch Kreislaufforsch 1954;;20:287-305.
19 +
Kellner R:  Neurosis in general practice . Br J Clin Pract 1965;;19:681-682.
20 +
Katon W:  Depression: Somatic symptoms and medical disorders in primary care . Compr Psychiatry 1982;;23:274-287.
21 +
Kellner R, Abbott P, Pathak D, et al:  Hypochondriacal beliefs and attitudes in family practice and psychiatric patients . Int J Psychiatry Med 1983;;13:127-139.
22 +
Bianchi GN:  The origins of disease phobia . Aust NZ J Psychiatry 1971;;5:241-257.
23 +
Kellner R, Abbott PJ, Winslow WW, et al:  Fears, beliefs and attitudes in hypochondriasis . J Nerv Ment Dis 1987;;175:20-25.
24 +
Mayou R:  The nature of bodily symptoms . Br J Psychiatry 1976;;129:55-60.
25 +
Kenyon FE:  Hypochondriasis: A clinical study . Br JPsychiatry 1964;:110;478-488.
26 +
Kellner R:  The prognosis of treated hypochondriasis: A clinical study . Acta Psychiatr Scand 1983;;67:69-79.
27 +
Barsky AJ, Wyshak G, Klerman GL:  Hypochondriasis: An evaluation of the DSM-III criteria in medical outpatients . Arch Gen Psychiatry 1986;;43:493-500.
28 +
Kellner R, Slocumb JC, Wiggins RG, et al:  The relationship of anxiety and depression to hypochondriacal fears and beliefs . Psychiatr Med , in press.
29 +
Kellner R:  Functional somatic symptoms and hypochondriasis . Arch Gen Psychiatry 1985;;42:821-833.
30 +
Cloninger CR, Sigvardsson S, von Knorring A-L, et al:  An adoption study of somatoform disorders: II. Identification of two discrete somatoform disorders . Arch Gen Psychiatry 1984;;41:863-871.
31 +
Sigvardsson S, Bohman M, von Knorring AL, et al:  Genetic causes of somatization in men . Epidemiology 1986;;3:153-185.
32 +
Shields J: Monozygotic Twins Brought up Apart and Brought up Together . New York, Oxford University Press Inc, 1962;.
33 +
Nielsen NJ:  Individual and environment . Acta Psychiatr Scand Suppl 1965;;40:1-292.
34 +
Apley T:  Common denominators in the recurrent pains of childhood . Proc R Soc Med 1958;;51:1023-1027.
35 +
Mechanic D:  The influence of mothers on their children's health attitudes and behavior . Pediatrics 1964;;33:444-453.
36 +
Parker G, Lipscombe P:  The relevance of early parental experiences to adult dependency, hypochondriasis and utilization of primary physicians . Br J Med Psychol 1980;;53:355-363.
37 +
Burns BH, Nichols MA:  Factors related to the localization of symptoms to the chest in depression . Br J Psychiatry 1972;;121:405-409.
38 +
Kreitman N, Sainsbury P, Pearce K, et al:  Hypochondriasis and depression in outpatients at a general hospital . Br J Psychiatry 1965;;111:607-615.
39 +
Zborovski M:  Cultural components in responses to pain . J Soc Issues 1952;;8:16-30.
40 +
Lerner J, Noy P:  Somatic complaints in psychiatric disorders: Social and cultural factors . Int J Soc Psychiatry 1968;;14:145-150.
41 +
Kirmayer LJ:  Culture, affect and somatization: Part 1 . Transcultural Psychiatric Res Rev 1984;;21:159-188.
42 +
Kirmayer LJ:  Culture, affect and somatization: Part 2 . Transcultural Psychiatric Res Rev 1984;;21:237-262.
43 +
Sternbach RA, Tursky B:  Ethnic differences among housewives in psychophysical and skin potential responses to electric shock . Psychophysiology 1965;;1:241-246.
