Illness Anxiety Disorder
Illness anxiety disorder, also known as hypochondria or hypochondriasis, is a chronic psychiatric condition in which a person without medical symptoms is preoccupied with worry about having or being at risk for getting sick or developing a serious medical illness. The condition typically emerges in early and middle adulthood, and appears to affect men and women equally. Individuals with illness anxiety may or may not have a diagnosed medical condition, but typically no serious disease is present in most cases. In cases when the person actually does have a medical condition, their anxiety about it and its progression is distracting and clearly excessive.
For more, see Hypochondria.
Individuals with illness anxiety disorder typically do not have physical symptoms, but they do have a high level of anxiety about their health. They are easily alarmed by illness — their own or others’ — and may have persistent, abnormal reactions to their own normal bodily sensations, regarding them with much greater seriousness than others would, and pursuing a diagnosis even where none is appropriate. Hearing about someone else’s illness, or reading about conditions in the news, can fuel their anxiety and lead them to perform excessive health-related behaviors, such as repeatedly checking their body for signs of illness.
According to the DSM-V, illness anxiety disorder should be diagnosed when the following symptoms are present for at least six months:
- Preoccupation with having or possibly getting a serious illness, despite a lack of somatic symptoms
- A high level of anxiety about health; for example, the person is easily alarmed about their personal health
- Excessive health-related behaviors such as repeatedly checking their body for signs of illness, or, at the other extreme, maladaptive avoidance of doctors and checkups. These two types of illness anxiety are known as “care-seeking” and “care-avoidant.”
The patient’s fixation does not need to be the same medical illness; the imagined or threatened condition may change, but the illness anxiety symptoms may still persist.
People with the care-seeking type of illness anxiety can become highly frequent users of the medical system; by some estimates, at least 5 percent of all medical appointments can be attributed to patients with the disorder. People with the condition can have medical bills 10 times higher than average — and their constant demand for testing may add billions of dollars to other people’s health insurance premiums. But even negative tests only provide them with temporary relief and reassurance; typically, their anxiety soon resurfaces.
However, people with care-avoidant illness anxiety fear any encounter that may confirm their worries, or make them sick, and so they avoid medical appointments altogether, as well as visits to sick family members. Similarly, many people with the condition refuse to acknowledge that their beliefs have a psychological origin and so they avoid mental health specialists.
The condition is related to, but differs from Somatic Symptom Disorder, in which worry about health manifests in actual bodily symptoms and the belief that a specific physical illness is present, if only the right doctor could find it.
For more, see Somatic Symptom Disorder.
It’s estimated that between 1.3 and 10 percent of people have illness anxiety disorder to some extent.
Generally, they do not, but some people with the condition appear to have heightened interoception — the perception of and sensitivity to their own bodies. What other people may experience as a minor twinge, for example, may have more power, and more staying power, for someone with this condition. And as with other forms of anxiety, the stress of their medical worries can absolutely lead to serious physical symptoms, although not necessarily those of the condition they believe they have.
Concerns about illness may be so extreme that they become are a central feature of a person’s identity and self-image: Health becomes a frequent topic of conversation and any stressful life events trigger even greater concerns. This high level of anxiety can frustrate others, leading to strain within friendships, families, or professional relationships.
Illness anxiety disorder is a chronic condition that is generally stable over time but its symptoms have been found to increase, or become triggered, at times of stress or after traumatic events. But even as the condition remains persistent, and anxious feelings continue to emerge, behavioral therapy can help people minimize their intrusiveness and learn to keep those thoughts from disrupting their lives.
The cause of illness anxiety disorder is not known, but major life stress might precede the development of symptoms in some cases, and a history of childhood abuse or serious childhood illness may be a risk factor for developing symptoms later in life.
While there does not appear to be a genetic cause of the disorder, research suggests that it is somewhat more common in people with a parent who has the condition, because they may model illness anxiety, or because their tendency toward overprotection may influence their children’s own beliefs.
Also, as with general anxiety, illness anxiety is linked to the personality trait of neuroticism, which has been shown to predict an individual’s susceptibility to anxiety and depression, as well as the development of emotional reactivity that makes people especially attuned to threat.
People with illness anxiety disorder are seen more often in medical than in mental health settings because they believe they are medically ill. It is common for people with this condition to visit multiple doctors as they search for a diagnosis, or confirmation of one they believe they have. The practical step of limiting their primary care to one provider can be an important step in preventing excessive tests or procedures, which both add to an individual’s stress and overtax the health-care system.
In cases when people do seek, or accept, treatment for illness anxiety disorder, psychotropic medications can help treat their underlying anxiety and/or depressive symptoms. Psychotherapy can also be effective in helping individuals recognize the triggers that cause their symptoms and learn coping skills to manage their anxiety.
It can potentially help them significantly. Research finds that cognitive behavioral therapy (CBT) helped patients identify their triggers, reduce their fears, and bolster their coping strategies. The challenge is convincing people to accept treatment. In these studies, only 30 percent of people with illness anxiety who were offered treatment were willing to accept it; generally, such individuals are convinced that only medical treatment can help them.
At least one in four medical visits are for medically unexplained symptoms. Most of these patients do have symptoms of an illness, albeit one that may be tricky to properly diagnose. Others surely have illness anxiety disorder. Both types of patients may be viewed as “difficult” by doctors, though. What happens next depends somewhat on a physician’s own beliefs. Some may reject the patient’s complaints and refuse to refer them to specialists, hindering the treatment of those with true medical symptoms. But others may fully commit themselves to finding the cause of a patient’s complaint, doubling down on exhaustive testing and involving a growing number of specialists. When the patient has illness anxiety, though, the doctor may only be reinforcing their fears and encouraging catastrophizing when they would better serve the patient and themselves by stepping back to consider and discuss the potential psychosocial basis of their complaints.
Those who are willing to work on their symptoms can adopt several CBT strategies in their daily lives. People with illness anxiety can experience distorted thoughts, the expectation of disastrous outcomes known as catastrophizing, and a tendency to jump to conclusions despite limited evidence of trouble. CBT teaches people how to question these beliefs, examining the evidence and challenging automatic, negative thoughts, as well as calming strategies such as diaphragmatic breathing and muscle relaxation.