Illness anxiety disorder is the current label used to describe a person who is overly anxious about their physical health. The illness anxiety disorder diagnosis was created to better identify people who have high health anxiety but no physical health symptoms. With the elimination of hypochondriasis as a diagnosis, understanding the differences between illness anxiety vs. somatic symptom disorder is essential.
What Is Illness Anxiety Disorder?
Illness anxiety disorder (IAD), or health anxiety, formerly known as hypochondriasis, is when a person constantly worries about the idea of being or becoming chronically ill. Someone living with this type of anxiety might believe they have a serious illness the moment they feel a slightly abnormal, or even normal ,bodily sensation or mild symptom like muscle twitching, dizziness, coughing etc. And even if there’s a diagnosable medical concern, the anxiety is extreme and disproportionate to the gravity of the actual health problem. Unfortunately, this mental health disorder can disrupt someone’s overall functioning and worsen overtime or during periods of stress.1
How Common Is Illness Anxiety Disorder?
Illness anxiety disorder can occur equally among men and women of all ages. The onset of IAD generally appears during early to middle adulthood. However, this mental health condition is very rare, only impacting approximately 0.1% of Americans.2
Illness Anxiety Disorder vs Hypochondria
Illness anxiety disorder, sometimes shortened to IAD, is a newer diagnosis used to identify a person who is currently preoccupied with having or getting a serious physical health illness. People with this condition could have frequent medical appointments, tests, and procedures to treat a nonexistent condition, or they could not seek any care at all only to stay at home with their worries.1
Prior to the current edition of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnosis of hypochondriasis was present to describe people who worried excessively about the physical health, but for this revision, the APA felt that the one condition should be split into two – illness anxiety disorder and somatic symptom disorder (which continues to be the case in the revised version of the DSM.) 1
About 75% of people who previously had a diagnosis of hypochondriasis shifted to somatic symptom disorder. The remaining 25% would fit into the illness anxiety disorder category.1
Illness Anxiety Disorder vs Somatic Symptom Disorder
The primary way a person or a mental health professional can determine if the condition is illness anxiety disorder versus somatic symptom disorder is the presence of somatic symptoms. When someone experiences one or more stressful symptoms like pain, discomfort, dizziness, breathing problems, or chest tightness, somatic symptom disorder may be the more appropriate diagnosis. If a person experiences more worry, nervousness, and concern over having an unknown condition or the possibility of having a condition in the future, illness anxiety disorder would be the diagnosis.1
In somatic symptom disorder, a person will experience:1
- One or more uncomfortable or distressing physical symptoms that cause a significant disruption of life
- Persistent thoughts and worries about the severity of symptoms
- High levels of anxiety about physical health
- Excessive time and energy spent dealing with these concerns
- Symptoms that last for six months or more
Symptoms of Illness Anxiety Disorder
When anxiety symptoms are low, a person with illness anxiety disorder may appear diligent about their physical health, but if symptoms become more severe, they will have little time left to find enjoyment and fulfillment in life. People with illness anxiety disorder will be constantly distracted and preoccupied with thoughts of medical issues and behaviors controlled by these uncomfortable thoughts.1
The typical signs and symptoms of illness anxiety disorder include:1,2,3
- Intense worry about having or getting a serious illness
- Symptoms are normally vague and the suspected condition may shift randomly
- An absence of physical symptoms or physical symptoms that are very mild compared to the person’s reaction
- High levels of health-related anxiety and being easily alarmed about health status
- Performing many pervasive behaviors linked to health or avoiding all health-related contacts
- Seeking out comfort and reassurance from loved ones, but this relief will only last for a short period
For the diagnosis of illness anxiety disorder, a person must show several of these symptoms for six months or longer.1
If a person has short stints of medical anxiety, they do not fit the diagnosis.
When to Call Your Doctor
If any of the signs/symptoms mentioned above resonate with you, or the people around you suspect that you could be suffering from illness anxiety disorder, it’s important to contact your primary health care provider. Your PCP can assess you and refer you to a mental health professional for further evaluation and psychological treatment.2
It’s worth mentioning that the presence of a medical condition doesn’t necessarily rule out having illness anxiety disorder. A general medical illness and IAD can co-occur. But when a person has a diagnosed medical condition, IAD is considered only when the health-related anxiety is disproportionate and excessive in relation to the illness.2
What Causes Illness Anxiety Disorder?
The most significant cause or trigger of illness anxiety disorder involves the person enduring a serious life stress. In some cases, the individual will have an unexpected health scare that ultimately resolves without issue. This type of benign health threat can prime the person towards being fearful in the future.1
Some other causes and triggers of illness anxiety disorder include:3,4
- History of physical, emotional, or sexual abuse or neglect
- Significant trauma
- Childhood physical health issues
- Certain family or individual views on health and wellness
- The presence of other mental health conditions like anxiety, OCD, and depression
Once the condition begins, numerous changes in physical health status can trigger symptoms to worsen. Something as common and normally harmless as a headache could result in someone thinking they have a brain tumor, and a few days of fatigue are a sign of multiple sclerosis.
