Hypochondriasis: considerations for ICD-11

Abstract

The World Health Organization (WHO) is currently revisiting the ICD. In the 10th version of the ICD, approved in 1990, hypochondriacal symptoms are described in the context of both the primary condition hypochondriacal disorder and as secondary symptoms within a range of other mental disorders. Expansion of the research base since 1990 makes a critical evaluation and revision of both the definition and classification of hypochondriacal disorder timely. This article addresses the considerations reviewed by members of the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders in their proposal for the description and classification of hypochondriasis. The proposed revision emphasizes the phenomenological overlap with both anxiety disorders (e.g., fear, hypervigilance to bodily symptoms, and avoidance) and obsessive-compulsive and related disorders (e.g., preoccupation and repetitive behaviors) and the distinction from the somatoform disorders (presence of somatic symptom is not a critical characteristic). This revision aims to improve clinical utility by enabling better recognition and treatment of patients with hypochondriasis within the broad range of global health care settings.

The Classification of Anxiety and Fear-Related Disorders in the ICD-11

“…The grouping of disorders specifically associated with stress brings together disorders in which the experience of an identifiable stressor is a requirement (though not sufficient) for manifestation of the condition. For example, hypochondriasis (health anxiety disorder) is a condition characterized by distress and anxiety about bodily symptoms but that is proposed for classification among the ICD-11 grouping of obsessive-compulsive and related disorders based on several lines of evidence, [47,49] but that will also be cross-referenced in the grouping of anxiety and fear-related disorders. These interrelationships are in part communicated by proposing that these groupings be presented adjacently, which is intended to be clinically meaningful rather than the merely historic ordering of groupings in previous editions of the ICD.…”

“…Cross-referencing of specific categories across groupings is also incorporated and is intended to enhance clinical utility. For example, hypochondriasis (health anxiety disorder) is a condition characterized by distress and anxiety about bodily symptoms but that is proposed for classification among the ICD-11 grouping of obsessive-compulsive and related disorders based on several lines of evidence, [47,49] but that will also be cross-referenced in the grouping of anxiety and fear-related disorders. Reification of distinctions between groupings has also been mitigated by the inclusion of practical guidance on how to differentiate between disorders with shared phenomenology as well as by omitting arbitrary non-evidenced based symptom counts or duration thresholds from the disorder guidelines.…”

Hypochondriasis: treatment options for a diagnostic quagmire

“…1 The reactions to the changes introduced by the DSM-5 have been mixed, but mostly negative. [2][3][4] In particular, somatic symptom disorder has been criticised because of its low diagnostic threshold, vague diagnostic criteria and greater conceptual heterogeneity than hypochondriasis. The key issue has been a failure to capture the important features of hypochondriasis (tendency to misinterpret somatic symptoms, belief that the person already has a serious disease and resistance to routine medical reassurance) by the diagnostic criteria for somatic symptom disorder and illness anxiety disorder.…”

Use of Web-Based Health Services in Individuals With and Without Symptoms of Hypochondria: Survey Study (Preprint)

“…The preoccupation is associated with a hypervigilance to and catastrophic misinterpretation of bodily signs or symptoms, including normal or commonplace sensations, and is accompanied by avoidance and/or repetitive behaviors. Minor symptoms are thus interpreted as evidence of suspected diseases, and concerns persist despite of reassurance by physicians [7,8]. Disease conviction can be maintained by repetitive symptom checking or reassurance seeking, including activities on the Internet: retrieving medical information, entering self-observed symptoms into "online diagnostic systems".…”