Illness Anxiety Disorder
What Is It?
Illness anxiety disorder is a persistent fear of having a grave medical illness. A person with this disorder pays excessive attention to health. He or she can become easily alarmed by anything that might be interpreted as a sign of illness, including normal sensations, bodily functions and mild symptoms. For them, such experiences may signal an illness with a grim outcome. For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be indicators of life-threatening disease.
Terminology has changed for disorders of this type. The field has moved away from using the word "hypochondriasis," because it is a demeaning term. The word "somatization" has been replaced by "somatic symptoms." It seems like a small difference but the change acknowledges that the person's physical (i.e., somatic) symptoms are real.
This new diagnosis (that is, illness anxiety disorder) focuses attention on the most prominent symptom, which — consistent with the name — is anxiety about having an illness.
Some individuals previously diagnosed with hypochondriasis would now be given a diagnosis of somatic symptom disorder rather than illness anxiety disorder. Generally speaking, people with somatic symptom disorder do complain of physical symptoms. People with illness anxiety disorder usually do not have physical symptoms, or if symptoms are present, they are mild.
A person with illness anxiety disorder may be especially concerned about a particular organ system, such as the cardiac or digestive system. A doctor's reassurance and even a complete medical evaluation often will not calm the person's fears. Or, if it does calm them, other worries may emerge later.
Generally, people with this disorder do not develop "somatic delusions" (ideas about health that are completely divorced from reality). One common perspective on this disorder is that health anxiety is so great that reassurance is only temporarily helpful at best. Patients may admit the possibility that their fears are exaggerated. However, they may not accept being told that there is "nothing wrong."
In severe forms of this disorder, a person may go from doctor to doctor, looking for one that will confirm a feared illness. The patient and the doctors may become frustrated or angry. The pattern sometimes interferes with the person getting proper care if he or she develops a medical illness for which there is a known and effective treatment.
Illness anxiety disorder is in some ways similar to obsessive-compulsive disorder. In fact, some researchers see it as a related disorder. The person is obsessively preoccupied with thoughts of illness and feels compelled to do things (feel lumps, browse for medical information, visit the doctor) to quell the anxiety they feel.
Some people with this disorder have had a significant illness in the past, for example, during childhood. Often illness anxiety disorder starts in young adulthood and can last many years. But it can occur at any age. Symptoms may become more intense after a stressful event, such as the death of a loved one.
Although medical illnesses are uncomfortable, they can bring benefits, such as relief from responsibilities along with the attention and care of family members, friends and doctors. Illness anxiety disorder may be motivated by these advantages, although the individual is often not aware of that motivation.
Less often, a person may feign illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. In cases where someone is consciously seeking such advantages, the condition is called malingering. But illness anxiety disorder is not malingering. In illness anxiety disorder, the patient is not pretending. He or she believes there is a real danger of becoming ill and truly feels anxious.
Symptoms of illness anxiety disorder include:
Preoccupation with having or developing a serious illness
Absence of physical symptoms or, if present, symptoms are mild
Behavior indicating health anxiety, such as checking for signs of illness
Easy alarm about medical problems; persistent fear despite medical reassurance
Overuse or underuse medical care.
Absence of delusions or psychosis
Clinical distress or functional impairment
Absence of delusions or psychosis
Patients with this disorder often seek care in a primary care office rather than a mental health setting. The diagnosis usually is suspected by a primary care physician. Although psychiatric or other mental health care may be recommended, the individual often refuses to see a mental health clinician. The diagnosis is based on a person's medical complaints and history, plus a doctor's physical examination and laboratory tests. The disorder may be accompanied by severe anxiety symptoms or obsessive-compulsive symptoms. The evaluator needs to consider the possibility that a person is suffering from another mental disorder where fear or exaggerated concerns about medical illness can appear, such as various forms of depression, schizophrenia or somatization disorder.
Illness anxiety disorder does not have a well-defined course. It can start any time in younger or middle adulthood. The disorder probably lasts longer in cases where the symptoms are severe and if the person has other psychiatric difficulties or vulnerabilities. If symptoms have a more sudden onset and are associated with other medical — but not psychiatric — symptoms, the duration tends to be shorter.
There is no known way to prevent this disorder.
Some people with illness anxiety may have their concerns because they are suffering from depression, anxiety or a psychotic disorder. Therefore, the doctor should explore those possibilities, and target them for treatment as needed.
The symptoms of illness anxiety disorder may be relieved by an antidepressant even when no other psychiatric illness is present. Experts who have noticed this disorder's similarity to obsessive-compulsive disorder (OCD) have found that it can help to prescribe OCD treatments, such as serotonin specific reuptake inhibitors (SSRIs) like fluoxetine or serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine.
There is evidence that a number of therapies can help people with illness anxiety disorder: cognitive therapy, behavior therapy, cognitive behavior therapy and stress management. Therapists teach distraction and relaxation techniques and help patients focus less on their symptoms and talk instead about how stress, anxiety and depression increase their psychological discomfort. Therapists explain that many of the actions patients take to try to relieve anxiety usually backfire. Feeling for lumps, reading about illness or otherwise scanning for illness makes symptoms worse not better.
Reassurance is also helpful when the primary care doctor provides it in the context of thoughtfully evaluating the physical complaints. Illness anxiety is such a common phenomenon that many primary care physicians understand how to provide reassurance in a kindly way that doesn't undermine the relationship. Since the medical complaints may never go away, the doctor may set up a regular schedule of short appointments, during which symptoms can be reviewed. This can help contain anxiety. On the other hand, anxiety may get worse if a doctor attempts to limit contact and treats the patient dismissively.
Doctors and therapists should take physical symptoms seriously because symptoms are real. Nonetheless, taking symptoms seriously does not mean doing unnecessary tests or procedures. While maintaining an attentive and respectful attitude toward the medical complaints, doctors try to intervene as they would with any patient – only when it is needed. Physicians minimize the ordering of overly intrusive tests. They avoid suggesting approaches that could be inappropriately risky. They do try to provide support for coping with chronic illness.
When To Call a Professional
People with illness anxiety disorder tend to contact health care professionals readily. At the same time, they usually do not want to see mental health professionals because they fear that people view the medical symptoms as "all in your head." Nonetheless, a combination of support and care from the primary care doctor along with psychotherapy (when it is acceptable to the patient) can be helpful.
Some patients respond well to medication, psychotherapy or both. If the person has anxiety or depression that responds to treatment with medication, the prognosis can be quite good. In mild cases, symptoms can be short-lived. If the symptoms are severe and the person has other mental health disorders, the person may be susceptible to chronic distress and problems functioning.
American Psychiatric Association
American Psychological Association