Cenesthopathy in adolescence: An appraisal of diagnostic overlaps along the anxiety–hypochondriasis–psychosis spectrum Andor E. Simon a,b,c, ⁎ , Stefan Borgwardt a , Undine E. Lang a , Binia Roth b a Department of Psychiatry and Psychotherapy (UPK), University of Basel, Basel 4056, Switzerland b Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Department of Psychiatry, 4101 Bruderholz, Switzerland c University Hospital of Psychiatry, University of Bern, 3010 Bern Switzerland Abstract Objective: To discuss the diagnostic validity of unusual bodily perceptions along the spectrum from age-specific, often transitory and normal, to pathological phenomena in adolescence to hypochondriasis and finally to psychosis. Methods: Critical literature review of the cornerstone diagnostic groups along the spectrum embracing anxiety and cenesthopathy in adolescence, hypochondriasis, and cenesthopathy and psychosis, followed by a discussion of the diagnostic overlaps along this spectrum. Results: The review highlights significant overlaps between the diagnostic cornerstones. It is apparent that adolescents with unusual bodily perceptions may conceptually qualify for more than one diagnostic group along the spectrum. To determine whether cenesthopathies in adolescence mirror emerging psychosis, a number of issues need to be considered, i.e. age and mode of onset, gender, level of functioning and drug use. The role of overvalued ideas at the border between hypochondriasis and psychosis must be considered. Conclusion: As unusual bodily symptoms may in some instances meet formal psychosis risk criteria, a narrow understanding of these symptoms may lead to both inappropriate application of the new DSM-5 attenuated psychosis syndrome and of treatment selection. On the other hand, the possibility of a psychotic dimension of unusual bodily symptoms in adolescents must always be considered as most severe expression of the cenesthopathy spectrum. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Over the past two decades, the early recognition and intervention of psychotic disorders have developed to one of the most vigorously studied fields in psychiatry with innumerous mental health services around the globe now providing early psychosis programs [1,2]. As a result, Section III of DSM-5 [3] has implemented the ‘attenuated psychosis syndrome’ as a new ‘condition for further study’, although not yet recommended for clinical use. The rising public awareness of both the availability of these services and the potential to improve illness outcome via early intervention has contributed to a larger diagnostic spectrum being assessed today in early psychosis services compared to pioneering days. This phenomenon is reflected by findings of significantly higher non-transition rates to psychosis [4] and considerable remission rates [5] in more recent studies of patients with psychosis risk states in comparison to earlier studies. This observation, however, is not surprising: symptoms that formally meet criteria for psychosis risk states may not always necessarily mirror an actual increased risk for psychosis, but may occur as epiphenomena of other underlying psychiatric disorders. Thus, whilst early psycho- sis services primarily set out to identify patients at risk for psychosis as early as possible in the disease course, they now more commonly face the additional task of disentangling genuine psychotic risk states from other overlapping psychiatric diagnoses. This task is all the more challenging as not only psychosis, but also most other mental illnesses begin in adolescence [6]. Furthermore, as adolescence is a period of life characterized by multitudinous variants in behaviour, developing diversity of contextual thinking, and frequent Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) 1122 – 1129 www.elsevier.com/locate/comppsych ⁎ Corresponding author at: Specialized Early Psychosis Outpatient Service for Adolescents and Young Adults, Psychiatric Outpatient Services, Department of Psychiatry, 4101 Bruderholz, Switzerland. Tel.: +41 61 553 57 50; fax: +41 61 553 57 79. E-mail address: andor.simon@bluewin.ch (A.E. Simon). http://dx.doi.org/10.1016/j.comppsych.2014.02.007 0010-440X/© 2014 Elsevier Inc. All rights reserved.