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Some research has suggested that the elderly tend to be hypochondriacal and preoccupied with their bodies, but other studies contradict this, suggesting that it may be an unfounded stereotype. In the general medical population, hypochondriasis is estimated to be present in 0.4 percent to 14 percent of all patients. In the elderly, the prevalence is estimated to be between 3.9 percent and 33.0 percent. There appear to be peak periods for the onset of hypochondriasis: adolescence, the fourth and fifth decades, and over age 60. There are methodological problems in the research, however, making consensus on the definition and prevalence of hypochondriasis difficult. Two groups of patients were studied to determine the relationship between hypochondriasis and age. Group one consisted of 60 patients already diagnosed with hypochondria, and group two was a normal comparison group of 100 patients. Each group was then divided further into elderly (65 years old and over) and younger patients. Hypochondriacal symptoms were assessed with two questionnaires, and clinical diagnosis of the disorder was made on the basis of a structured interview and standard diagnostic criteria. Psychiatric status was assessed as well, as was medical history, life stress, and sensitivity to unpleasant but harmless bodily sensations. There was no significant age difference between the hypochondriacal and the comparison groups, and elderly patients did not have more symptoms than the younger patients. Though not a statistically significant finding, the elderly as a group actually scored lower on disease fear and disease conviction measures than the younger patients as a group. No support was found, therefore, for a relationship between age and hypochondriasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The term hypochondriasis (hypochondria) refers both to symptoms and to a disorder. The symptoms include fear of disease, belief that one is ill, and experience of physical complaints, all without any medical justification. Hypochondriasis is also a distinct psychiatric disorder that includes all the hypochondriacal symptoms that are not caused by another underlying psychiatric disorder. The relationship of hypochondriasis to illness is not clear, and hypochondriacs may in fact be ill. What distinguishes the hypochondriac is that the fears and symptoms are out of proportion to the actual state of health or illness. It is difficult to determine whether a symptom is psychosomatic or whether there is a medical basis for it. To determine the relationship between hypochondriasis and medical illness, 41 diagnosed hypochondriacs and 75 controls were interviewed, and their medical records were audited. The interview separated reasonable from unreasonable health concerns, so that some patients who were ill were also diagnosed as hypochondriacs. The medical review indicated that hypochondriacs had the same amount of illness as the control patients in the study, and physician ratings of medical status and outcome were essentially the same for both groups. This suggests that hypochondriacs are not sicker than other patients. The medical records of the hypochondriacs did contain more reports of symptoms that could not be diagnosed as a medical condition, probably as a result of more complaints and more contact with physicians. Bodily preoccupations and a belief that one has a disease are more often associated with actual medical illness among those who are not hypochondriacal than among hypochondriacs. Responding appropriately to hypochondriacal patients is difficult, and the clinician must not cause adverse consequences by ordering diagnostic tests that may in themselves cause harm. On the other hand, there is a risk of overlooking an actual illness, and of harming the patient through rejection of the person and of his real suffering. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hypochondriasis is viewed by the compilers of the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R) as a distinct disorder involving the conviction that disease is present when it is not, fear of disease, and a preoccupation with bodily sensations and functions. It may also be conceived of as a disorder of cognition and perception, in which ordinary physical sensations are interpreted as disease states. It has been suggested that medical patients exhibiting a hypochondriacal syndrome generally tend to have a heightened awareness of their senses (amplification). A study of 177 outpatients at Massachusetts General Hospital was conducted to assess the relationship between hypochondriacal symptoms and the tendency to misinterpret benign physical signs and sensations. The subjects (62 percent of whom were women, 92 percent were white, and their average age was 54.2 years) were given a questionnaire designed to measure hypochondriasis, amplification, somatization (the tendency to express emotional problems in the form of bodily symptoms), and beliefs and attitudes toward health and medical care, including fears of aging and death. Statistical analysis of the results revealed that amplification was most strongly related to hypochondriasis, followed by fear of aging and a childhood history of illness. It was also observed that men who are not married are more likely to be hypochondriacal than those who are, while among women, being married was more closely related to hypochondriasis. In addition to excessive sensitivity to bodily symptoms, it appears that hypochondriacs are also more disturbed by such sensations as noise, heat and hunger, and are less tolerant of experimentally induced pain. The authors caution that these findings should not be interpreted to imply a causal connection between amplification and hypochondriasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Although there are now several million traumatized refugees in the world, knowledge about ways to help them function best psychologically is far from complete. Information is needed about the kinds of mental health problems they experience, the course of mental illness as it may develop, and about the most effective treatments for an extremely diverse group of people. Psychiatric patients from three Indochinese ethnic groups (Cambodian, Hmong/Laotian, and Vietnamese) were evaluated before and after a six-month treatment program. The treatment consisted of psychotropic medication, counselling, social service support, and psychiatric help, with additional aid provided by an Indochinese mental health worker. Patients were seen weekly by this team. Cambodian patients had been the most highly traumatized group, Vietnamese the least. Patients with posttraumatic stress disorder (PTSD, a condition resulting from exposure to extreme, inescapable trauma or violence) had higher anxiety and depression scores than those without PTSD, both before and after treatment. Cambodian patients experienced some improvement in depressive symptoms, and this type of symptom was more responsive to treatment than anxiety or somatic (bodily) symptoms, such as headache. (In fact, some somatic symptoms actually became more pronounced after treatment). The patients who improved did so not only according to assessment by professionals, but also in terms of their own experience of feeling better. Paradoxically, most symptoms grew worse for the Hmong/Laotian group of patients, a group which had lower literacy and more drug use than the other two. The fact that many tortured and traumatized refugees can improve with informed psychological intervention is encouraging for patient and professional alike. (Consumer Summary produced by Reliance Medical Information, Inc.)

The article refers to research on older employees' absenteeism in the General Foods Company's Walter Baker Chocolate Division, which was conducted by a program at Harvard University School of Public Health's Gerontology and Chronic Disease Unit. Statistics indicate that workers in the 45 to 55 age group had better attendance records. Topics include: data showing the number of absences and days lost for employees by age, gender, and length of absence; absence rates for the company by age and length of absence; and the traditional line of age 45 as a divider for establishing employees' efficiency and nonefficiency.