There is a growing interest in psychiatry and somatic medicine to the cognitive approach in psychology was associated with an increased interest in the psychological and behavioral factors involved in the etiology and pathogenesis of hypochondriacal disorders (HD). Th e paper gives a review of modern psychological approaches to hypochondriasis. First, we analyze the role of psychological phenomena in the diagnostics of HD demonstrating necessity of hierarchical and system relationships between development and dynamics of unexplained somatic symptoms, generalized anxiety and health anxiety. Second, four factors possibly precipitating, triggering or perpetuating disease are analyzed: somatosensory amplifi cation, health anxiety, motivational and personality factors, illness behavior, “hypochondriac” discourse adopted in contemporary society. The dynamics of hypochondriacal symptoms when each of the four factors dominate in the clinical picture is discussed from body regulation psychology approach and cultural-historical approach in psychosomatics. Possibilities of developing and validating a psychological model of hypochondriasis are suggested.