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.
• 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

• Panic disorder
• Generalized anxiety disorder
• Depressive disorders
• Factitious disorder
• Somatic symptom disorder
• Malingering
• Conversion disorder
• Delusional disorder
• Body dysmorphic disorder
• Obsessive-compulsive disorder

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

• Factitious disorder
• Somatic symptom disorder
• Conversion disorder