Psychiatry and Behavioral Health Rotation

Psychiatry EOR: Illness anxiety disorder

Patient will present as → a 25-year-old male graduate engineering student who is at your office for the fourth time in 1 week to be sure he does not have chlamydia. Despite having one sex partner, he learned there is an increase in the incidence of STDs on campus. He reports that he has only had sex once but learned that chlamydia is hard to culture. He reports he may have dysuria intermittently but is not sure. He has been evaluated at each visit, and physical and laboratory examination has been completely normal each time.

Key Points:

  • Patient's are worried about having or developing a serious illness and
  • This preoccupation is present for at least 6 months and
  • Is not better explained by another mental disorder (e.g., obsessive-compulsive disorder and somatic symptom disorder)

DSM-5 Diagnostic Criteria

  • Preoccupation with having or acquiring a serious illness.
  • Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
  • There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
  • The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
  • Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
  • The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.

Specify whether:

  • Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is frequently used.
  • Care-avoidant type: Medical care is rarely used.

The goal is to improve coping skills while never dismissing their fears -caregivers should closely follow their patients and develop a therapeutic alliance

  • Group/insight-oriented therapy
  • Regular appts with provider for reassurance
  • Medications: (SSRIs) if concurrent/underlying anxiety or major depressive disorder
Psychiatry EOR: Factitious disorder (Prev Lesson)
(Next Lesson) Psychiatry: Somatic symptom disorder
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