The relationship between hypochondriacal concerns, as assessed by the
Illness Attitude Scales, and depressive symptoms was examined in a sam
ple of 100 drug-free outpatients with major depressive disorder. These
patients were treated with fluoxetine for 8 weeks, and the effect of
treatment on hypochondriacal symptoms was examined. All patients were
administered the Structured Clinical Interview for DSM-III-R, the Hami
lton Depression Rating Scale, the Symptom Questionnaire, and the Perso
nality Disorders Questionnaire-Revised. We found little relationship b
et ch een severity of depressive symptoms and hypochondriacal concerns
. Measures of anxiety, somatic symptoms, and psychological distress we
re more consistently related to these concerns. Similarly, patients wi
th either histrionic personality disorder or a lifetime history of pan
ic disorder had greater hypochondriacal concerns than patients without
these diagnoses. After open treatment with fluoxetine, the degree of
hypochondriacal concern showed statistically significant decreases, wh
ich were only partly related to the degree of change in depression and
anxiety severity. Our findings suggest that the presence of hypochond
riacal concerns among depressed outpatients is more closely related to
the presence of anxiety than depressive symptoms. The relatively smal
l impact of an acute course of antidepressant treatment on hypochondri
acal concerns in our sample suggests that these concerns may be enduri
ng characteristics modulated only to a limited extent by short term ph
armacological alterations of affective state.