THE VALIDITY OF DSM-III-R HYPOCHONDRIASIS

Background: Because of the uncertainty about the status of hypochondri asis, the disorder is rarely diagnosed. To address this problem we exa mined the validity of DSM-III-R hypochondriasis as identified by struc tured interview. Methods: Patients in a general medicine clinic were s creened for hypochondriacal attitudes and symptoms. Those patients who scored above an established cutoff had a structured diagnostic interv iew, and 50 patients who met DSM-III-R criteria for hypochondriasis an d 50 age- and sex-matched controls were thus identified. Information w as obtained from both groups on health perceptions, health care utiliz ation, and level of functioning using self-report and physician-rated measures. Additional information on diagnoses and treatment recommenda tions was obtained from record audits. Results: Clinic physicians rate d hypochondriacal subjects as having more unrealistic fear of illness (hypochondriasis) and diagnosed psychiatric and functional somatic syn dromes more frequently in hypochondriacal than in control subjects. Hy pochondriacal subjects viewed their health as worse, had more health w orries, and had more severe psychiatric symptoms than control subjects . They also reported poorer physical functioning and work performance, greater health care utilization, poorer response to medical treatment , and less satisfaction with the care received than controls. Conclusi ons: Results show that, although the diagnosis of hypochondriasis is r arely made, physician recognition is high. They also show that several indicators of internal and external validity of this diagnostic categ ory exist. Findings suggest that if physicians are to reduce the funct ional impairment and nonproductive health care utilization of these pa tients, they will need to make the diagnosis of hypochondriasis and in tervene appropriately. However, for this to occur, research demonstrat ing predictive validity and treatment responsiveness of the disorder w ill be required.