B. 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 for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or dispro- portionate.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
D. The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doc- tor appointments and hospitals).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmor- phic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.
Specify whether:
Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
Care—avoidant type: Medical care is rarely used.
Most individuals with hypochondriasis are now classified as having somatic symptom disorder; however, in a minority of cases, the diagnosis of illness anxiety disorder applies instead. Illness anxiety disorder entails a preoccupation with having or acquiring a seri- ous, undiagnosed medical illness (Criterion A). Somatic symptoms are not present or, if present, are only mild in intensity (Criterion B). A thorough evaluation fails to identify a serious medical condition that accounts for the individual’s concerns. While the concern may be derived from a nonpathological physical sign or sensation, the individual’s dis- tress emanates not primarily from the physical complaint itself but rather from his or her anxiety about the meaning, significance, or cause of the complaint (i.e., the suspected med- ical diagnosis). If a physical sign or symptom is present, it is often a normal physiological sensation (e.g., orthostatic dizziness), a benign and self—limited dysfunction (e.g., transient tinnitus), or a bodily discomfort not generally considered indicative of disease (e.g., belch- ing). If a diagnosable medical condition is present, the individual’s anxiety and preoccu- pation are clearly excessive and disproportionate to the severity of the condition (Criterion
B). Empirical evidence and existing literature pertain to previously defined DSM hypo- chondriasis, and it is unclear to what extent and how precisely they apply to the descrip- tion of this new diagnosis.
The preoccupation with the idea that one is sick is accompanied by substantial anxiety about health and disease (Criterion C). Individuals with illness anxiety disorder are easily alarmed about illness, such as by hearing about someone else falling ill or reading a health- related news story. Their concerns about undiagnosed disease do not respond to appro— priate medical reassurance, negative diagnostic tests, or benign course. The physician’s at- tempts at reassurance and symptom palliation generally do not alleviate the individual’s concerns and may heighten them. Illness concerns assume a prominent place in the indi- vidual’s life, affecting daily activities, and may even result in invalidism. Illness becomes a central feature of the individual’s identity and self—image, a frequent topic of social dis- course, and a characteristic response to stressful life events. Individuals with the disorder often examine themselves repeatedly (e.g., examining one’s throat in the mirror) (Crite- rion D). They research their suspected disease excessively (e.g., on the Internet) and re- peatedly seek reassurance from family, friends, or physicians. This incessant worrying often becomes frustrating for others and may result in considerable strain within the family. In some cases, the anxiety leads to maladaptive avoidance of situations (e.g., visiting sick family members) or activities (e.g., exercise) that these individuals fear might jeopardize their health.