Diagnostic criteria for 300.7 Hypochondriasis

300.7 Hypochondriasis

A. The preoccupation with fears of having, or the idea that one has, a serious disease based on the person’s misinterpretation of bodily symptoms.

B. The preoccupation persists despite appropriate medical evaluation B. and reassurance.

C. The belief in Criterion A is not of delusional intensity (as in Delusional Disorder, Somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).

D. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

E. The duration of the disturbance is at least 6 months.

F. The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

Specify if:

With Poor Insight: if, for most of the time during the current episode, the person does not recognize that the concern about having a serious illness is excessive or unreasonable.

Diagnostic Features

The essential feature of Hypochondriasis is preoccupation with fears of having, or the idea that one has, a serious disease based on a misinterpretation of one or more bodily signs or symptoms (Criterion A). A thorough medical evaluation does not identify a general medical condition that fully accounts for the person’s concerns about disease or for the physical signs or symptoms (although a coexisting general medical condition may be present). The unwarranted fear or idea of having a disease persists despite medical reassurance (Criterion B). However, the belief is not of delusional intensity (i.e., the person can acknowledge the possibility that he or she may be exaggerating the extent of the feared disease, or that there may be no disease at all). The belief is also not restricted to a circumscribed concern about appearance, as seen in Body Dysmorphic Disorder (Criterion C). The preoccupation with bodily symptoms causes clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion D) and lasts for at least 6 months (Criterion E). The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major
Depressive Episode, Separation Anxiety, or another Somatoform Disorder (Criterion F).

The preoccupation in Hypochondriasis may be with bodily functions (e.g., heartbeat, sweating, or peristalsis); with minor physical abnormalities (e.g., a small sore or an occasional cough); or with vague and ambiguous physical sensations (e.g., “tired heart,”"aching veins”). The person attributes these symptoms or signs to the suspected disease and is very concerned with their meaning, authenticity, and etiology. The concerns may involve several body systems, at different times or simultaneously. Alternatively, there may be preoccupation with a specific organ or a single disease (e.g., fear of having cardiac disease). Repeated physical examinations, diagnostic tests, and reassurance from the physician do little to allay the concern about bodily disease or affliction. For example, an individual preoccupied with having cardiac disease will not be reassured by the repeated lack of findings on physical examination, ECG, or even cardiac angiography. Individuals with Hypochondriasis may become alarmed by reading or hearing about disease, knowing someone who becomes sick, or from observations, sensations, or occurrenceswithin their own bodies. Concern about the feared illness often becomes a central feature of the individual’s self-image, a topic of social discourse, and a response to life stresses.

Specifier

With Poor Insight. This specifier is used if, for most of the time during the current episode, the individual
does not recognize that the concern about having a serious illness is excessive or unreasonable.

Associated Features and Disorders

Associated descriptive features and mental disorders.

Fears of aging and death are common. Although individuals with Hypochondriasis place greater importance on physical health, they generally have no better health habits (e.g., healthy diet, regular exercise, avoidance of smoking) than individuals without the disorder. The medical history is often presented in great detail and at length in Hypochondriasis.

“Doctor-shopping” and deterioration in doctor-patient relationships, with frustration and anger on both sides, are common. Individuals with this disorder often believe that they are not getting proper care and may strenuously resist referral to mental health professionals. Complications may result from repeated diagnostic procedures that carry their own risks and are costly. However, because these individuals have a history of multiple complaints without a clear physical basis, they may receive cursory evaluations and the presence of a general medical condition may be missed. Social relationships become strained because the individual with Hypochondriasis is preoccupied with his or her condition and often expects special treatment and consideration. Family life may become disturbed as it becomes centered around the individual’s physical well-being. Often, the preoccupation interferes with job performance and causes the person to miss time from work. In more severe cases, the individual with Hypochondriasis may become a complete invalid.

Serious illnesses, particularly in childhood, and past experience with disease in a family member are associated with the occurrence of Hypochondriasis. Psychosocial stressors, in particular the death of someone close to the individual, are thought to precipitate the disorder in some cases. Individuals with Hypochondriasis often have other mental disorders (particularly Anxiety, Depressive, and other Somatoform Disorders).

Associated laboratory findings.

Laboratory findings do not confirm the individual’s preoccupation.

Associated physical examination findings and general medical conditions.

Physical examination findings do not confirm the individual’s preoccupation.

Specific Culture and Gender Features

Whether it is unreasonable for the preoccupation with disease to persist despite appropriate medical evaluation and reassurance must be judged relative to the individual’s cultural background and explanatory models. The diagnosis of Hypochondriasis should be made cautiously if the individual’s ideas about disease have been reinforced by traditional healers who may disagree with the reassurances provided by medical evaluations. Findings with respect to age and gender differences in prevalence are inconsistent, but the disorder occurs across the lifespan in both men and women.

Prevalence

The prevalence of Hypochondriasis in the general population is 1%–5%. Among primary care outpatients,
estimates of current prevalence range from 2% to 7%.

Course

Hypochondriasis can begin at any age, with the most common age at onset thought to be in early adulthood. The  course is usually chronic, with waxing and waning symptoms, but complete recovery sometimes occurs. It appears that acute onset, brief duration, mild hypochondriacal symptoms, the presence of general medical comorbidity, the absence of a comorbid mental disorder, and the absence of secondary gain are favorable prognostic indicators.

Because of its chronicity, some view this disorder as having prominent “traitlike” characteristics (i.e., a
long-standing preoccupation with bodily complaints and focus on bodily symptoms).