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

Stephen Soreff, MD

Disclosures

May 01, 2018

One difficulty with which physicians struggle is related to the physicians' own emotional reactions to the patient. Typically, physicians feel angry, hopeless, and/or helpless because their assessments and interventions are not effective, and efforts at reassuring the patient are usually met with resistance and even escalation of physical symptoms. These feelings may lead physicians to reject or withdraw from patients with illness anxiety disorder.

As with the other somatoform disorders, inpatient psychiatric hospitalization for the somatoform disorder itself is rarely necessary. If the patient experiences suicidal ideation or makes a suicide act based on comorbid depression or personality disorder or develops uncontrollable anxiety, then an inpatient psychiatric hospitalization may be indicated. In such a case, an illness anxiety disorder diagnosis may be established in the context of an inpatient admission.

Premature reassurance, prescription of psychotropic medications, and referral for mental health services may suggest to the patient that he or she is not being taken seriously. Therefore, while such treatments may be indicated at some time (in the future), prematurely offering a diagnosis or psychiatric treatment may, in fact, impair the establishment of a trusting patient-physician relationship. This premature diagnosis can lead to missing a medical condition.

Acknowledge the patient's pain and suffering. Couple reassurance statements of normal findings with statements that the patient will not be abandoned. For example, "Mr Smith, it appears that you are still having concern about having several medical disorders despite all the workup, which, so far, has not showed any abnormal finding. I will continue to work with you to maximize you overall well-being and health."

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

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