Notes on some non-psychotic hypochondriacal states

The aim of this paper is to propose a psychodynamic hypothesis based on control-mastery theory (CMT) about the self-punishment function of some non-psychotic hypochondriacal states. After a review of several major psychoanalytic hypotheses about hypochondria, we will show the main concepts of CMT, an integrative, relational, cognitive-dynamic theory of mental functioning, psychopathology, and therapeutic process that is the theoretical framework that has helped us understand and treat these states in our patients. We will then describe two clinical cases to show how some hypochondriacal states can be interpreted as self-punishments connected to three main kinds of guilt hypothesized by CMT: survivor guilt, burdening guilt, and separation/disloyalty guilt. Finally, we will discuss the implications of these hypotheses.