Somatic symptom disorder. Somatic symptom disorder is diagnosed when significant somatic symptoms are present. In contrast, individuals with illness anxiety disorder have minimal somatic symptoms and are primarily concerned with the idea they are ill.
Anxiety disorders. In generalized anxiety disorder, individuals worry about multiple events, situations, or activities, only one of which may involve health. In panic disorder, the individual may be concerned that the panic attacks reﬂect the presence of a medical ill- ness; however, although these individuals may have health anxiety, their anxiety is typi- cally very acute and episodic. In illness anxiety disorder, the health anxiety and fears are more persistent and enduring. Individuals with illness anxiety disorder may experience panic attacks that are triggered by their illness concerns.
Obsessive-compulsive and related disorders. Individuals with illness anxiety disor- compulsive behaviors (e.g., seeking reassurance). However, in illness anxiety disorder, the preoccupations are usually focused on having a disease, whereas in obsessive-compulsive disorder (OCD), the thoughts are intrusive and are usually focused on fears of getting a disease in the future. Most individuals with 0CD have obsessions or compulsions involv- ing other concerns in addition to fears about contracting disease. In body dysmorphic dis- order, concerns are limited to the individual’s physical appearance, which is viewed as defective or ﬂawed.
Major depressive disorder. Some individuals with a major depressive episode rumi- nate about their health and worry excessively about illness. A separate diagnosis of illness anxiety disorder is not made if these concerns occur only during major depressive epi- sodes. However, if excessive illness worry persists after remission of an episode of major depressive disorder, the diagnosis of illness anxiety disorder should be considered.
Psychotic disorders. Individuals with illness anxiety disorder are not delusional and can acknowledge the possibility that the feared disease is not present. Their ideas do not attain the rigidity and intensity seen in the somatic delusions occurring in psychotic dis- orders (e.g., schizophrenia; delusional disorder, somatic type; major depressive disorder, with psychotic features). True somatic delusions are generally more bizarre (e.g., that an organ is rotting or dead) than the concerns seen in illness anxiety disorder. The concerns seen in illness anxiety disorder, though not founded in reality, are plausible.
Because ilhiess anxiety disorder is a new disorder, exact comorbidities are unknown. Hy- pochondriasis co—occurs with anxiety disorders (in particular, generalized anxiety disor- der, panic disorder, and OCD) and depressive disorders. Approximately two-thirds of individuals with illness anxiety disorder are likely to have at least one other comorbid ma- jor mental disorder. Individuals with illness anxiety disorder may have an elevated risk for somatic symptom disorder and personality disorders.
A. One or more symptoms of altered voluntary motor or sensory function.
B. Clinical findings provide evidence of incompatibility between the symptom and recog- nized neurological or medical conditions.
C. The symptom or deficit is not better explained by another medical or mental disorder.
D. The symptom or deticit causes clinically significant distress or impairment in social, oc- cupational, or other important areas of functioning or warrants medical evaluation.
Coding note: The |CD-9-CM code for conversion disorder is 300.11, which is assigned regardless of the symptom type. The |CD-10-CM code depends on the symptom type (see below).