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An Evaluation of the DSM-III Criteria in Medical Outpatients

Arthur J. Barsky, MD; Grace Wyshak, PhD; Gerald L. Klerman, MD

Arch Gen Psychiatry. 1986;43(5):493-500.

Abstract
• We attempted to integrate the DSM-III criteria for hypochondriasis with the clinical literature and derived six positive and two negative diagnostic criteria. Seven of these were assessed in a random sample of 92 medical outpatients by means of a self-report questionnaire, structured interview, and medical record audit. The results are in accord with previous work: there appears to be considerable internal validity and consistency in the syndrome in that disease conviction, disease fear, bodily preoccupation, and somatic symptoms are significantly intercorrelated. The three hypochondriacal attitudes (conviction, fear, and preoccupation) were not statistically related to the number of medical diagnoses in the patients' medical records. Depressive symptoms, as measured by the Beck Depression Inventory, were highly correlated with the other hypochondriacal symptoms. The hypochondriacal syndrome in these patients appears to be consistent with the clinical disorder described in DSM-III.

Author Affiliations
From the Department of Psychiatry, Harvard Medical School, Boston (Drs Barsky and Klerman); the Center for Population Studies, Harvard University, Cambridge, Mass (Dr Wyshak); and the Psychiatry Service and Primary Care Program, Massachusetts General Hospital, Boston (Drs Barsky and Klerman).

Footnotes
Accepted for publication May 23, 1985.

Dr Klerman is now at the Cornell University Medical Center, New York.

Reprint requests to Department of Psychiatry, Massachusetts General Hospital, Fruit Street, Boston, MA 02114 (Dr Barsky).

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