The Differences Between Hypochondria and OCD
There are disorders that may sound similar to us but that actually have big differences between them. That being said, are you aware of the differences between hypochondria and OCD (obsessive compulsive disorder)?
Hypochondria (now called illness anxiety disorder) is an anxiety spectrum disorder, while OCD (obsessive-compulsive disorder) is an obsessive spectrum disorder. Therefore, both their nature (or typology) and other characteristics differ.
Before going into these differences, let’s know what each of these disorders consists of and what their characteristic symptoms are.
According to the latest edition of the DSM (Diagnostic and Statistical Manual of Mental Disorders ), hypochondria is no longer the term, but the disorder is now known as illness anxiety disorder. Therefore, it falls into the category of anxiety disorders and constitutes a new diagnostic category.
According to a 2017 study by Rodríguez-Quiroga, illness anxiety disorder would explain the symptoms that appear in 25% of patients diagnosed with hypochondria. The disorder involves persistent worry and fear about the possibility of having or developing a serious illness.
The hypochondriac patient (we’ll use hypochondria and disease anxiety disorder interchangeably), interprets any physical symptom as “proof” that they’re suffering from a certain disease (this being serious). Typically, there’s an absence of significant somatic symptoms in patients with this disorder.
DSM-5 defines OCD as a “mental disorder involving the presence of obsessions, compulsions, or both”.
Obsessions are understood to be all those images, impulses, or thoughts that appear in the individual in an intrusive and unwanted way, and that the person tries to neutralize through some mental or behavioral compulsion (ritual).
Therefore, compulsions are all those actions, either on a behavioral or mental level, that the person performs in order to reduce the anxiety caused by the obsessions. A person with OCD may have obsessions, compulsions, or both.
However, as we said, presenting one of these two symptoms is enough to diagnose OCD, as long as these symptoms produce interference or suffering.
The differences between hypochondria and OCD
What differences between hypochondria and OCD can we find? We’ll talk about the most relevant:
Typology of the disorder
The first of the differences between hypochondria and OCD is the typology of each disorder. In the case of hypochondria, as we’ve seen, we’re talking about an anxiety-type disorder.
On the other hand, OCD is an obsessive-compulsive spectrum disorder (which we shouldn’t confuse with obsessive personality disorder, also with marked obsessive traits). Therefore, the nature of both disorders (hypochondria and OCD) is very different.
Resistance to thoughts
In hypochondria, or illness anxiety disorder, the patient doesn’t generate resistance toward their thoughts or obsessions about the illness; rather, the individual is carried away by them.
In OCD, the patient does try to resist their obsessive thoughts (obsessions) because they cause them discomfort and because they experience them as intrusive.
Another difference between hypochondria and OCD is the factor that triggers the symptom. In the case of hypochondria, it’s a bodily factor, a physical “symptom” that, in turn, triggers other symptoms such as fear and excessive worry about having a serious illness.
In OCD, sometimes there’s no external trigger that stimulates the obsessions (the compulsions are triggered by an element, in this case, internal: The obsessions).
But sometimes there’s an external factor that triggers obsessions, such as cleaning OCD: Seeing something dirty in a house and having the obsessive thought of “I must wash my hands immediately or I’ll be contaminated”.
Communication with the environment
A person who suffers from hypochondria tends to be more communicative with their surroundings when explaining what’s happening to them. As a result, they frequently communicate their fear of developing some disease (or the belief that they already suffer from it).
In fact, hypochondriacs often seek the reaffirmation of their symptoms (or rather, the interpretation of their symptoms) in their environment with questions such as: “Isn’t this a symptom of cancer”? or the like.
In the case of OCD, patients with the disorder tend to be more reluctant to communicate their obsessions and compulsions to their environment because it usually generates fear (of being judged or misunderstood) or shame.
Irrationality of thoughts
In hypochondria, patients identify their symptoms as typical of a certain disease, and that’s what generates fear and concern. They see their thoughts as rational, meaningful, and consistent with their symptoms.
