What is Hypochondriasis?

Hypochondriasis, more commonly referred to today as illness anxiety disorder, involves a persistent preoccupation with having or developing a serious medical condition despite little or no medical evidence to support this belief. Individuals experiencing hypochondriasis are not “imagining” symptoms in a superficial sense, but are intensely hyperaware to bodily sensations and interpret normal physical changes through a lens of catastrophe. This preoccupation can significantly impair daily functioning, relationships, communication, and overall quality of life, as much of the person’s emotional and mental energy is devoted to monitoring their health, seeking reassurance, thinking the worst, or avoiding perceived medical threats.

Study for "Bathers at Asnières", Painting by Georges Seurat, 1883-1884

From a psychodynamic perspective, hypochondriasis is understood not only as anxiety about physical illness but as a deeper expression of underlying emotional conflicts. Physical symptoms and health fears may serve as a way of communicating or containing psychological distress that feels otherwise unmanageable or unacceptable to acknowledge. Early relational experiences, especially those involving inconsistent caregiving, illnesses in the family, or unprocessed trauma, can play a role in influencing how an individual learns to interpret and cope with bodily sensations. In this sense, the body becomes a stage where unresolved emotional struggles are played out.

George Vaillant’s work on defence mechanisms is especially useful in understanding hypochondriasis within a psychodynamic framework. Individuals with health anxiety may rely heavily on immature or neurotic defences, such as projection or somatization to manage internal distress. For example, feelings of vulnerability, helplessness, exhaustion or aggression may be displaced onto the body, where they appear as fears of disease or bodily malfunction. Vaillant’s developmental hierarchy of defences shows how these patterns can reflect attempts to preserve psychological stability when more adaptive mechanisms are not yet accessible or developed.

Children on the Beach, Painting by Winslow Homer, 1873

At the same time, hypochondriasis can serve important psychological functions. The focus on physical health may provide a structured way of expressing fear, opening up, obtaining care, or legitimizing emotional pain that otherwise feels inexpressible or shameful. In some cases, it also creates a sense of control in the face of internal chaos or uncertainty. While these defences may be protective in the short term, over time they can also reinforce cycles of anxiety and dependency on reassurance, which makes it difficult for individuals to develop more flexible and resilient ways of coping.

Psychodynamic psychotherapy provides a space to look into the deeper emotional meanings underlying hypochondriacal behaviours and concerns. Therapy focuses on understanding how these fears relate to the person’s life story, relationships, traumas, and internal worlds, rather than challenging beliefs about illness at a surface level. Through the therapeutic relationship, patients can begin to identify and strengthen more mature defences, as described by Vaillant, such as intellectualization, suppression, humour, and sublimation, and as a result, creating greater emotional insight and self regulation.