Commentary

Extract

“Hypochondriasis is a condition in which there are no established effective treatments” (Fallon et al, 1991).

Warwick's paper shows how recent advances have completely altered the previous therapeutic nihilism expressed in the above quotation. Physicians and surgeons have long been aware that medical and surgical problems turn out to have no organic cause. Joyce et al (1986) from New Zealand examined 105 people with abdominal pain who had been admitted to a surgical ward. They found that the most common surgical diagnosis was non-specific abdominal pain, closely followed by appendicitis. Those with non-specific abdominal pain contained a very interesting group of patients: they were predominantly female, did not have any physical findings, and were more anxious and conformed to the pattern of patients showing fear of illness. This group presented, in the words of the New Zealand team:

“a caricature of the female ‘non-organic’ abdominal pain patient… whose health is the greatest difficulty of her life, who fears she may suddenly fall ill, who denies having silly thoughts about health yet thinks there is something seriously wrong with her body, who admits to no problems or personal worries other than her illness, and for whom illness may be construed as a punishment. These patients also deny feeling irritable towards other people and yet lose patience with them, while being unable to express angry feelings.”