Provision of appropriate and effective reassurance

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Abstract
Primary hypochondriasis is a severe problem which can run a chronic course, and patients with this disorder are probably the most difficult to reassure in medical practice. Current opinion and existing research regarding the role of reassurance in hypochondriasis will be described. Traditional medicine and psychiatry have failed to consider the psychological processes involved in this disorder. Consideration of a cognitive-behavioural formulation of hypochondriasis suggests new techniques which may effectively reassure these patients, but these are not in frequent use. The psychological processes which interfere with reassurance are described and two main areas of difficulty will be discussed. First, management of patients who have failed to understand previous reassurance and will need more information and second, management of those in whom repetitive requests for reassurance should be refused. Management strategies for dealing with these patients are outlined, and areas for further research are described. Finally, an attempt is made to define the necessary components of successful reassurance for patients with primary hypochondriasis, and it is suggested that these factors should be considered in the reassurance of patients in all clinical settings.

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