Hypochondriasis and Panic Disorder

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Abstract
Background: To determine the nosological and phenomenological overlap and boundaries between panic disorder and hypochondriasis, we compared the symptoms, disability, comorbidity, and medical care of primary care patients with each diagnosis. Methods: Patients withDSM-III-Rpanic disorder were recruited by screening consecutive primary care clinic attenders and then administering a structured diagnostic interview for panic disorder. Patients also completed selfreport questionnaires, and their primary care physicians completed questionnaires about them. They were then compared with patients withDSM-III-Rhypochondriasis from the same setting who had been studied previously. Results: One thousand six hundred thirty-four patients were screened; 135 (71.0% of the 190 eligible patients) completed the research battery; 100 met lifetime panic disorder criteria. Twenty-five of these had comorbid hypochondriasis. Those without comorbid hypochondriasis (n=75) were then compared with patients with hypochondriasis without comorbid panic disorder (n=51). Patients with panic disorder were less hypochondriacal (P<.001), somatized less (P<.05), were less disabled (P<.001), were more satisfied with their medical care (P<.001), and were rated by their physicians as less help rejecting (P<.05) and less demanding (P<.01). Major depression was more prevalent in the group with panic disorder (66.7% vs 45.1%;P<.05), as were phobias (76.0% vs 37.3%;P<.001), but somatization disorder symptoms (P<.0001) and generalized anxiety disorder were less prevalent (74.5% vs 16.0%;P<.001) in panic disorder than was hypochondriasis. Conclusions: While hypochondriasis and panic disorder co-occur to some extent in a primary care population, the overlap is by no means complete. These patients are phenomenologically and functionally differentiable and distinct and are viewed differently by their primary care physicians.

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