2025-Aug - MBH-CRG Meeting

1

Illness anxiety disorder

Hypochondriasis

For discussion

• Review concepts to determine correct location in hierarchy and whether duplicates

• Discuss potential relationship to 247808006 | Anxiety about body function or health (finding) |

• Is there a difference between "preoccupation with having a serious illness" (DSM), "preoccupation or fear of having a serious illness" (ICD-11) and  "anxiety about illness" (literature) or are these just different ways of describing the same idea?

Relationship to phobia concepts

• 403593004 | Phobic fear of skin cancer (disorder) |

• Note -  many fear and phobia disorders relate to fear of illness; are phobic fears of illness more specific types of illness anxiety disorders and/or hypochondriasis?

DSM-5: Illness Anxiety 

A. Preoccupation with having or acquiring a serious illness.
B. 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.
C. There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
D. 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).
E. Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
F. 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.

"Enduring and distressing anxiety about health and illness" (pubmed.ncbi.nlm.nih.gov/38748190)

ICD 11: Hypochondriasis

https://icd.who.int/browse/2025-01/mms/en#675329566

Description
Hypochondriasis is characterised by persistent preoccupation or fear about the possibility of having one or more serious, progressive or life-threatening illnesses. The preoccupation is accompanied by either: 1) repetitive and excessive health-related behaviours, such as repeatedly checking the body for evidence of illness, spending inordinate amounts of time searching for information about the feared illness, repeatedly seeking reassurance (e.g. arranging multiple medical consultations); or 2) maladaptive avoidance behaviour related to health (e.g. avoids medical appointments). The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

Inclusions
Hypochondriacal neurosis
Illness anxiety disorder

Exclusions
Body dysmorphic disorder(6B21)
Bodily distress disorder(6C20)
Fear of cancer(MG24.0)

For discussion:

References:

2

Avoidant disorder of childhood or adolescence (disorder)

Decide

• Is this disorder the same as social anxiety and therefore a subtype of social anxiety disorder

• Should the original distinct meaning be persisted and therefore not made a child of social anxiety disorder 

Background:

This disorder originally appeared in DSM-III as a subtype of Anxiety Disorders of Childhood or Adolescence

DSM-III Diagnostic Criteria

Open

In DSM-III It was mapped to ICD-9 code 313.21 - Shyness disorder of childhood.

Here is the corresponding ICD-9 hierarchy with disorders

Open

DSM-III-R contains language advising clinicians to diagnose this disorder for people under 18 who meet criteria for Avoidant personality disorder.

DSM-IV removed the disorder and redefined it as Social anxiety disorder.

Withdrawing reaction of childhood

Determine whether this is semantically equivalent to 'Avoidant disorder of childhood' 

• This is currently a SYN for 'Avoidant disorder of childhood'

• Withdrawing reaction of childhood​ (DSM-II)  specifically says the child withdraws from all relationships

• Avoidant disorder of childhood (DSM-III) specifically says the child does not withdraw from parents (only peers)

Review | Mood swings (finding) |

Question:

Is there are more specific FSN for mood swings?

Is | Diurnal variation in mood (finding) | a subtype?

Definitions from PubMed (last 5 years, entry term "mood swings")

https://pubmed-ncbi-nlm-nih-gov.ezp3.lib.umn.edu/35346786/ "Mood instability, defined as frequent, sudden, and unpredictable alterations in irritability, elation/activation, and anxiety/depression"

https://doi-org.ezp1.lib.umn.edu/10.1080/02770903.2024.2434516 "frequent, sudden, and unpredictable changes in emotional states" "Mood swings—rapid and unpredictable shifts in emotional states"

https://pmc-ncbi-nlm-nih-gov.ezp1.lib.umn.edu/articles/PMC7189499/ "Mood swings refer to abnormal mood changes that are characterized by oscillation, intensity, and inability to regulate affect change, triggered by the environment but without a recognized, activating source. There are a variety of terms referring to these changes, such as mood swings, affective instability, and mood dysregulation"

https://pubmed-ncbi-nlm-nih-gov.ezp1.lib.umn.edu/26144588/ "Mood instability is defined as frequent fluctuations of mood over time, which may be as brief as a few hours"

192562009 | Disorder of psychological development (disorder) |

Decide whether this should be inactivated as an outdated classification-based concept

• DSM

  • No reference to this concept in any version of DSM

• ICD010

  • Disorder grouper in ICD-10:  Disorders of psychological development (F80-F89)

Open

• ICD11

  • Entry term for 6A0Z Neurodevelopmental disorders, unspecified