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Hypochondriasis: considerations for ICD-11.

Odile A van den Heuvel1, David Veale2, Dan J Stein3

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The World Health Organization is revising hypochondriasis classification in ICD-11. The proposed changes focus on symptom overlap with anxiety and obsessive-compulsive disorders, aiming for better clinical recognition and treatment.

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Area of Science:

  • Psychiatry
  • Mental Health Classification

Background:

  • The current International Classification of Diseases (ICD-10) defines hypochondriacal symptoms within primary hypochondriacal disorder and secondary to other mental disorders.
  • Significant research advancements since 1990 necessitate a re-evaluation of hypochondriasis definition and classification.

Purpose of the Study:

  • To present the considerations of the World Health Organization (WHO) ICD-11 Working Group regarding the classification of hypochondriasis.
  • To propose a revised description and classification for hypochondriasis in the upcoming ICD-11.

Main Methods:

  • Review of phenomenological overlap between hypochondriasis, anxiety disorders, and obsessive-compulsive and related disorders.
  • Distinguishing hypochondriasis from somatoform disorders based on the non-critical presence of somatic symptoms.

Main Results:

  • The proposed revision highlights the overlap in fear, hypervigilance, and avoidance seen in anxiety disorders.
  • It also notes preoccupation and repetitive behaviors characteristic of obsessive-compulsive and related disorders.
  • The revision clarifies that the presence of somatic symptoms is not a defining feature, differentiating it from somatoform disorders.

Conclusions:

  • The proposed ICD-11 revision aims to enhance clinical utility for recognizing and treating hypochondriasis.
  • Improved classification will support better patient care across diverse global healthcare settings.