Hypochondriasis and Somatization Disorder: New Perspectives

Don R. Lipsitt MA, MD


The blurred boundaries between illnesses presenting with somatic symptoms confronts both psychiatrists and primary care physicians with one of the most challenging issues in patient care. On a typical day in a general physician’s office, perhaps 50 % or more of the patients with physical complaints will have no definitive explanation for their ailment (Simon et al. 1996; Kroenke and Mangelsdorff 1989; Kroenke 2003; Baumeister and Harter 2007; Smith and Dwamena 2007). The patients present with distress from fatigue, chest pain, cough, back pain, shortness of breath, and a host of other painful or worrisome bodily concerns. For most, the physician’s expression of interest, taking a thorough history, doing a physical examination, and offering reassurance, a modest intervention, or a pharmacologic prescription suffices to assuage the patient’s pain, anxiety, and physical distress. But for some, these simple measures fall short of their expected result, marking the beginning of what may become a chronic search for relief, including frequent anxiety-filled visits to more than one physician, and in extreme cases even multiple hospitalizations and possibly surgery.

Hoyle Leigh, Jon Streltzer, eds. Handbook of Consultation-Liaison Psychiatry. New York: Springer, 2015, pp. 317-333.

Link to Online Publication


Other recent publications by Don R. Lipsitt MA, MD:

  • Developmental Life of the Medical Student: Curriculum Considerations. Academic Psychiatry, 39 (1), 2015, pp. 63-69 Link to Online Publication.
  • Psychodynamic models and therapeutic approaches to hypochondriasis. In Hypochondriasis and Health Anxiety: A Guide for Clinicians. Edited by Vladan Starcevic and Russell Noyes, Jr. New York: Oxford University Press, 2014, pp. 222-240.
  • From alienist to collaborator: the twisting road to consultation-liaison psychiatry. In Psychiatry: Past, Present, and Prospect. Edited by Sidney Bloch, Stephen A. Green, and Jeremy Holmes. New York: Oxford University Press, 2014, pp. 196-218.
  • Partners at the “Interface”. American Journal of Psychiatry, 170 (12), 2013, pp. 1401-1402 Link to Online Publication.

Previous Posts:

José Saporta, MD (2014). Psychoanalysis Meets China: transformative dialogue or monologue of the Western voice. In David E. Scharff and Sverre Varvin, eds. Psychoanalysis in China. London: Karnac, pp. 73-90.

John C. Foehl, PhD (2014). A Phenomenology of DepthPsychoanalytic Dialogues, 24:289-303.

Malkah Tolpin Notman, MD (2014). Reflections on Widowhood and Its Effects on the Self. Psychodynamic Psychiatry: Vol. 42, No. 1, pp. 65-88.

Fred Busch, PhD (2013). Changing views of what is curative in 3 psychoanalytic methods and the emerging, surprising common groundThe  Scandinavian Psychoanalytic Review, 36:27-34.

Bennett Simon, MD (2013). Mondrian’s Search for Geometric Purity: Creativity and Fixation. American Imago, 70/3: 515-555.

Elsa Ronningstam, PhD; Arielle R. Baskin-Sommers, MS (2013). Fear and decision-making in narcissistic personality disorder—a link between psychoanalysis and neuroscience. Dialogues in Clinical Neuroscience. 15(2): 191–201.

Phillip S. Freeman (2013). ARGO: Actuality in Cinema. International Journal of Applied Psychoanalytic Studies, 10/2: 178-180 (posted under Film Series)

Dan H. Buie (2013). Core Issues in the Treatment of Personality-Disordered Patients. Journal of the American Psychoanalytic Association, 61/1: 10-23.

Ana-María Rizzuto, MD (2013). Field Theory, the “Talking Cure,” and Metaphoric Processes.Psychoanalytic Inquiry, 33:3, 210-228.

Phillip S. Freeman, MD (2012). The Resilience of Illusion. International Journal of Applied Psychoanalytic Studies (First Brief Communication, 9: 78-83; Second Brief Communication, 9: 344-349).

Paul Ornstein, MD (2012). The Novelist’s Craft: Reflections on The Brothers Karamazov. American Imago, 69/3, p. 295-316.

Stephanie R. Brody, PsyD (2013). Entering Night Country: Reflections on Self-Disclosure and Vulnerability. Psychoanalytic Dialogues, 23:1, p. 45-58.

Ellen Pinsky, PsyD (2012). PHYSIC HIMSELF MUST FADE: A View of the Therapeutic Offering through the Lens of Mortality. American Imago, Vol. 69, No. 1, 29-56.

All articles are available in the library.