COMMENTARY

New Diagnoses Replacing Hypochondria Undergo First Study

Peter M. Yellowlees, MBBS, MD

Disclosures

February 09, 2017

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In DSM-5, two new diagnoses—somatic symptom disorder (SSD) and illness anxiety disorder (IAD)—have replaced DSM-IV's hypochondriasis, yet there are no previously reported treatment studies for these disorders. Now a team of investigators[1] from the Karolinska institute in Sweden have undertaken a randomized controlled trial with 132 patients to investigate the effect of cognitive-behavioral therapy delivered as guided Internet treatment, unguided Internet treatment, or unguided bibliotherapy.

The researchers found that, compared with the control group, all three treatment groups made large and significant improvements on the primary outcome measure, the Health Anxiety Inventory. They concluded that Internet-accessed treatments can be highly effective in the treatment of SSD and IAD.

What is the significance of this study for the practicing physician? First, the main outcome measure used is not a measure of clinical change or functional improvement. Therefore, these results must be taken with a grain of salt and await replication, while the new DSM-5 diagnostic groupings themselves require much more clinical validation and examination. What is important about this study is the fact that the first published treatment for these disorders has been a series of Internet-enabled interventions, and that given the popularity and high use of such interventions for many psychiatric and medical disorders, they can now be considered demonstrably mainstream. How our practice continues to change.

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