Hypochondria: A tentative approach

The author begins his investigation of hypochondria by defining the conditi on and distinguishing between hypochondriacal symptoms and hypochondriacal crises, the latter being stated to arise when the defensive function of the former fails. After an enumeration of the main psychogenetic element obser ved in the psychoanalytic psychotherapy of a sample population of eight pat ients, he concentrates on the psychodynamic and psychostructural aspects an d demonstrates by means of clinical examples how conflicts of separation an d dependence give to oral-sadistic, anal-sadistic and progressive-perverse defensive structures. Although regressive and progressive psychodynamic pro cesses established between these structures may temporarily stabilise the p sychic system to some extent, splits cause them to loom large in a hypochon driacal world full of disintegrative anxiety that is accompanied by an aggr essive excitation pervaded with threatening confusion and sexual perversion , where the patient flees into quasi autistic withdrawal and tormenting sel f-observation. Catastrophic states resulting fron earlier traumas are here fused with more mature psychic elements owing to earlier traumas. The autho r shows how instability in these structures, together with the failure of i mportant ego and superego functions, may lead to a malignant regression and the consequent pathogenic reintrojection of projections. When the psyche i s threatened by a dynamic of this kind, hypochondriacal symptoms may ensure as a last-ditch attempt by the patient to defend against psychic decompens ation.