44 +
Tursky B, Sternbach RA:  Further physiological correlates of ethnic differences in responses to shock . Psychophysiology 1967;;4:67-74.
45 +
Petrie A: Individuality in Pain and Suffering . Chicago, University of Chicago Press, 1967;.
46 +
Merskey HA, Evans PR:  Variations in pain complaint threshold in psychiatric and neurological patients with pain . Pain 1975;;1:59-72.
47 +
Tyrer P, Lee I, Alexander J:  Awareness of cardiac function in anxious, phobic and hypochondriacal patients . Psychol Med 1980;;10:171-174.
48 +
Sullivan MA, Cohen S, Snape WJ Jr:  Colonic myoelectrical activity in irritable-bowel syndrome . N Engl J Med 1978;;298:878-883.
49 +
Clouse RE, Lustman PJ:  Psychiatric illness and contraction abnormalities of the esophagus . N Engl J Med 1983;;309:1337-1342.
50 +
Chaudhary NA, Truelove SC:  Human colonic motility: A comparative study of normal subjects, patients with ulcerative colitis, and patients with the irritable colon syndrome . Gastroenterology 1961;;40:1-36.
51 +
Wangel AG, Deller DJ:  Intestinal motility in man: III. Mechanisms of constipation and diarrhea with particular reference to the irritable colon syndrome . Gastroenterology 1965;;48:69-84.
52 +
Malmo RB, Shagass C:  Physiologic study of symptom mechanisms in psychiatric patients under stress . Psychosom Med 1949;;11:25-29.
53 +
Sainsbury P, Gibson JG:  Symptoms of anxiety and tension and the accompanying physiological changes in the muscular system . J Neurol Neurosurg Psychiatry 1954;;17:216-224.
54 +
Lewis BI:  Hyperventilation syndrome: A clinical and physiological evaluation . Calif Med 1959;;3:121-129.
55 +
Tyrer P: The Role of Bodily Feelings in Anxiety . New York, Oxford University Press Inc, 1976;.
56 +
Lacey JI:  The evaluation of autonomic responses: Toward a general solution . Ann NY Acad Sci 1956;;67:123-164.
57 +
Grings WW, Dawson ME: Emotions and Bodily Responses: A Psychophysiological Approach . Orlando, Fla, Academic Press Inc, 1978;.
58 +
Barsky AJ:  Patients who amplify bodily symptoms . Ann Intern Med 1979;;91:63-70.
59 +
Mechanic D:  Social psychologic factors affecting the presentation of bodily complaints . N Engl J Med 1972;;286:1132-1139.
60 +
Braütigam VW:  Analyse der hypochondrischen Selbstbeobachtung . Nervenarzt 1956;;27:409-418.
61 +
Feldmann H:  Symptomwahrnehmung und Überbewertung bei der Hypochondrie . Arch Psychiatrie Nervenkrankheiten 1977;;224:235-245.
62 +
Kellner R, Pathak D, Romanik R, et al:  Life events and hypochondriacal concerns . Psychiatr Med 1983;;1:133-141.
63 +
Adám G: Interception and Behaviour . Budapest, Akademiai Kiado, 1967;.
64 +
Ruesch J: Chronic Disease and Psychological Invalidism: A Psychosomatic Study . Los Angeles, University of California Press, 1951;.
65 +
Cope RL:  The psychogenic factor in chest pain . Tex Med 1969;;65:78-81.
66 +
Chappell MN, Stevenson TI:  Group psychological training in some organic conditions . Mental Hygiene 1936;;20:588-597.
67 +
Stenbäck A:  Hypochondria in duodenal ulcer . Adv Psychosom Med 1960;;1:307-312.
68 +
Kellner R, Samet J, Pathak D:  Fears, beliefs and attitudes in patients with chronic airflow obstruction . JPsychosom Res , in press.
69 +
Kenyon FE:  Hypochondriacal states . Br J Psychiatry 1976;;129:1-14.
