Bernd Nissen has been developing a metapsychology of hypochondria and ‘autistoid’ states for 20 years, working within the Kleinian object relations tradition to formulate the earliest events of psychic life. His imaginative work shows careful thinking about early catastrophic developmental experiences which may lead to various forms of psychopathology. In the current paper, Hypochondria as an actual neurosis, Nissen extends his progressive work on hypochondria and joins his evolving theory of autistoid encapsulation to a revival of interest in Freud's concept of actual neurosis, the experience of unrepresentable early trauma, the problems of historicization, and to Winnicott's description of the fear of breakdown. I first summarize Nissen's theoretical work in the area of hypochondria and autistoid encapsulation, and then comment on his current paper including the challenge of historicization in unrepresented states. Finally I consider the question of parsimony in Nissen's metapsychology.