Health anxiety and hypochondriasis in the light of DSM-5

Abstract

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.

Keywords:

• health anxiety
• hypochondriasis
• somatic symptom disorder
• illness anxiety disorder
• symptom attributions
• anxiety sensitivity

Acknowledgment

We are grateful to Dr Julia Ofer, Dr Iris Wollgarten, Dr Stefania Utzeri, Henriette Wagner, and Maja Erkic for their helpful assistance with data collection.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

This study was funded by the German Research Foundation (DFG, BA 1597/5-1,2). The sponsors had no role in the design, execution, interpretation, or decision to publish any aspect of the project.

Additional information

Funding

This study was funded by the German Research Foundation (DFG, BA 1597/5-1,2). The sponsors had no role in the design, execution, interpretation, or decision to publish any aspect of the project.