70 +
Pisztora F:  The determining part of personality pattern in the pathogenesis of cenestepathic hypochondriasis . Pszichologiai Tanulmányok 1967;;10:575-579.
71 +
Katon W, Kleinman A, Rosen G:  Depression and somatization: I. A review . Am J Med 1982;;72:127-135.
72 +
Kellner R, Fava GA, Lisansky J, et al:  Hypochondriacal fears and beliefs in DSM-III melancholia: Changes with amitriptyline . J Affective Disord 1986;;10:21-26.
73 +
Noyes R Jr, Reich J, Clancy J, et al:  Reduction of hypochondriasis with treatment of panic disorder . Br J Psychiatry 1986;;149:631-635.
74 +
Astrup C, Noreik K, Elkes J: Functional Psychoses: Diagnostic and Prognosis Models . Springfield, Ill, Charles C Thomas Publisher, 1966;, pp 45-53.
75 +
Munroe A, Chmara J:  Monosymptomatic hypochondriacal psychosis: A diagnosis checklist based on 50 cases of the disorder . Can J Psychiatry 1982;;77:374-376.
76 +
Pilowsky I:  Primary and secondary hypochondriasis . Acta Psychiatr Scand 1970;;46:273-285.
77 +
Baker B, Merskey H:  Classification and associations of hypochondriasis in patients from a psychiatric hospital . Can J Psychiatry 1983;;28:629-634.
78 +
Cohen ME, White PD:  Life situations, emotions and neurocirculatory asthenia . Psychosom Med 1951;;13:335-357.
79 +
Cope RL:  The psychogenic factor in chest pain . Tex Med 1969;;65:78-81.
80 +
Sarno JE:  Psychosomatic backache . J Fam Pract 1977;;5:353-357.
81 +
Sapira JD:  Reassurance therapy . Ann Intern Med 1972;;77:603-604.
82 +
Draspa LJ:  Psychological factors in muscular pain . Br J Med Psychol 1959;;32:106-116.
83 +
Svedlund J, Ottosson J, Sjödin I, et al:  Controlled study of psychotherapy in irritable bowel syndrome . Lancet 1983;;1:589-592.
84 +
Nemiah JC:  Hypochondriasis (hypochondriacal neurosis) , in Freedman AM, Kaplan HI, Sadock BJ (eds): Comprehensive Textbook of Psychiatry . Baltimore, Williams & Wilkins, 1980;, vol 2, pp 1538-1543.
85 +
Laughlin HP: The Neuroses . Washington, DC, Butterworths, 1967;.
86 +
Wahl CW:  Psychodynamics of the hypochondriacal patient , in Wahl CW (ed): New Dimension in Psychosomatic Medicine . Boston, Little Brown & Co Inc, 1964;, pp 201-213.
87 +
Lowy FH:  Management of the persistent somatizer . Int J Psychiatry Med 1975;;6:227-239.
88 +
Galatzer-Levy RM:  The opening phase of psychotherapy of hypochondriacal states . Int J Psychoanal Psychother 1982;-1983;9:389-413.
89 +
Busse EW:  The treatment of the chronic complainer . Med Rec Annals 1956;;50:196-200.
90 +
Brown HN, Vaillant GE:  Hypochondriasis . Arch Intern Med 1981;;141:723-726.
91 +
Cooper CD, Dickinson JB, Adams HB, et al:  Interviewer's role-playing and responses to sensory deprivation: A clinical demonstration . Percept Mot Skills 1975;;40:291-303.
92 +
Kellner R, Sheffield BF:  The relief of distress following attendance at a clinic . Br J Psychiatry 1971;;118:195-198.
93 +
Kellner R:  Psychotherapeutic strategies in hypochondriasis: A clinical study . Am J Psychotherapy 1982;;36:146-157.
94 +
Katzenelbogen S:  Hypochondriacal complaints with special reference to personality and environment . Am J Psychiatry 1942;;98:815-822.
