Illness Anxiety Disorder
What is Illness Anxiety Disorder?
Illness anxiety disorder, also referred to as hypochondriasis, hypochondria, or health anxiety, is a disorder in which someone has an unrealistic belief that they have a serious medical condition or fears that they are at a high risk of becoming severely ill.
People with illness anxiety disorder, even after medical tests rule out any severe medical condition, remain preoccupied with the belief or fear that they are sick or will become severely sick. They often misinterpret normal or slight differences in body sensations as impending severe illness. People with illness anxiety disorder cannot control their fears and beliefs, and it seems real to them.
The disorder affects all ages and genders but seems to be more common in early adulthood.
Subtypes of Illness Anxiety Disorder
There are two categories of illness anxiety disorder that people usually fit into. These include:
- Care-seeking. A person may spend a significant amount of time in healthcare settings. It is common to have multiple visits to specialists and consistent requests for tests and assessments.
- Care-avoidant. A person may avoid healthcare settings and express a distrust in doctors or fear that their symptoms will not be believed. This often leads to more fear and anxiety regarding illness.
Illness Anxiety Disorder vs Somatic Symptom Disorder
People with somatic symptom disorder exhibit a similar pattern of preoccupation, obsessive thinking, fear, and worry regarding their condition. However, the difference between illness anxiety disorder and somatic symptom disorder is that people with somatic symptom disorder have actual physical symptoms, but medical testing has not been able to identify a cause. Unlike those with illness anxiety disorder, people with somatic symptom disorder are more concerned with the discomfort or disturbance their physical symptoms are causing verses worrying about a serious illness these symptoms might represent.
Symptoms of illness anxiety disorder involve a preoccupation with an unrealistic belief of being or becoming seriously ill. Often, the slightest change in a body sensation may lead to extreme anxiety and worry. Symptoms include:
- Preoccupation with having or getting a serious illness
- Unable to be reassured, even after medical tests or doctors have ruled out any serious illness
- Even a slight change in body sensations can cause significant distress and fear that it signals a serious illness
- Exhibits much anxiety and panic around health status
- Anxiety can significantly impair normal daily functioning
- Excessive worry about a specific medical condition, or risk of being diagnosed with it, especially if there is a family history
- Repeatedly checking your body for signs of illness
- Exaggerating symptoms and their severity
- Scheduling frequent doctor appointments seeking care or reassurance, or avoiding doctors and healthcare settings completely over fear of being diagnosed or fear of not being believed
- Compulsive need to constantly talk about your health or potential illness
- Obsessive checking on the internet about symptoms and medical diagnosis
- Constantly avoiding people or places for fear of health risks
The exact cause of illness anxiety disorder is unknown. There are several factors that may make someone more prone to developing illness anxiety disorder. Those factors include:
- Experienced a severe illness in childhood, or experienced a family member with a severe illness
- Diagnosed with another anxiety disorder, such as generalized anxiety disorder, obsessive-compulsive disorder, or panic disorder
- Experienced childhood trauma (physical, psychological, sexual abuse; neglect)
- Experienced trauma in adult life (anything that threatens your felt sense of safety)
- A family history of health anxiety or other anxiety disorders
- Maladaptive or distorted beliefs about unusual or slightly different body sensations
To diagnose illness anxiety disorder, your healthcare provider may refer you to a mental health professional. In some instances, if you have had a long history with your healthcare provider, and they know your medical and mental health history, mental health status, have ruled out any medical conditions, and know that the illness anxiety has been going on for 6 months or more, they may choose to diagnose.
A mental health professional will do a thorough intake, gathering a medical and mental health history, and may give specific anxiety and depression related assessments. To make a diagnosis, there is specific criteria that must be met. According to the American Psychiatric Association’s Diagnostic and Statistical Manual, 5th Edition, to receive a diagnosis of illness anxiety disorder, the following criteria must be met:
- Preoccupation with having or acquiring a serious illness
- Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition, the preoccupation is clearly excessive or disproportionate
- There is a high level of anxiety about health, and the individual is easily alarmed about personal health status
- The individual performs excessive health-related behaviors or exhibits maladaptive avoidance
- Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period
- The illness-related preoccupation is not better explained by other mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type
Treatment for illness anxiety disorder typically consists of your healthcare provider partnering with a mental health professional, such as a psychiatrist or psychologist. In this partnership, healthcare providers will continue to meet with the patient to oversee any medical issues. A mental health professional will conduct a thorough intake and may administer different assessments or tests to screen for anxiety related disorders. Studies have shown that psychotherapy (talk therapy) combined with medication is the most effective at treating illness anxiety disorder. More specifically, treatments include:
- Cognitive-behavioral therapy. This type of therapy seeks to identify fears and worries and change or replace any negative thought patterns or core beliefs to something more realistic and positive.
- Antidepressants. SSRI’s (serotonin reuptake inhibitors) have been shown to help reduce anxiety symptoms in some people
The effectiveness or success of treatment may depend on the severity of the illness and whether there are any other co-occurring mental health disorders. The patient’s consistency and compliance with treatment may also be a factor in improving symptoms.
Illness anxiety disorder is a chronic condition, and while many patients may experience a significant reduction in symptoms with appropriate treatment, it is not uncommon to have occasional flare ups over time. It is important to reach out to your healthcare and mental healthcare providers if symptoms of illness anxiety disorder return.
Health anxiety, which can develop into illness anxiety disorder, usually develops in early or middle adulthood, and tends to worsen with age. In older populations, health anxiety may revolve more around the fear of losing memory. There are several risk factors in developing illness anxiety disorder. These include:
- Major life stress, change, or transition
- Experienced trauma (in childhood or adulthood; a threat to felt sense of safety; physical, psychological, sexual, neglect)
- Severe illness in childhood (either self, or a close family member)
- Death of a loved one from illness
- Prone to anxiety and worry
- Presence of a different mental health disorder
- Frequently checking the internet for health-related concerns
Complications that can arise from illness anxiety disorder include:
- Financial problems from excessive medical expenses (frequent office visits, seeing specialists, diagnostic and lab testing, etc.)
- Having to go on medical disability
- Work-related issues due to absences, leaving early, or calling off due to anxiety related to health concerns
- Relationship problems due to excessive worry, anxiety, and preoccupation with health and medical conditions
- Significant issues with normal daily functioning
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