Illness Anxiety Disorder (Hypochondriasis)

Clinical Description

Illness Anxiety Disorder is a new term in the DSM-5, which essentially subsumes the disorder formerly known in DSM-IV as “Hypochondriasis.” The core feature of Illness Anxiety Disorder (DSM-5) or Hypochondriasis (ICD-10) is an excessive concern that one has (or is likely to develop) a serious but undiagnosed physical illness. This belief may occur in response to physiological (i.e., normal) bodily sensations or, when occurring in the context of an actual physical illness, the anxiety is grossly disproportionate to the severity of that illness. Affected individuals only experience a transient reduction in anxiety when test results are normal and when clinicians provide reassurance; anxiety later increases once more, leading to further healthcare seeking.

Illness Anxiety Disorder occurs with similar frequency in men and women and can occur at any age. Point prevalence estimates vary from 1-10% in the background population and may be higher in enriched healthcare environments. Left untreated, the condition can become chronic, ingrained, and difficult to manage. Detailed personal history can be useful; in many cases there may be a history of a close relative or friend having a serious medical condition that was overlooked.

Illness Anxiety Disorder results in considerable distress to affected individuals, but critically can also be extremely functionally impairing. The functional impact of Hypochondriasis (e.g., in terms of elevated unemployment and time off work) can be similar to that of serious medical disorders with known organic bases.

Patients often visit different doctors and keep re-presenting themselves to various family doctors and outpatient clinics, which can be very challenging to healthcare professionals who are faced with a dilemma:

  • 1. Investigate further when there is in fact negligible risk of an underlying physical illness, and thereby provide transient relief for the patient and clinician; or
  • 2. Risk the possibility of being perceived as rejecting the patient by recommending against further investigations
 
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