Differential Diagnosis
The most important differential diagnostic consideration in Hypochondriasis is an underlying general medical condition, such as the early stages of neurological conditions (e.g., multiple sclerosis or myasthenia gravis), endocrine conditions (e.g., thyroid or parathyroid disease), diseases that affect multiple body systems (e.g., systemic lupus erythematosus), and occult malignancies. Although the presence of a general medical condition does not rule out the possibility of coexisting Hypochondriasis, transient preoccupations related to a current general medical condition do not constitute Hypochondriasis. Somatic symptoms (e.g., abdominal pain) are common in children and should not be diagnosed as Hypochondriasis unless the child has a prolonged preoccupation with having a serious illness. Bodily preoccupations and fears of debility may be frequent in elderly persons. However, the onset of health concerns in old age is more likely to be realistic or to reflect a Mood Disorder rather than Hypochondriasis.
A number of other disorders may be characterized by concerns about health or illness. Hypochondriasis is not diagnosed if the individual’s health concerns are better accounted for by one of these disorders. For example, individuals with Generalized Anxiety Disorder worry about a number of events and activities that may include worries about having a disease. A separate diagnosis of Hypochondriasis should be considered only if the preoccupation with having an illness is the individual’s predominant focus of concern. Some individuals in a Major Depressive Episode will be preoccupied with excessive worries over physical health. A separate diagnosis of Hypochondriasis is not made if these concerns occur only during Major Depressive Episodes. However, depression often occurs secondary to the Hypochondriasis, in which case Hypochondriasis should also be diagnosed.
Individuals with Hypochondriasis may have intrusive thoughts about having a disease and also may have associated compulsive behaviors (e.g., asking for reassurances). A separate diagnosis of Obsessive-Compulsive Disorder is given only when the obsessions or compulsions are not restricted to concerns about illness (e.g., checking locks). Occasionally, individuals with Hypochondriasis experience Panic Attacks that are triggered by hypochondriacal concerns. However, a separate diagnosis of Panic Disorder is made only when recurrent unexpected Panic Attacks are also present. In Body Dysmorphic Disorder, the concern is limited to the person’s physical appearance. In contrast to a Specific (“disease”) Phobia in which the individual is fearful of developing or being exposed to a disease, Hypochondriasis is characterized by a preoccupation that one has the disease.
In Hypochondriasis, the disease conviction does not reach delusional proportions (i.e., the individual can entertain the possibility that the feared disease is not present), as opposed to somatic delusions that can occur in Psychotic Disorders (e.g., Schizophrenia, Delusional Disorder, Somatic Type, and Major Depressive Disorder, With Psychotic Features).