Complications of Illness Anxiety Disorder
Even though the physical distress of illness anxiety disorder has a mental source, the condition can lead to new and worsening physical health and mental health issues.
The consequences and complications of illness anxiety disorder include:3
- Discomfort and other issues stemming from invasive or repetitive tests
- Dependence on prescription medications to relieve symptoms
- Other mental health conditions like depression, anxiety, and panic disorder
- Missed time at work or being fired for attending so many appointments
- Expensive medical bills
With illness anxiety disorder, what started as a disproportionate response to a physical sensation can result in real problems.
How to Cope With Illness Anxiety
Illness anxiety disorder is an especially negative mental health condition because it makes a person second guess their insights and intuition. Because of this, a person must find new ways to cope and calm their anxiety symptoms.
Here are eight coping strategies that work well for those with illness anxiety disorder:
1. Practice Mindfulness
Mindfulness and meditation can help a person acknowledge and accept what their body is telling them without passing judgment. Mindfulness can help calm the mind and body while offering assurance the sensations are only IAD-related.
2. Get Second Opinions
Illness anxiety disorder will make a person believe something is wrong when there are no real problems. Since these bodily sensations will be misleading, they should consult with a trusted friend or family member for an opinion about the symptom and the best course of action.
3. Delay, Delay, Delay
Rather than heading to the emergency room or phoning the doctor after every ache and pain, sleep on it. Let time pass and confront the growing anxiety. It will be uncomfortable to live with the stress but avoiding doctors and testing could keep illness anxiety disorder from spiraling out of control.
4. Care for Your Physical Health
Since physical health issues are at the center of IAD, it will be essential to attend to these needs. Get enough sleep, eat well, and get plenty of exercise to do your best in stabilizing your physical status. Be sure to practice moderation and avoid being too rigid with your expectations.
5. Learn Your Triggers
Illness anxiety disorder will have certain triggers that spark symptoms. Identifying these anxiety triggers can help you recognize the effects and note the source as mental, not physical.
6. Have Fun
It may sound like an unnecessary lifestyle change, but people with IAD tend to spend so much time focused on their physical health and worries that they forget to have fun. Plan leisure time activities with people you love to break the anxious pattern.
7. Avoid Excessive Doctor Visits
IAD treatment is not going to be effective if the person keeps scheduling and attending frivolous medical appointments. Talk to your doctors about your condition and discourage them from accepting your appointments.
8. Share the Secret
Illness anxiety disorder is a condition many people have never heard of, so you can’t expect everyone to understand your state. Correct this problem by sharing information about your condition, what it means, and how they can help. Letting people in on the secret will diminish secrecy, isolation, and shame.
How Is Illness Anxiety Disorder Diagnosed?
A diagnosis of illness anxiety disorder will be made by a medical or mental health professional when they witness the troubling symptoms of the condition emerge in a patient. Because of the focus on medical issues, physicians may suspect or make the initial diagnosis more often than mental health providers.
With mental health conditions like major depressive disorder or generalized anxiety disorder, a person only needs to have some of the possible symptoms to meet criteria for the diagnosis, but in the case of illness anxiety disorder, a person must meet all the symptoms listed earlier to have the condition.
The person must be very worried about having or getting an illness, lack symptoms that warrant the worry, be easily alarmed by issues affecting personal health, and perform health-related behaviors excessively. If any of these issues are missing from the presentation, IAD may not be the best diagnosis.
Additionally, for the person to receive an illness anxiety disorder diagnosis, their condition cannot be better explained by another mental health condition.
Some conditions that share many similarities with illness anxiety disorder include:1
- Somatic symptom disorder
- Panic disorder
- Generalized anxiety disorder
- Body dysmorphic disorder
- Obsessive-compulsive disorder (OCD)
- Delusional disorder
For example, if the person’s worries about their physical health are better explained by OCD, illness anxiety disorder will not be the proper diagnosis. As always, identifying the correct mental health condition is essential to drive appropriate and effective treatment.
Illness Anxiety Disorder Treatments
Illness anxiety disorder responds well to a combination of psychotherapy and medication management. In other situations, people may find the relief they seek with only therapy or only medication. The most important, and at times most challenging, facet of treatment is to accurately identify the person’s experience of illness anxiety disorder. Since most people with this condition will visit physical health appointments regularly, these professionals will be responsible for assessing and directing treatment, especially early in the process.
People with illness anxiety disorder will aim to achieve three main goals from their treatment:4
- To function as typically as possible
- To lower their mental distress and the unwanted influence of IAD
- To stop overusing medical treatments
With a focused treatment plan, these goals can be attained.
