Illness anxiety disorder

Background

  • A preoccupation with having or acquiring a serious, undiagnosed medical illness. Previously referred to as hypochondriasis.

Clinical Features

  • A. Preoccupation with having or acquiring a serious illness.[1]
  • B. Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
  • C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
  • D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
  • E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
  • F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmor­phic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Differential Diagnosis

Evaluation

  • Difficult to diagnose, as often a diagnosis of exclusion. Refer to the patient's medical record for indication of repeated visits or recurrent testing.

Management

  • Reassure patient, but set clear, reasonable boundaries on extent of workup to be provided in the ED
  • Close outpatient psychotherapy focused on establishing and maintaining a relationship with the patient.

Disposition

  • Discharge

See Also

External Links

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Authors:

Claire, Matin Shah