Psychoanalytic of Hypochondriasis

Freud was the earliest proponent of the theory that hypochondriasis was the result of sexual drives. He originally stated that the sexual libido, when withdrawn from external objects, would be redirected to the self in the form of narcissistic libido.

Eventually, the narcissistic libido ‘‘overflows,’’ and the resulting energy is transformed into physical symptoms. Brown and Vaillant conceptualized hypochondriasis as repressed hostility. These authors felt that the disorder arose from anger over having been disappointed, hurt, abandoned, or unloved; rather than openly complain, the individual displaces these thoughts and feelings onto the body. Other analysts thought that hypochondriasis occurred in individuals defending against very low self-esteem and against the experience of the self as worthless, inadequate, and defective.

According to this view, it is easier and more tolerable to feel that something is wrong with one’s body than with oneself. In addition, pain and physical suffering in the hypochondriacal patient can be seen as an atonement, expiation, and deserved punishment for past wrongdoing and the sense that one is evil and sinful.

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