Health Anxiety (Hypochondriasis): an Emotional Disorder in An Alternative Taxonomy

The DSM-5 revision of the health anxiety classification (i.e., hypochondriasis) highlights deficiencies in the present DSM taxonomy and the need to consider an alternative. Health anxiety is a clinical syndrome that has been and remains difficult to classify in the DSM system. We argue that the current DSM-5 proposal that splits this syndrome between two diagnoses, somatic symptom disorder (SSD) and illness anxiety disorder (IAD), has significant limitations. We anticipate that SSD will problematically increase comorbidity because criteria for this syndrome feature nonspecific symptoms that overlap with depressive and anxiety disorders. Further, the proposed IAD criteria are overly restrictive and not likely to capture the heterogeneous presentation of individuals with anxiety about their health. We propose an alternative organization that will increase the clinical utility and construct validity of many DSM-IV-TR, Axis I disorders, including health anxiety. This taxonomy, proposed by Goldberg, Krueger, Andrews and Hobbs, is based on the shared etiology of syndromes called emotional disorders. The emotional disorders include health anxiety, other somatoform, unipolar depressive, and anxiety disorders, all of which share the risk factor of negative emotionality/neuroticism (NE/N). We propose a research agenda to support this alternative taxonomy.