DSM-II

In DSM-II, this disorder is called Hypochondriacal neurosis

This condition is dominated by preoccupation with the body and with fear of presumed diseases of various organs. Though the fears are not of delusional quality as in psychotic depressions, they persist despite reassurance. The condition differs from hysterical neurosis in that there are no actual losses or distortions of function.

DSM-III

In DSM-III, this disorder is called Hypochondriasis (or Hypochondriacal Neurosis)

Diagnostic Criteria

A. The predominant disturbance is an unrealistic interpretation of physical signs or sensations as abnormal, leading to preoccupation with the fear or belief of having a serious disease.

B. Thorough physical evaluation does not support the diagnosis of any physical disorder that can account for the physical signs or sensations or for the individual's unrealistic interpretation of them.

C. The unrealistic fear or belief of having a disease persists despite medical reassurance and causes impairment in social or occupational functioning.

D. Not due to any other mental disorder such as Schizophrenia, Affective Disorder, or Somatization Disorder.

Differential Diagnosis

True organic disease

The most important differential diagnostic consideration is true organic disease, such as early stages of neurological disorders (e.g., multiple sclerosis), endocrine diosrders (e.g., thyroid or parathyroid disease), and illnesses that frequently affect multiple body systems (e.g., systemic lupus erythematosis). However, the presence of true organic disease does not rule out the possibility of coexisting Hypochondriasis.

Psychotic disorders

In some psychotic disorders, such as Schizophrenia and Major Depression with Psychotic Features, there may be somatic delusions of having a disease. In Hypochondriasis the belief of having a disease generally does not have the fixed quality of a true somatic delusion in that usually the individual with Hypochondriasis can entertain the possibility that the feared disease is not present. The symptoms of hypochondriacal preoccupation may be present in psychotic disorders, in which case the additional diagnosis of Hypochondriasis is not made.

Other mental disorders

In Dysthymic Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, and Somatization Disorder the symptom of hypochondriacal preoccupation may appear, but generally it is not the predominant disturbance. In Somatization Disorder there tends to be preoccupation with symptoms rather than fear of having a specific disease or diseases. When the criteria for any of these disorders are met and the hypochondriacal preoccupation is due to one of these disorders, the additional diagnosis of Hypochondriasis is not made.

DSM-IV

In DSM-IV, this disorder is called Hypochondriasis

Diagnostic Criteria

A. 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 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

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.

Differential Diagnosis

General medical condition

The most important differential diagnostic consideration in Hypochondriasis is an underlying general medical condition, such as the early stages of neurological conditions (e.g., multiple sclerosis or myasthenia gravis), endocrine conditions (e.g., thyroid or parathyroid disease), diseases that affect multiple body systems (e.g., systemic lupus erythematosus), and occult malignancies. Although the presence of a general medical condition does not rule out the possibility of coexisting Hypochondriasis, transient preoccupations related to a current general medical condition do not constitute Hypochondriasis. Somatic symptoms (e.g., abdominal pain) are common in children and should not be diagnosed as Hypochondriasis unless the child has a prolonged preoccupation with having a serious illness. However, the onset of health concerns in old age is more likely to be realistic or to reflect a Mood Disorder rather than Hypochondriasis.

Other mental disorders

Hypochondriasis is diagnosed only when the individual's health concerns are not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety Disorder, or another Somatoform Disorder. Individuals with Hypochondriasis may have intrusive thoughts about having a disease and also may have associated compulsive behaviors (e.g., asking for reassurances). A separate diagnosis of Obsessive-Compulsive Disorder is given only when the obsessions or compulsions are not restricted to concerns about illness (e.g., checking locks). In Body Dysmorphic Disorder, the concern is limited to the person's physical appearance. In contrast to a Specific ("disease") Phobia in which the individual is fearful of being exposed to a disease, Hypochondriasis is characterized by a preoccupation that one has the disease.

Psychotic Disorders

In Hypochondriasis, the disease conviction does not reach delusional proportions (i.e., the individual can entertain the possibility that the feared disease is not present), as opposed to somatic delusions that can occur in Psychotic Disorders (e.g., Schizophrenia, Delusional Disorder, Somatic Type, and Major Depressive Disorder, With Psychotic Features).

DSM-5

Diagnostic Criteria

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 perform excessive health-related behaviors (e.g., repeated 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.

Specify whether:

  • Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
  • Care-avoidant type: Medical care is rarely used.

Differential Diagnosis

Other medical conditions

The first differential diagnostic consideration is an underlying medical condition, including neurological or endocrine conditions, occult malignancies, and other diseases that affect multiple body systems. The presence of a medical condition does not rule out the possibility of coexisting illness anxiety disorder. If a medical condition is present, the health-related anxiety and disease concerns are clearly disproportionate to its seriousness. Transient preoccupations related to a medical condition do not constitute illness anxiety disorder.

Adjustment disorders

Health-related anxiety is a normal response to serious illness and is not a mental disorder. Such nonpathological health anxiety is clearly related to the medical condition and is typically time-limited. If the health anxiety is severe enough, an adjustment disorder may be diagnosed. However, only when the health anxiety is of sufficient duration, severity, and distress can illness anxiety disorder be diagnosed. Thus, the diagnosis requires the continuous persistence of disproportionate health-related anxiety for at least 6 months.

Somatic symptom disorder

Somatic symptom disorder is diagnosed when significant somatic symptoms are present. In contrast, individuals with illness anxiety disorder have minimal somatic symptoms and are primarily concerned with the idea they are ill.

Anxiety disorders

In generalized anxiety disorder, individuals worry about multiple events, situations, or activities, only one of which may involve health. In panic disorder, the individual may be concerned the the panic attacks reflect the presence of a medical illness; however, although these individuals may have health anxiety, their anxiety is typically very acute and episodic. In illness anxiety disorder, the health anxiety and fears are more persistent and enduring. Individuals with illness anxiety disorder may experience panic attacks that are triggered by their illness concerns.

Obsessive-compulsive and related disorders

Individuals with illness anxiety disorder may have intrusive thoughts about having a disease and also may have associated compulsive behaviors (e.g., seeking reassurance). However, in illness anxiety disorder, the preoccupations are usually focused on having a disease, whereas in obsessive-compulsive disorder (OCD), the thoughts are intrusive and are usually focused on fears of getting a disease in the future. Most individuals with OCD have obsessions or compulsions involving other concerns in addition to fears about contracting disease. In body dysmorphic disorder, concerns are limited to the individual's physical appearance, which is viewed as defective or flawed.

Major depressive disorder

Some individuals with a major depressive episode ruminate about their health and worry excessively about illness. A separate diagnosis of illness anxiety disorder is not made if these concerns occur only during major depressive episodes. However, if excessive illness worry persists after remission of an episode of major depressive disorder, the diagnosis of illness anxiety disorder should be considered.

Psychotic disorders

Individuals with illness anxiety disorder are not delusional and can acknowledge the possibility that the feared disease is not present. Their ideas do not attain the rigidity and intensity seen in the somatic delusions occurring in psychotic disorders (e.g., schizophrenia; delusional disorder, somatic type; major depressive disorder, with psychotic features). True somatic delusions are generally more bizarre (e.g., that an organ is rotting or dead) than the concerns seen in illness anxiety disorder. The concerns seen in illness anxiety disorder, though not founded in reality, are plausible.

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