Avoidance in hypochondriasis

The DSM-5 diagnosis of illness anxiety disorder adds avoidance as a component of a behavioral response to illness fears - one that was not present in prior DSM criteria of hypochondriasis. However, maladaptive avoidance as a necessary or useful criterion has yet to be empirically supported.

195 individuals meeting DSM-IV criteria for hypochondriasis based on structured interview completed a variety of self-report and clinician-administered assessments. Data on maladaptive avoidance were obtained using the six-item subscale of the clinician-administered Hypochondriasis - Yale Brown Obsessive Compulsive Scale - Modified. To determine if avoidance emerged as a useful indicator in hypochondriasis, we compared the relative fit of continuous latent trait, categorical latent class, and hybrid factor mixture models.

A two-class factor mixture model fit the data best, with Class 1 (n=147) exhibiting a greater level of severity of avoidance than Class 2 (n=48). The more severely avoidant group was found to have higher levels of hypochondriacal symptom severity, functional impairment, and anxiety, as well as lower quality of life.

These results suggest that avoidance may be a valid behavioral construct and a useful component of the new diagnostic criteria of illness anxiety in the DSM-5, with implications for somatic symptom disorder.