Maladaptive Denial of Physical Illness: A Useful New “Diagnosis”

Abstract

Objective: Denial of physical illness and/or refusal of treatment are critical issues in the practice of medicine. A previous article proposed DSM-IV consider a new diagnosis for a subgroup of patients who refuse treatment, i.e., maladaptive denial of physical illness [1]. It is necessary to be able to use this form of denial as a diagnosis rather than invoke the term denial as merely a mental mechanism. This is a report of a prospective descriptive study of psychiatric consultations for medical inpatients who deny that they are ill or who refuse treatment. Method: In order to investigate the utility of this proposed diagnosis we conducted a one year study of all psychiatric consultations at a community hospital in Manhattan, New York. Results: The diagnosis of maladaptive denial of physical illness was made in 2.5 percent of 317 psychiatric consultations. The patients did not fit into other DSM-III-R or DSM-IV categories. Conclusions: We suggest a clarification of the concept of denial for use with medically ill patients. The findings in this study demonstrate that the current categories in DSM-IV do not provide physicians with a diagnosis that describes this particular type of pathological denial of illness.