Illness anxiety disorder: Epidemiology, clinical presentation, assessment, and diagnosis
- James L Levenson, MD
James L Levenson, MD
- Professor of Psychiatry, Medicine, and Surgery
- Virginia Commonwealth University School of Medicine
Illness anxiety disorder is characterized by excessive concern about having or developing a serious, undiagnosed general medical disease . The patient’s distress comes primarily from an unfounded fear of having a disease rather than physical symptoms, and persists despite appropriate physical examination and laboratory testing that are negative. Physical symptoms are not present, or they are minimal and often represent a misperception of normal bodily sensations. Illness anxiety disorder is usually chronic. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosis of illness anxiety disorder conceptually overlaps with the prior Diagnostic and Statistical Manual, Fourth Edition, Text Revision, diagnosis of hypochondriasis [1,2].
This topic reviews the epidemiology, pathogenesis, clinical presentation, assessment, diagnosis, and differential diagnosis of illness anxiety disorder. Treatment and prognosis of illness anxiety disorder, and the clinical features, medical evaluation, and treatment of somatization are discussed elsewhere. (See "Illness anxiety disorder: Treatment and prognosis" and "Somatization: Epidemiology, pathogenesis, clinical features, medical evaluation, and diagnosis" and "Somatization: Treatment and prognosis".)
TERMINOLOGY AND DSM-5
Illness anxiety disorder is a diagnosis (table 1) that was introduced with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013 . The clinical features and diagnostic criteria are discussed elsewhere in this topic. (See 'Clinical presentation' below and 'Diagnosis' below.)
Illness anxiety disorder was derived in part from the diagnosis of hypochondriasis, which was eliminated from DSM-5. In DSM-5, patients previously diagnosed with hypochondriasis are nearly always diagnosed with either somatic symptom disorder (if physical complaints are prominent) or illness anxiety disorder (if physical complaints are minimal or nonexistent). Although relatively few studies of illness anxiety disorder have been published, there is a larger literature on the symptom of health anxiety, defined as persistent unrealistic worry or conviction about having an illness. The spectrum of health anxiety ranges from none to severe, with the severe end representing a clinical endpoint (such as illness anxiety disorder or hypochondriasis) [3-5].
In the previous edition of the Diagnostic and Statistical Manual (Fourth Edition, Text Revision; DSM-IV-TR), the term hypochondriasis (table 2) described patients who misinterpreted one or more bodily symptoms and believed that they had a serious disease or were preoccupied with fear of a disease, despite appropriate medical evaluation and reassurance . Both the DSM-IV-TR diagnosis of hypochondriasis and the DSM-5 diagnosis of illness anxiety disorder include patients who believe that they have a serious disease or are preoccupied with fear of a disease, despite a normal physical examination, negative tests, and reassurance [1,2].
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- TERMINOLOGY AND DSM-5
- Genetics and biological correlates
- CLINICAL PRESENTATION
- Comorbid psychopathology
- Course of illness
- When to suspect the disorder
- DIFFERENTIAL DIAGNOSIS
- General medical disorders
- Psychiatric disorders