In a sample of 131 patients with panic disorder, we explored both the
presence of DSM-III-R criteria for hypochondriasis and the occurrence
of illness phobia before the onset of panic disorder. To explore furth
er the possible relationship between hypochondriacal features and pani
c-agoraphobic syndrome, we compared patients both with and without cur
rent hypochondriasis and then patients both with and without illness p
hobia before the onset of panic disorder. Finally, we investigated the
relationship between premorbid phobic-anxious traits and hypochondria
sis during panic disorder. No differences were found between patients
with and without hypochondriasis, either in terms of clinical features
or in the course of panic disorder. patients with illness phobia befo
re the onset of panic disorder reported higher levers of anticipatory
anxiety in nonagoraphobic situations and more depersonalization and de
realization during panic attacks, and they met our definition of phobi
c-anxious temperament more frequently than the rest of the sample. Thi
s would suggest that illness phobia before the onset of panic disorder
may be viewed either as a separate disorder, a prodrome, or a mild, e
arly-onset form of panic disorder without full-blown attacks. Although
patients with premorbid illness phobia are more likely to develop hyp
ochondriasis after the onset of panic disorder, approximately 40% of t
hem do not; therefore, illness phobia should not be considered the onl
y factor that influences the development of hypochondriasis during pan
ic disorder. Copyright 1997 by W.B. Saunders Company.