Fast Five Quiz: Are You Prepared to Treat Patients With Illness Anxiety Disorder?

Stephen Soreff, MD

Disclosures

May 01, 2018

The DSM-5 criteria for illness anxiety disorder are as follows:

  • The individual is preoccupied with having or acquiring a serious illness.

  • 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 of developing a medical condition (eg, strong family history is present), the preoccupation is clearly excessive or disproportionate.

  • The individual has a high level of anxiety about health and is easily alarmed about personal health status.

  • The individual performs excessive health-related behaviors or exhibits maladaptive avoidance.

  • The individual has been preoccupied with illness for at least 6 months.

  • The individual's preoccupation is not better explained by another mental disorder.

The thought content of individuals with illness anxiety disorder is typically as follows:

  • Preoccupation with being ill

  • Anxious themes concerning what in the body is wrong, how it is wrong, and how it is experienced

  • May have feelings of despair and/or hopelessness, although these are not usually of significant depth unless little relief has come from seeing multiple providers and/or the patient is concurrently depressed

  • Catastrophizing tendencies (focused on dire consequences of various symptoms and obtaining more diagnostic testing; patient views the medical diagnosis as a death sentence)

  • Uninterested in revealing other aspects of daily functioning or general lifestyle topics at length

  • Inflexibility regarding bodily concerns but only rarely to the point of a delusion (ie, fixed, false belief that does not yield to reason) and, if so, limited to somatic complaints rather than grandiose or persecutory complaints

  • No perceptual disturbances (eg, hallucinations)

  • No suicidal ideation, unless concurrently depressed

  • No homicidal ideation

General appearance, behavior, and speech of individuals with illness anxiety disorder is typically as follows:

  • Modestly or well groomed, not grossly disheveled (care about their appearance)

  • Cooperative with the examiner yet ill at ease and not easily reassured

  • Possible signs of anxiety, including moist hands, perspiring forehead, strained/tremulous voice, and wide eyes and intense eye contact

Cognitive function in individuals with illness anxiety disorder is typically as follows:

  • Attentive

  • Oriented fully to time, place, and person

  • Rare difficulties with concentration, memory, and other faculties but functions in the normative range with refocusing and encouragement

  • May have some deficits if concurrently depressed; these also tend to be overcome in response to encouragement

  • Of note, may have selective attention (eg, the patient is distressed by an ongoing bodily complaint but not by a newly sprained ankle)

For more on the presentation of illness anxiety disorder, read here.

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