hypochondriasis diagnosis criteria

Diagnosis

It is not presently clear whether hypochondriasis is a true independent, discrete, and cohesive diagnostic category.

The scientific examination of hypochondriasis has been problematic for several reasons. First, hypochondriacal patients often present themselves to general medical settings rather than to psychiatric settings. Second, hypochondriasis tends to be a condition that falls between medicine and psychiatry. Third, the lack of clarity and knowledge about hypochondriasis reflects modern medicine’s emphasis on disease rather than illness. On a positive note, there has been a significant increase in empirical attention to this topic in the last 10 years.

Despite their best intentions, internists and general practitioners are not equipped to handle these cases. Even among psychiatrists, who are more interested in hypochondriasis than internists and general practitioners, there has been some degree of controversy. For example, hypochondriasis was not included in DSM-I. Hypochondriasis was first included in DSM-II and has remained the same until DSM-IV, but hypochondriasis was moved from the neurosis section in DSM-II to the somatoform section in DSM-III where it has remained. DSM-III-R added a 6month duration requirement before the diagnosis of hypochondriasis could be given. DSM-IV includes the specifier ‘‘poor insight’’ when the person does not recognize that the concern of serious illness for most of the duration of a hypochondriacal symptom is exaggerated or unreasonable. Table 3 presents the DSM-IV criteria for hypochondriasis.

Clinical Description.Although not data based, Nemiah presents an excellent description of the clinical aspects of hypochondriasis. Hypohondriacal symptoms are often diffuse and involve many areas of the body. As observed in Kenyon’s study, the abdomen, viscera, chest, head, and neck are the areas most commonly affected. Patients commonly experience a general bodily sense of fatigue or malaise. A patient’s symptoms typically arise from a heightened awareness of normal bodily functions (i.e., bowel movements or heartbeats).

Patients with hypochondriacal concerns usually present their complaints at great length and may even exhibit what may look like pressured speech. The clinical encounter with the hypochondriac can be characterized more as a monologue than as a dialogue. Hypochondriacal patients’ thoughts and speech are entirely centered around their symptomatology, and any attempt by the clinician to discuss anything else is resisted. These patients are very well versed in medical terminology, which makes them more likely to try to manage their medical care instead of following the clinician’s recommendations. Doctor–patient relationships tend to be difficult and rife with tension and hostility on both sides. Unlike patients with conversion disorder, who may show a lack of concern, hypochondriacal patients are very worried and anxious about their symptoms. Frequently, hypochondriacal patients present symptomatology that is out of proportion to the medical findings.