95 +
Pilowsky I:  The response to treatment in hypochondriacal disorders . Aust NZ J Psychiatry 1968;;2:88-94.
96 +
Bursztajn H, Barsky AJ:  Facilitating patient acceptance of a psychiatric referral . Arch Intern Med 1985;;145:73-75.
97 +
Mendel E: Hypochondrie beim Weiblichen Geschlecht. Dtsh Med Wochenschr, 1889, pp 205-209.
98 +
Kellner R:  Hypochondriasis , in Karasu T (ed): Treatment of Mental Disorders . Washington, DC, American Psychiatric Association, in press.
99 +
Kessel N:  Reassurance . Lancet 1979;;1:1128-1133.
100 +
Ley P, Spellman MS: Communicating With the Patient . Worchester, Mass, Staples Press, 1967;.
101 +
Floru L:  Verhaltenstherapeutische Versuche durch systematische Desensibilisierung . Psychiatr Clin 1973;;6:300-318.
102 +
Sulk SKD:  Verhaltenstherapie der Herzphobie: Ein klinischer Erfahrungsbericht über ein Training kognitiver Angstbewältigung . Psychiat Prax 1986;;13:10-16.
103 +
O'Donnell JM:  Implosive therapy with hypnosis in the treatment of cancer phobia: A case report . Psychother Theory Res Prac 1978;;15:8-12.
104 +
Ford CV, Long KD:  Group psychotherapy of somatizing patients . Psychother Psychosom 1977;;28:294-304.
105 +
Wooley SC, Blackwell B, Winget C:  A learning theory model of chronic illness behavior: Theory, treatment and research . Psychosom Med 1978;;40:379-401.
106 +
Blackwell B, Gutman M:  The management of chronic illness behavior , in McHugh S, Vallis TM (eds): Illness Behavior . New York, Plenum Press, 1986;, pp 401-408.
107 +
Turnbull JM:  The hypochondriacal patient , in Bowden CL, Burstein AG (eds): Psychosocial Basis of Medical Practice . Baltimore, Williams & Wilkins, 1974;, pp 73-80.
108 +
Thomas KB:  The consultation and the therapeutic illusion . Br Med J 1978;;1:1327-1328.
109 +
Uhlenhuth EH, Glass RM, Haberman SJ, et al:  Relative sensitivity of clinical measures in trials of antianxiety agents , in Burdock EF, Sudilorsky A, Gershon S (eds): Quantitative Techniques for the Evaluation of Behavior of Psychiatric Patients . New York, Marcel Dekker Inc, 1982;, pp 393-409.
110 +
Covi L, Lipman RS, Derogatis LR, et al:  Drugs and group psychotherapy in neurotic depression . Am J Psychiatry 1974;;131:191-198.
111 +
Kahn RJ, McNair DM, Lipman RS, et al:  Imipramine and chlordiazepoxide in depressive and anxiety disorders: II. Efficacy in anxious outpatients . Arch Gen Psychiatry 1986;;43:79-85.
112 +
Sheehan DV, Ballenger J, Jacobsen G:  Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms . Arch Gen Psychiatry 1980;;37:51-59.
113 +
Robinson DS, Nies A, Ravaris CL, et al:  The monoamine oxidase inhibitor, phenelzine, in the treatment of depressive-anxiety states . Arch Gen Psychiatry 1973;;29:407-413.
114 +
Goldenberg DL, Felson DT, Dinerman H:  A randomized, controlled trial of amitriptyline and naproxen in the treatment of patients with fibromyalgia . Arthritis Rheum 1986;;29:1371-1377.
115 +
Okasha A, Ghaleb HA, Sadek A:  A double-blind trial for the clinical management of psychogenic headache . Br J Psychiatry 1973;;122:181-183.
116 +
Lewis A:  Melancholia: A clinical survey of depressive states . J Ment Sci 1934;;80:277-378.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems