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hypochondriasm; illness anxiety disorder

Preoccupation with fear of having a serious disease. Involves one somatic concern* (in contrast to somatoform disorder) Condition must persist for 6 months [4] * that somatic concern might be general health [2] Etiology: 1) commonly associated with depression [3] 2) symptoms considered a form of learned social behavior 3) behavior may be a source of secondary gain [3] Epidemiology: 1) equally frequent in men & women 2) patients are generally older (not true [2]) Pathology: - based on a misinterpretation of bodily symptoms leading to anxious ruminations about disease [3] Clinical manifestations: 1) anxiety 2) few, mild or no somatic symptoms 3) patients are often obsessive 4) excessive rumination 5) generalized fear of having a serious disease persists despite repeated medical evaluation & reassurance 6) reassurance is not willingly accepted even after detailed medical examination Differential diagnosis: 1) delusions 2) depression 3) generalized anxiety disorder - easily fatigued, insomnia, restlessness, impairment (>= 6 months) 4) somatic symptom disorder - characterized by a symptom-specific complaint, such as pain or dysphagia - may be multiple complaints - patient does not ruminate about somatic concern(s) 5) panic disorder - anxiety disorder characterized by discrete intense periods of fear & associated symptoms, worry about additional attacks, change in behavior 6) functional neurologic disorder/conversion disorder - physical symptoms (paralysis, abnormal movement, dysphagia, speech disorder, seizures, sensory impairment) 7) caregiver stress - no generalized fear of serious illness - obsessive behavior not a feature Complications: - psychotic/delusional depression Management: 1) frequent follow-up with brief focused history & physical 2) cognitive behavioral therapy [5,6] 3) treat depression, major depression, psychotic/delusional depression

General

somatoform (psychosomatic) disorder; somatic symptom & related disorders (SSRD)

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1105-1107
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 17. American College of Physicians, Philadelphia 1998, 2015 - Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022
  3. Geriatrics Review Syllabus, American Geriatrics Society, 5th edition, 2002-2004 - Geriatric Review Syllabus, 11th edition (GRS11) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2022
  4. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, DSM-IV-TR, American Psychiatric Association, Washington DC, 2000
  5. Journal Watch 24(8):63, 2004 Barsky AJ & Ahern DK, Cognitive behavior therapy for hypochondriasis: a randomized controlled trial. JAMA 291:1464, 2004 PMID: 15039413
  6. Tyrer P et al Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet, Early Online Publication, 18 October 2013 PMID: 24139977 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61905-4/abstract
  7. Scarella TM, Boland RJ, Barsky AJ. Illness anxiety disorder: psychopathology, epidemiology, clinical characteristics, and treatment. Psychosom Med. 2019;81(5):398-407 PMID: 30920464 https://journals.lww.com/psychosomaticmedicine/Abstract/2019/06000/Illness_Anxiety_Disorder__Psychopathology,.2.aspx
  8. Newby JM, Hobbs MJ, Mahoney AEJ, Wong SK, Andrews G. DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. J Psychosom Res. 2017 Oct;101:31-37. PMID: 28867421