Hypochondriasis Linked to Earlier Death

People who have hypochondriasis (health anxiety disorder) may have an increased risk of dying by either natural or unnatural causes, including death by suicide, compared with people who do not have the disorder, a study in JAMA Psychiatry has found. According to the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), people who have hypochondriasis are preoccupied with thoughts that they have one or more serious and progressive physical disorders and repeatedly check for symptoms and seek reassurance from health professionals.

Martin Hammar

“This is a wakeup call. We need to work toward developing better models of shared care for these patients, focusing on tighter collaboration between primary care, medical specialists, and mental health professionals,” lead author David Mataix-Cols, Ph.D., told Psychiatric News. He is a professor of child and adolescent psychiatric science at the Karolinska Institutet in Stockholm.

The researchers examined data from 4,129 people in the Swedish National Patient Register who received a diagnosis of hypochondriasis between January 1, 1997, and December 31, 2020. (The median age of diagnosis was approximately 34 years.) The researchers matched those individuals with 41,290 demographically similar people without hypochondriasis. All individuals were followed from the date of diagnosis until the date of death; emigration from Sweden; or the end of the study on December 31, 2020, whichever occurred first.

A total of 268 individuals with hypochondriasis and 1,761 individuals without hypochondriasis died during the follow-up. Those with hypochondriasis died at a mean age of 70 years, compared with a mean age of 75.1 years for those without the disorder.

After strict adjustment of sociodemographic confounders (for example, highest level of education and family income), those with hypochondriasis had a 69% increased risk of dying of any cause, a 60% increased risk of dying of natural causes (for example, diseases of the circulatory, nervous, or respiratory systems), and a 143% increased risk of dying of unnatural causes compared with people without hypochondriasis.

Those with hypochondriasis also had a 314% increased risk of dying by suicide, which was the most common cause of unnatural death. However, after the researchers adjusted for a history of depressive or anxiety disorders, suicide risk was no longer statistically significant. According to the researchers, comorbid depression and anxiety are the norm in individuals with hypochondriasis.

Mataix-Cols noted that the absolute risks of death were small. For example 0.7% of the people with hypochondriasis died by suicide, compared with 0.1% in the general population during the same period.

“Of course, we should still consider the risks unacceptably high, particularly because effective treatments do exist and at least some deaths could have been prevented,” he said.

Mataix-Cols said that hypochondriasis was underdiagnosed.

“We ‘only’ found a little over 4,000 cases in the whole of Sweden during a period of more than 20 years. This is far fewer than we would expect given the known prevalence of the disorder being somewhere around 3-5% [and] the population of Sweden is around 10 million people,” he explained.

“We need to get better at diagnosing the disorder in a variety of medical settings and persuading sufferers to see mental health professionals,” Mataix-Cols added. “Good treatments exist, particularly cognitive-behavioral therapy. SSRIs are also an option, though many patients prefer talking therapies due to the fact that the medication side effects, such as bodily sensations, can trigger health anxiety.”

This study was supported by the Swedish Research Council for Health, Working Life and Welfare; Region Stockholm; the Swedish Society of Medicine; and the Karolinska Institutet. ■