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Hypochondria is a psychopathological [[formation ]] whose locus of [[suffering]], [[anxiety]], or even (fantasized) erasure is the [[body ]] or one of its parts or functions, even though the [[symptoms ]] in most cases appear to have no [[material ]] [[cause]]. Symptoms can range from minor, transient forms to massive, debilitating forms. Despite some strong lines of evidence pointing toward a link with various specific [[structural ]] organizations of the [[psyche]], hypochondria is currently seen as transnosographic, as [[present ]] as an element in a neuropsychosis or preceding certain [[psychoses]].

For centuries, hypochondria has challenged [[medicine]], [[philosophy]], and even [[religion]]. Some ancient lines of inquiry are echoed by modern investigations, notably on the enigmatic link between psyche and soma and on similarities between hypochondria and [[melancholia]]. The [[absence ]] of any material [[organic ]] cause has elicited a variety of hypotheses from [[psychoanalysts]], including accounts of pathogenicity that extend to [[delusions ]] in the [[subject]].

Has the enigma of hypochondria been fully deciphered by contemporary [[psychoanalysis]]? [[Freud ]] acknowledged this poorly [[understood ]] disorder as an awkward gap in his theories. Later it was deemed surprising that hypochondriacs had been the [[object ]] of so little [[psychoanalytic ]] research, but in the 1990s there were a [[number ]] of studies on the topic. One [[reason ]] that psychoanalysis has paid little attention to hypochondria is that the autocratic attitude of hypochondriacs has made [[analysts ]] unreceptive to types of [[transference ]] unconducive to [[analytic ]] [[listening]]. However, a broadening of [[treatment ]] indications seems to have made psychoanalysis more receptive to hypochondriacs, and this has allowed psychoanalysis to draw conclusions from [[them ]] that go beyond Freud's hypotheses. It is also [[true ]] that hypochondriacal [[behavior ]] can emerge in the course of any treatment, as a [[displacement ]] or means of [[discharge ]] when the [[patient]]'s psyche is placed under stress.

Freud encountered hypochondria early on in his [[work]]. On the basis of the semantics and nosology of his era as well as his own theories, he placed hypochondria among the pure forms of "actual [[neurosis]]," alongside neurasthenia and [[anxiety neurosis]], and thus [[outside ]] of the realm of the defensive neuropsychoses. His description of the actual [[neuroses ]] contains the same elements as hypochondria: the patient's representational [[contents ]] have a basis in current [[reality ]] and not in what has been [[repressed ]] into the [[unconscious]]; the patient's meaningful contents or unconscious overdeterminations capable of [[being ]] [[symbolized ]] do not indicate an [[internal ]] [[conflict ]] with current reality.

In "On [[Narcissism]]: An Introduction" (1914c), Freud revised his account of hypochondria in light of his [[theory ]] that the [[libido ]] is [[divided ]] into the object-libido and the ([[narcissistic]]) ego-libido. He placed ([[bodily]]) ego-libido, the realm of hypochondriacal anxiety, in opposition to object libido, the realm of [[neurotic ]] anxiety. As a function of this opposition, the more one realm absorbs, the more the [[other ]] is impoverished. Therefore, the [[idea ]] of excessive, dammed-up narcissistic libido is essential to [[understanding ]] hypochondria. The chosen [[organ ]] of hypochondria, which has strong [[erotogenic ]] potential, is nevertheless a source of [[unpleasure]], suffering, and anxiety owing to this increase in tension, this damming up of libido. Many authors have viewed this account, a schematic [[model ]] of [[dynamic ]] energies, as problematic and fraught with questions.

During the same period, Freud tried to [[understand ]] the possible [[relationship ]] between hypochondria and [[paraphrenia]]. In "[[On Narcissism]]: An Introduction" (1914c) he wrote, "We may suspect that the relation of hypochondria to paraphrenia is similar to that of the other 'actual' neuroses to [[hysteria ]] and [[obsessional ]] neurosis: we may suspect, that is, that it is dependent on ego-libido just as the [[others ]] are on object-libido, and that hypochondriacal anxiety is the [[counterpart]], as coming from ego-libido, to neurotic anxiety" (p. 84). In this perspective he viewed hypochondria as the first [[stage ]] in [[delusion ]] and linked it to narcissistic pathologies affecting the body. [[Three ]] years earlier he wondered [[about ]] the connections between hypochondria and [[paranoia]]. For example, in "[[Psycho]]-Analytic [[Notes ]] on an Autobiographical Account of a [[Case ]] of Paranoia ([[Dementia ]] Paranoides)" (1911c [1910]), his [[text ]] on Daniel [[Paul ]] [[Schreber]], he wrote, "I shall not consider any theory of paranoia trustworthy unless it also covers the hypochondriacal symptoms by which that disorder is almost invariable accompanied" (pp. 56-57, n. 3). Freud thus viewed hypochondria as a precursor to [[psychosis ]] and sometimes as an independent condition.

Some authors have [[interpreted ]] hypochondria in [[terms ]] of true projections that are no longer directed outward but instead are directed at the body, like an internal paranoia. In his subsequent writings Freud did not [[return ]] to the comparison with melancholia, nor did he reexamine his hypotheses in light of his second theory of the [[instincts ]] or in terms of the [[concept ]] of primary [[masochism]], as later authors did, thereby somewhat undermining Freud's classification of hypochondria as an actual neurosis.

Many others, notably followers of Melanie [[Klein]], have emphasized the close relationship between hypochondria and melancholic [[depression]]. Others have inferred a masochistic [[dimension ]] or a "locked-up" [[autoerotism]]. In the view of still others, the "hypochondriacal solution," despite its fragile and largely unstructured [[nature ]] and despite being pregnant with the [[death ]] [[instinct]], is the subject's last bastion against [[madness]].

See also: [[Actual neurosis/defense neurosis]]; Body [[image]]; [[Eroticism]], [[anal]]; Erotogenic zone; [[Erotogenicity]]; "On Narcissism: An Introduction"; "Neurasthenia and Anxiety Neurosis"; Organ [[pleasure]]; [[Persecution]]; [[Psychoanalytical ]] nosography.[[Bibliography]]