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health anxiety disorder and diagnosis

Definition and diagnosis

Diagnosis using DSM IV (APA 1994) is often through the use of hyponchondriasis, a somatoform disorder. A pattern of recurring, clinical complaints, which result in clinical assessment and intervention or cause significant impairments in social, occupational or other areas of functioning occur. DSM IV diagnostic criteria for hyponchondriasis requires six criteria to be present:

1 The person is preoccupied with fears of having, or the idea of having, a serious disease based on the person’s misinterpretation of bodily symptoms;

2 The preoccupation persists despite appropriate medical evaluation and reassurance;

3 The belief is not of delusional intensity and is not restricted to a concern about appearance (i.e. BDD);

4 The preoccupation causes clinically significant distress or impairment in social, occupational or other important areas of functioning;

5 The duration of the disturbance is at least six months;

6 The preoccupation is not better accounted for by GAD, OCD disorder, a major depressive episode, separation anxiety or another somatoform disorder. An alternative diagnosis is illness phobia. Illness phobia falls under the category of a specific phobia (other subtype) and is made when a person has a fear and significant avoidance of contracting an illness. The feared illness will usually be consistent, and the feared illness and avoidance of possible stimuli that may cause such an illness does not fluctuate over time (for example, avoidance of asbestos or possible asbestos materials for fear of developing cancer). A range of current societal fears regarding specific or ‘new’ illnesses can influence such illness phobias. Marks  suggests that phobias of specific illnesses reflect those worries, which are fashionable either in the culture at large or in the family subculture.

Illness-related fears cause many diagnostic problems and there are a number of differing views regarding whether it is a separate disorder (illness phobia) or part of a hypochondriachal disorder. Marks  distinguishes between illness phobia and hypochondriasis: ‘Where the fears concern multiple bodily symptoms and a variety of illnesses we speak of hypochondriasis. When the fear persistently focuses on a single symptom or illness in the absence of another psychiatric disorder the term illness phobia is appropriate: it is the focal form of hypochondriasis’.

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