559136 research-article2014
ANP0010.1177/0004867414559136Australian & New Zealand Journal of PsychiatryStarcevic
Letters Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(1) 88–92
Letters
Will hypochondriasis be “alive and well” in the ICD-11? Vladan Starcevic
University of Sydney, Sydney Medical School – Nepean, Discipline of Psychiatry, Sydney, Australia Corresponding author: Vladan Starcevic, Nepean Hospital, Department of Psychiatry, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected] DOI: 10.1177/0004867414559136
To the Editor Aubrey Lewis (1975) famously commented in reference to hysteria that some psychiatric concepts tend to outlive their obituarists. In this regard, is hypochondriasis of the 2010s similar to hysteria of the 1970s? The DSM-5 has controversially discarded hypochondriasis and replaced it with illness anxiety disorder and somatic symptom disorder. This decision has been met with both criticism (Starcevic, 2014) and cautious approval (Tyrer and Tyrer, 2014). While hypochondriasis has been officially “dead” in the United States for more than a year insofar as the DSM-5 is the “law of the land” there, the term has been revived in the proposals for ICD-11. The description of hypochondriasis in the ICD-11 Beta
© The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Draft (available online) is quite similar to the DSM-IV diagnostic criteria for hypochondriasis. Thus, hypochondriasis is depicted as a persistent preoccupation with or fear of the possibility of having a serious disease or the conviction that one is already seriously ill. Misinterpretation of bodily symptoms is also included in the description. Using exactly the same wording as the DSM-IV, it is stipulated that hypochondriasis persists despite appropriate medical evaluation and reassurance. Classifying hypochondriasis has always been challenging. Importantly, the ICD-11 Beta Draft suggests that it should be classified among both obsessive-compulsive and related disorders (OCRD) and “anxiety and fear-related disorders”. The classification of hypochondriasis as an OCRD is due to an emphasis on “preoccupation” in its description, a questionable assumption that preoccupations and obsessions are conceptually related to the point of being almost synonymous and the fact that some cases of hypochondriasis resemble obsessive-compulsive disorder. The conceptualisation of hypochondriasis as an anxiety disorder makes sense when it is primarily characterised by fear and avoidance behaviour, but hypochondriasis could also be grouped along with “bodily distress disorders” when its predominant features are distressing bodily symptoms. Such a “multiple” classification would resemble the DSM-5 classification of schizotypal personality disorder both
Australian & New Zealand Journal of Psychiatry, 49(1)
among personality disorders and schizophrenia spectrum and other psychotic disorders and classification of antisocial personality disorder both as a personality disorder and as one of disruptive, impulse-control and conduct disorders. Although the proposed ICD-11 description and classification of hypochondriasis are not final, it is clear that hypochondriasis possesses a remarkable resilience. Perhaps that is not surprising for an ancient term that has survived many psychiatric perturbations. Indeed, we may still have something to learn from the concept it embodies instead of eliminating it as a presumably useless and politically incorrect term. Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References Lewis AJ (1975) The survival of hysteria. Psychological Medicine 5: 9–12. Starcevic V (2014) Should we deplore the disappearance of hypochondriasis from DSM-5? Australian and New Zealand Journal of Psychiatry 48: 373–374. Tyrer P and Tyrer H (2014) The departure of hypochondriasis is no loss. Australian and New Zealand Journal of Psychiatry 48: 772–773.
ANP0010.1177/0004867414559136Australian & New Zealand Journal of PsychiatryStarcevic
Letters Australian & New Zealand Journal of Psychiatry 2015, Vol. 49(1) 88–92
Letters
Will hypochondriasis be “alive and well” in the ICD-11? Vladan Starcevic
University of Sydney, Sydney Medical School – Nepean, Discipline of Psychiatry, Sydney, Australia Corresponding author: Vladan Starcevic, Nepean Hospital, Department of Psychiatry, PO Box 63, Penrith, NSW 2751, Australia. Email: [email protected] DOI: 10.1177/0004867414559136
To the Editor Aubrey Lewis (1975) famously commented in reference to hysteria that some psychiatric concepts tend to outlive their obituarists. In this regard, is hypochondriasis of the 2010s similar to hysteria of the 1970s? The DSM-5 has controversially discarded hypochondriasis and replaced it with illness anxiety disorder and somatic symptom disorder. This decision has been met with both criticism (Starcevic, 2014) and cautious approval (Tyrer and Tyrer, 2014). While hypochondriasis has been officially “dead” in the United States for more than a year insofar as the DSM-5 is the “law of the land” there, the term has been revived in the proposals for ICD-11. The description of hypochondriasis in the ICD-11 Beta
© The Royal Australian and New Zealand College of Psychiatrists 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav anp.sagepub.com
Draft (available online) is quite similar to the DSM-IV diagnostic criteria for hypochondriasis. Thus, hypochondriasis is depicted as a persistent preoccupation with or fear of the possibility of having a serious disease or the conviction that one is already seriously ill. Misinterpretation of bodily symptoms is also included in the description. Using exactly the same wording as the DSM-IV, it is stipulated that hypochondriasis persists despite appropriate medical evaluation and reassurance. Classifying hypochondriasis has always been challenging. Importantly, the ICD-11 Beta Draft suggests that it should be classified among both obsessive-compulsive and related disorders (OCRD) and “anxiety and fear-related disorders”. The classification of hypochondriasis as an OCRD is due to an emphasis on “preoccupation” in its description, a questionable assumption that preoccupations and obsessions are conceptually related to the point of being almost synonymous and the fact that some cases of hypochondriasis resemble obsessive-compulsive disorder. The conceptualisation of hypochondriasis as an anxiety disorder makes sense when it is primarily characterised by fear and avoidance behaviour, but hypochondriasis could also be grouped along with “bodily distress disorders” when its predominant features are distressing bodily symptoms. Such a “multiple” classification would resemble the DSM-5 classification of schizotypal personality disorder both
Australian & New Zealand Journal of Psychiatry, 49(1)
among personality disorders and schizophrenia spectrum and other psychotic disorders and classification of antisocial personality disorder both as a personality disorder and as one of disruptive, impulse-control and conduct disorders. Although the proposed ICD-11 description and classification of hypochondriasis are not final, it is clear that hypochondriasis possesses a remarkable resilience. Perhaps that is not surprising for an ancient term that has survived many psychiatric perturbations. Indeed, we may still have something to learn from the concept it embodies instead of eliminating it as a presumably useless and politically incorrect term. Declaration of interest The author reports no conflicts of interest. The author alone is responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References Lewis AJ (1975) The survival of hysteria. Psychological Medicine 5: 9–12. Starcevic V (2014) Should we deplore the disappearance of hypochondriasis from DSM-5? Australian and New Zealand Journal of Psychiatry 48: 373–374. Tyrer P and Tyrer H (2014) The departure of hypochondriasis is no loss. Australian and New Zealand Journal of Psychiatry 48: 772–773.
