In a chronic illness Facebook group I’m part of, a member talked about having “possible hypchondriac” written in her medical records. This led to a discussion of chornic illnes, hypochondriasis and illness anxiety, as hypochondriasis is now called in DSM-5, medical knowledge, imagining or faking symptoms. There are a lot of prevailing myths about health anxiety, which I feel compelled to write about.
First, this person had a known chornic illness. The DSM-5 criteria for illness anxiety disorder clearly state that, if a general medical condition is present or there is a high risk of developing such a condition (eg. strong family history), illness anxiety disorder should only be diagnosed if the person’s anxiety is clearly out of proportion to the medical condition. Also, the criteria say that people with illness anxieyt usually suffer no or only mild somatic symptoms. I am not sure how to interpret this, as everyone suffers somatic symptoms at times, and the DSM-IV specified that hypochondriacs misinterpreted real bodily signals. That’s not the same as somatic symptoms, I believe. Anyway, for these reasons, it is pretty unlikely that a person who has a known chornic illness, can be diagnosed with illness anxiety disorder.
Another prevailing myth is that knowing a lot about medical terminology indicates you’re ahypochondriac. Well, in such a case all doctors ought to be hypochondriacs. Also, talking, writing or reaidng a lot about illness is not a symptom of illness anxiety disorder, unless it’s accompanied by anxiety about having the acctual illness. I am not a hypochondriac for reading blogs about medical disorders that I don’t have. Yay!
Making up symptoms or creating them is also not hypochondriasis. People who fake illness to take on the sick role have a factitious disorder (aka Münchausen Syndrome). People who fake illness for secondary gains (eg. disability benefits), are malingering. These two need to be differentiated: factitious disorder, even in its harmful forms (ie. Münchausen by proxy), is a real mental illness and should be treated as such. Malingering is not. Doctors still have a hard time diagnosing certain cases of malingering due to having sympathy for the faker.
Lastly, please remember that having or being perceived as having a bad attitude about your health or illness, is not hypochondriasis. People deal with chronic or serious illness differently, and most of this falls within the normal range. Where it becomes distressing to the patient, it may be illness anxiety disorder (or depression or another mental illness). Being a pain in the butt for other people, may be too bad, but it’s not a psychiatric disorder.