The Boundary between Hypochondriasis, Personality Dysfunction, and Trauma

Hypochondriasis (HC) has presented physicians and researchers with nosological challenges since Freud’s era. Part of the difficulty lays in the significant overlap between the constructs of mental illness and personality disorders that already exists when it comes to understanding almost any psychological phenomena (i.e., state versus trait debate). Indeed, many of the symptoms of HC are similar to those of other mental illnesses such as anxiety, yet HC has also been associated with particular personality traits, cognitive styles, attitudes, and personality disorders. Likewise, there has been debate as to whether HC should be considered secondary to some other disorder or as a primary diagnosis in its own right. Finally, the etiology of HC is not well understood. Empirical literature suggests possible genetic components to HC, in addition to several potential environmental factors. In this article we review key theoretical works and empirical studies on the intersection of personality dysfunction and HC. In addition, we consider the role that trauma may play in the development of HC in certain individuals. Traumatic experiences are already widely linked to somatoform disorders. However, the characteristic features of hypochondriacal presentation (e.g., illness conviction, illness phobia, and failure to respond to reassurance from physicians) may be related to particular types of traumatic experiences which, when they occur in infancy and/or childhood, interfere with secure attachment and identity formation.