Hypochondriasis: difficulties in diagnosis and management.

The hypochondriacal patient presents numerous frustrations for the physician. The typical hypochondriac is a middle-aged person dominated by a preoccupation with bodily symptoms. Bereavement, serious life failures, and severe blows to self-esteem put patients at high risk for somatization. Hypochondrisis has been cited as a symptom of masked depression, early paranoid schizophrenia, and dementia and/or delirium. A careful diagnostic work-up with attention to any correctable psychiatric illness sets the stage for regularly scheduled, long-term supportive therapy.