Phenomenology of delusional hypochondriasis as a sixth form of somatization in immigrants

Marcella Cavallo, Federica Ferrari, Francesca Raho, Mariarosa Aromatario, Christian Napoli, Massimiliano Aragona

Background. Somatization is frequently observed among migrants, especially in primary care. One problem is that patients with somatization are often different, the same label including different psychopathological syndrome. Previous phenomenological research has identified five different types of somatization syndromes in immigrants (anxious hypochondriasis, somatization with culture playing a pathogenetic role, somatization with pathoplastic effects of culture, somatization in adjustment reactions to migratory living difficulties, and somatization as post-traumatic reaction). This article adds evidence to previous research with a phenomenological description of a sixth type of somatization in immigrants: delusional hypochondriasis.

Methods. The description was based on seven levels: medical examination, description of somatization symptoms, the patients’ interpretation of their somatic experience, associated psychopathological phenomena, genetic understanding, clinician’s interpretation, and course and treatment.

Results. Two cases of delusional hypochondriasis are presented, a man from Africa and a woman from Eastern Europa. The analysis of the cases shows that the understandable basis of the future delusion is the experience of an alarming event that radically changes the trust in the naturalness of the lived bodily experience, as well as the interpersonal trust. It is in this experience of suspension of habitual meanings, with an atmosphere of radical insecurity, that the delusional development starts. The possible role of culture in the way these events are experienced is discussed. Later, progressive jumps of meaning occur, increasing the oddity of the somatic experience, leading to bizarre delusions. The consequences for both psychopathological theory and clinical management are also discussed.