Patients with persistent complaints about somatic symptoms, which cannot be explained by somatic disease, constitute a major healthcare problem. Hypochondriacal paranoia is an important subset of paranoid conditions, which should not be overlooked in patients with persistent hypochondriacal complaints. It is rare, in contrast to illness anxiety disorder or body dysmorphic disorder optionally with insufficient insight. Recent research indicates, that hypochondriacal complaints present a spectrum of evident psychotic conditions over delusion-like complaints to excessive illness anxiety.