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People with hypochondriasis had an increased risk of death from both natural and unnatural causes, according to a Swedish cohort study.

In analyses adjusted for sociodemographic variables, those diagnosed with hypochondriasis had a significantly increased risk of all-cause mortality compared with individuals without a diagnosis (HR 1.69, 95% CI 1.47-1.93), David Mataix-Cols, PhD, of the Karolinska Institute in Stockholm, and colleagues reported in .

The heightened risk was present for both natural (HR 1.60, 95% CI 1.38-1.85) and unnatural (HR 2.43, 95% CI 1.61-3.68) causes. Most deaths from unnatural causes were attributed to suicide (HR 4.14, 95% CI 2.44-7.03).

"Despite their pervasive fears of illness and death and frequent medical consultations, individuals with hypochondriasis have an increased risk of death, both from natural and unnatural causes, compared to individuals from the general population," Mataix-Cols told 番茄社区 Medical Today in an email.

Most of the deaths among people with hypochondriasis could be classified as preventable, Mataix-Cols added, suggesting patients would benefit from improved detection and access to evidence-based treatment.

Hypochondriasis is characterized by a persistent preoccupation with the possibility of having one or more severe physical disorders, the researchers wrote. It is typically accompanied by hypervigilance and catastrophizing of potential symptoms.

However, an individual's heightened awareness of their health does not translate to healthier outcomes, Mataix-Cols said.

"Superficially, one might think that because they frequently consult with doctors, individuals with hypochondriasis may have lower risk of death," he said. "However, clinicians working with this patient group know that many individuals experience considerable suffering and hopelessness, which could explain the elevated risk of suicide we describe in the paper."

For their study, the researchers identified 4,129 individuals diagnosed with hypochondriasis from January 1, 1997, through December 31, 2020, and matched them with 41,290 controls without the condition. The majority of those with hypochondriasis were female (56.7%) and had a median age at first diagnosis of 34.5.

Most individuals with hypochondriasis (85.7%) received at least one other lifetime psychiatric diagnosis, primarily anxiety-related and depressive disorders, compared with 19.9% of people without hypochondriasis (P<0.001).

Overall, 268 people with hypochondriasis and 1,761 people without it died during the study period, leading to crude mortality rates of 8.5 and 5.5 per 1,000 person-years, respectively.

The researchers noted that risk of all-cause mortality and death from natural causes was attenuated but remained significantly higher when controlling for lifetime psychiatric comorbidities. However, the risk of death from suicide was no longer significant after adjusting for depressive and anxiety-related disorders, they reported.

While the study didn't assess the mechanisms behind the findings, the researchers theorized that "multiple factors, probably acting in tandem, are likely to be associated with the increased risks."

Plausible explanations include "chronic stress leading to dysregulated hypothalamic-pituitary-adrenal axis function, immune dysfunction, chronic inflammation, lifestyle factors [such as alcohol and substance use], the underrecognition of hypochondriasis as a genuine psychiatric disorder that requires treatment, and/or limited access to evidence-based treatment," they wrote.

The study was limited because hypochondriasis may be underdiagnosed, diluting the estimates, and so "true excess mortality" among people with hypochondriasis "may be even higher than reported," the researchers wrote. Limited statistical power also posed a potential challenge, they wrote.

Still, they concluded that theirs is the first study to suggest that people with hypochondriasis have a greater risk of death, particularly from suicide, which can be prevented.

"More must be done to reduce stigma, improve detection, diagnosis, and appropriate integrated (i.e., psychiatric and somatic) care for these individuals," Mataix-Cols told 番茄社区. "Evidence-based treatments for hypochondriasis exist, mainly in the form of specialized cognitive behavioral therapy, and should be made available to as many patients as possible, and as early as possible."

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