Maladaptive denial of physical illness: A useful new "diagnosis"

Objective: Denial of physical illness and/or refusal of treatment are criti cal issues in the practice of medicine. A previous article proposed DSM-IV consider a new diagnosis for a subgroup of patients who refuse treatment, i .e., maladaptive denial of physical illness [1]. It is necessary to be able to use this form of denial as a diagnosis rather than invoke the term deni al as merely a mental mechanism. This is a report of a prospective descript ive study of psychiatric consultations for medical inpatients who deny that they are ill or who refuse treatment. Method: In order to investigate the utility of this proposed diagnosis we conducted a one year study of all psy chiatric consultations at a community hospital in Manhattan, New York. Resu lts: The diagnosis of maladaptive denial of physical illness was made in 2. 5 percent of 317 psychiatric consultations. The patients did not fit into o ther DSM-III-R or DSM-IV categories. Conclusions: We suggest a clarificatio n of the concept of denial for use with medically ill patients. The finding s in this study demonstrate that the current categories in DSM-IV do not pr ovide physicians with a diagnosis that describes this particular type of pa thological denial of illness.