HYPOCHONDRIACAL PATIENTS, THEIR PHYSICIANS, AND THEIR MEDICAL-CARE

Objective: To examine the views hypochondriacal patients have of their physicians, and their physicians' assessments of the hypochondriacal patients. Design: A sample of patients meeting DSM-III-R diagnostic criteria for hypochondriasis was obtained by screening consecutive medical outpatients. They underwent a battery of self-report questionnaires and structured interviews, their medical records were audited, and their physicians completed questionnaires about them. A random sample of nonhypochondriacal patients from the same clinic served as a comparison group. Setting: A large general medicine outpatient clinic of an academic teaching hospital. Patients: 41 DSM-III-R hypochondriacs and 71 comparison patients. Measurements and main results: Hypochondriacal patients were more dissatisfied with their physicians than were comparison patients. Physicians rated the hypochondriacal patients as more frustrating to care for, more help-rejecting, and more demanding. Physician ratings of how hypochondriacal their patients were correlated significantly with their ratings of how frustrating they considered the patients (R2 = 0.36) and with objective measures of how hypochondriacal the patients were (incremental R2 = 0.08). Physician estimates of anxiety and depression in the hypochondriacal patients were not statistically related to patient anxiety and depression. In contrast, physician estimates of patient anxiety and depression were significantly associated with the presence of anxiety and depression in comparison patients. Conclusions: The physician's use of the term hypochondriasis is closely associated with his or her frustration with the patient and is associated with objective measures of the extent of hypochondriacal symptoms. In addition, the presence of DSM-III-R hypochondriasis impairs the physician's accuracy in assessing the levels of the patient's anxiety and depression.