Illness Anxiety Disorder - DSM-5

Diagnostic Criteria

a) preoccupation with having or acquiring a serious illness

b) somatic symptoms aren’t present or are only mild. if another medical condition is present or there’s a high risk of developing a condition, the preoccupation is excessive / disproportionate

c) individual has high level of anxiety about health + is easily alarmed about their personal health status

d) performance of excessive health-related behaviours or maladaptive avoidance

e) preoccupation has lasted for at least 6 mos — feared illness may have changed during that time

f) not better explained by another mental disorder such as somatic symptom disorder, panic disorder, generalised anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder somatic type

Specifiers

• care-seeking type: medical care is frequently used

• care-avoidant type: medical care is rarely used

Associated Features

• more likely to be found in medical settings than MH settings

• have extensive but unsatisfactory history of medical care

• consult multiple doctors for the same problem + obtain consistently negative diagnostic results

• often feel like doctors aren’t taking them seriously

• may be too anxious to seek medical condition in a minority of cases

Prevalence

• new diagnosis so not much info

• 1.3 - 10% of genpop

• no gender diffs

• study in specialty medical clinics found ~20% of pts experienced illnesss anxiety disorder

Development + Course

• unclear

• generally considered chronic, episodic, + relapsing

• onset usually in early / middle adulthood

• rare in children

Risk Factors

• family members experiencing health anxieties

• had serious illness as child or sibling with serious medical condition

• having another anxiety disorder

• reviewing health-related materials on the internet for long periods of time

Differential Diagnosis: Somatic Symptom Disorder

main difference is experience of somatic symptoms — if someone has anything more severe than mild somatic symptoms related to health concerns but with no evidence of a medical cause, that indicates somatic symptom disorder

previous study found that people w/ prev. diagnosis of hypochondriasis (split into illness anxiety disorder + somatic symptom disorder in DSM-5) rarely experience both (~8%)

Treatments

• CBT seen as gold standard

  • identify fears + beliefs abt having a serious medical illness, learn alternate ways to look at body sensations by changing unhelpful thoughts

• SSRIs as secondary treatment