In this way, according to experts, a patient with hypochondria doesn’t usually generate high resistance toward their obsessive thoughts, because they don’t feel them as irrational (as they do in the case of OCD, in which a great resistance to negative thoughts is generated).
Therefore, in OCD, the patient often recognizes the irrationality of their thoughts or obsessions. What happens is that they can’t control them because they’re intrusive thoughts.
The element that produces discomfort
The element that produces discomfort and psychological suffering in the patient varies in each of these disorders and would constitute another difference between hypochondria and OCD. Therefore, in hypochondria, what causes discomfort is the fear of becoming or being ill, derived from an inappropriate and excessive (wrong) interpretation of the physical symptoms.
On the other hand, in OCD, obsessions are what produce discomfort. Therefore, the person resorts to compulsions to alleviate that tension, anxiety, or discomfort.
Obsessions can be of any kind: Ranging from cleaning, checking, or repetition to the fear of committing some harmful act without realizing it… And they’re very irrational.
At the same time, compulsions can also be of any kind; sometimes related to the obsession itself. For example, in cleaning OCD, the compulsions are the act of continually washing, either the hands, the body, etc.
“People have no idea how far they’re driven by fear. This fear isn’t easily definable. There are times when this fear becomes almost an obsession.”
-George Ivanovich Gurdjieff-
As hypochondria and OCD are very different disorders, the treatment of each of them also differs. In OCD, according to the Guide to effective psychological treatments I by Marino Pérez et al. (2010), there are two treatments of choice: Exposure therapy with response prevention (ERP) and cognitive therapy.
In hypochondria, on the other hand, cognitive-behavioral therapy (one of the most important psychological therapies) is usually used.
The objective of treatment
The goal of treating OCD is to reduce the interference of the obsessions and get the person to stop carrying out the compulsions. In a way, the patient is taught to tolerate discomfort without resorting to compulsions (they come to understand that nothing bad happens to them if they stop performing them).
Patients are educated about the irrationality of their thoughts (although sometimes they already know they’re irrational). In the case of hypochondria, the goal of therapy is to help the patient detect beliefs about their health and to understand how they affect their life.
Subsequently, they’re presented with the alternative that they may be dealing with an anxiety problem, and they’re taught an explanatory model of this pathology (psychoeducation).
Hypochondria and OCD: Two distinct disorders with common elements
We’ve seen some of the differences between hypochondria and OCD, although there are definitely more (for example, their etiology or causes, the type of patient, etc.). It’s true that there’s a type of OCD that may be related to the fear of getting infected or the fear of getting sick, but it’s not the same as hypochondria.
Both disorders have in common the suffering of the patient, although each of them, as we’ve seen, suffers from different causes or symptoms. These disorders share the obsessive trait that characterizes both people with OCD and hypochondriacs.
In hypochondria, worry and obsession are configured around a possible disease (which one doesn’t have), and in OCD, the obsession is articulated around the thought itself (irrational ideas related to any field, which don’t necessarily have to do with illness).It might interest you...
- American Psychiatric Association –APA- (2014). DSM-5. Manual diagnóstico y estadístico de los trastornos mentales. Madrid: Panamericana.
- Avia, M.D. (1993). Hipocondría. Ediciones Martínez Roca S.A., Barcelona.
- Barsky, A. & Ahern, D. (2004). Cognitive behavior therapy for hypochondriasis: a randomized controlled trial, JAMA, 291(12):1464-1470.
- Caballo (2002). Manual para el tratamiento cognitivo-conductual de los trastornos psicológicos. Vol. 1 y 2. Madrid. Siglo XXI.
- Pérez, M., Fernández, J.R., Fernández, C. y Amigo, I. (2010). Guía de tratamientos psicológicos eficaces I: Adultos. Madrid: Pirámide
- Rodríguez-Quiroga, A. (2017). Trastorno de ansiedad por enfermedad: a propósito de un caso. Psiquiatría Biológica, 24(2): 81-84.