DSM-5 bids farewell to hypochondriasis and welcomes somatic symptom disorder and illness anxiety disorder

To the Editor

The diagnosis of hypochondriasis is rarely used by psychiatrists and the nature of the condition precludes its use by most sufferers, while terms like ‘health anxiety’ have become increasingly popular. Despite their limitations, the new diagnoses (somatic symptom disorder and illness anxiety disorder) that replace hypochondriasis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) represent a welcome attempt to improve the diagnostic conceptualisation of a disorder that has outgrown its ancient origins in the ‘hypochondrium’.

Although the diagnostic validity of somatic symptom disorder and illness anxiety disorder is not well supported (Starcevic, 2013), the new diagnoses are not alone in this regard. The greatest potential of these two new diagnoses appears to lie in their clinical utility. The new diagnoses more accurately describe the disorder and are likely to be less stigmatising. Although patients with hypochondriasis do not have a greater chance of developing medical illnesses in the future (Barsky et al., 1998), it is not uncommon for people labelled with hypochondriasis to be given a medical diagnosis at a later date. Under the new diagnosis of somatic symptom disorder, whether somatic symptoms are medically explained or not, is less relevant and attention is focused on helping patients with their somatic symptoms whatever the cause (Sharpe, 2013). The popularity of the non-formal diagnostic term of ‘health anxiety’ also indicates that the term is more acceptable. As health is not threatening, it is appropriate that illness, which is threatening, replaces health in ‘health anxiety’ and becomes ‘illness anxiety’. This allows for validation of some of the patient’s concerns and increases our ability to engage with our patients and help alleviate their suffering.

These new diagnoses are likely to promote collaboration with other medical colleagues and with our patients, as the descriptive nature of the diagnostic terms appear to acknowledge that not all patients react to somatic symptoms or to illness in the same way, and that addressing psychological, social and cultural influences is likely to improve outcomes for all patients.