In this chapter we shall first consider some general aspects of health concern, somatization and hypochondriasis, and then look at relevant areas concerning body image and its disorders. Thereafter we will look at the overall features of delusional disorder of the somatic subtype, then go on to some of the more important specific hypochondriacal delusional presentations which we are likely to encounter.

Somatization and hypochondriasis (Munro, 1988; Kellner, 1992; Warwick and colleagues, 1996)

Modern society, especially in developed countries, is preoccupied with health concerns such as diet, exercise, the need for a clean environment, and the avoidance of toxic substances. While all of this is positive, it is unfortunate that people who are over-concerned with their health are likely to be made excessively anxious, especially as a result of all the media material on health-related subjects which have become so commonplace.

Health concern has two outstanding aspects, the first being a persistent preoccupation with the body and its functions, and the second a persistent concern with health matters. These are quite consistent with normal mental health and motivate people towards positive living styles. Unhappily, some individuals move on to pathological self-concern in which there is constant fear of physical symptoms, with over-awareness of physiological signals or exaggeration of slight aches. From there, another sub-group may develop actual hypochondriasis in which there is a constant conviction of being ill, misinterpretation of minor symptoms as actual illness, and resistance to reassurance that no serious disorder is present.