Hypochondriasis, neuroticism, and aging: When are somatic complaints unfounded?

An analysis of the relation between subjective and objective health provides the framework for an evaluation of the view that medical complaints among the elderly are often unfounded. Naive realist, psychiatric-categoricaL and dimensional models of somatic concern are compared, and it is argued that individuals differ along a continuum from persistent underreporting of symptoms to frank hypochondriasis. Data are presented showing that, even among psy- chiatrically normal individuals, the personality di- mension of neuroticism is systematically related to the number of medical symptoms reported and that neuroticism-related complaints are best viewed as exaggerations of bodily concerns rather than as signs of organic disease. Psychometric data purporting to show that hypochondriasis increases in the elderly are confounded by real health changes with age, and evidence from longitudinal studies shows that where health complaints increase, they probably reflect veridical reports of changing health status. These conclusions have implications for health research, medical diagnosis, and public policy and suggest that the stereotype of old men and women as hypo- chondriacs is unfounded.