Therapy
Anxiety therapy in the form of individual, group, and family therapy sessions can provide much needed assistance for people with illness anxiety disorder. Psychotherapy, provided by psychologists, counselors, and social workers, can help the person to:3
- Recognize situations that make symptoms worse
- Develop coping skills to manage symptoms
- Stay active, even when symptoms remain
Common Type of Therapies
Various psychotherapy options are effective for IAD, but the most frequently recommended treatment type is called cognitive behavioral therapy (CBT).5 CBT helps people look at the interconnected relationship between their thoughts, feelings, and behaviors to see how worries and actions about illness only escalate symptoms.
When CBT is working, the person will gain a better understanding of their illness anxiety, tips to change their thinking, and tools to modify their behaviors. CBT may involve relaxation skills, stress management techniques, and bibliotherapy to boost benefits.7
Several other therapy styles have been proven safe and effective when anxious symptoms present, including:5
- Acceptance and commitment therapy (ACT): ACT employs mindfulness to accept the current situation balanced with commitment to behavioral change to address unwanted thoughts and physical sensations
- Dialectical behavioral therapy (DBT): DBT builds upon the central concepts of CBT to specifically focus on communication skills, regulating emotions, tolerating distress, and establishing mindfulness to help people understand themselves.
Intended Treatment Outcome & Timeline
In some situations, CBT can significantly reduce symptoms in as little as 12 sessions, but this may not be the case with illness anxiety disorder. Due to its nature, IAD may never go away fully.5 Instead, the condition has a more chronic course with periods of relapse and remittance. People may need to attend treatment for long periods of time to achieve and maintain the desired results.1
Medication
There are no medications specifically approved for the treatment of IAD, but clinicians find that antidepressants, like the ones commonly used to treat OCD, work well for people with illness anxiety disorder.6 Two groups of antidepressants have been especially helpful in the treatment of illness anxiety disorder – SSRIs and SNRIs.6
Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medications that allow more serotonin to remain available in the brain to promote feelings of happiness and relaxation. Fluoxetine (Prozac) is one specific SSRI that has been beneficial to people with IAD.
Prescribers may use various other medications to improve symptoms related to illness anxiety disorder. Some other medications used for IAD include:7
- Beta-blockers. Medications which are normally prescribed for high blood pressure, but this class of medications can help with the physical symptoms of anxiety. Propranolol (Inderal) is one helpful option from this group.
- Benzodiazepines. This category of medications can treat a range of anxiety disorders, but it also poses the risk of substance abuse or dependence. Alprazolam (Xanax) is commonly used with IAD.
- Antipsychotics. Drugs like pimozide (Orap), risperidone (Risperdal), and olanzapine (Zyprexa) can help reduce the anxiety and worries that present with IAD. These drugs may not be the first option, though, due to possible side effects.
Other Treatment Options
Due to the focus on medical health issues with illness anxiety disorder, the individual should strive to have a strong relationship with their primary care physician (PCP). The PCP, along with the therapist and prescriber, will play a vital role in treatment.4
To support illness anxiety treatment, a doctor can:4
- Provide physical evaluations to reassure the patient that their health is stable
- Schedule regular office visits at specific durations that make sense for the needs of the client. Someone who is used to weekly appointments may need to be seen biweekly or monthly to address any fears or needs.
- Help the patient decide if the symptoms warrant further investigation with a specialist or if they are better accounted for by IAD
- Coordinate efforts with the therapist and prescriber to keep each member of the treatment team aware of symptoms and changes
- Discourage “doctor-shopping” as a way for the patient to schedule more appointment and more testing from physicians that do not know about the patient’s needs
A person with IAD needs the trust and support from their PCP. No treatment plan for illness anxiety disorder is complete without it.
How to Get Help for Illness Anxiety Disorder
Many people will not have the insight to realize their symptoms stem from illness anxiety disorder, so the best way to get help for the condition is to listen and respect the assessments and recommendations of health professionals. PCPs and mental health experts will be on the frontlines of IAD diagnosis, and respecting their evaluation could be the best step towards getting help.
If you’re ready to get the help of a therapist, you can ask your PCP for a referral, or you can use an online therapist directory where you can search by specialty and insurance coverage.
How to Help a Loved One
Just as people with IAD may reject the recommendations of professionals, they may dismiss the opinions of loved ones, but consistently approaching the situation from a place of love and support is a wonderful start. Never address their symptoms during periods of anger or frustration as this will only create defensiveness.
Here are some ideas for helping someone with illness anxiety disorder:
- Learn about IAD: To help your loved one, you have to educate yourself regarding the signs and symptoms of the condition.
- Communicate your concerns: If you worry about your loved one, engage them in a respectful conversation during calm times for the most benefit. Let them know what you see and what you would like them to do.
- Offer your assistance: Going to appointments with your loved one could be a good way to communicate your concerns to the medical professionals. Adding loved ones to the treatment team is essential.
- Establish limits: Some people with IAD will go to extreme lengths that endanger their well-being. Let your loved ones know that at some point, you will take necessary steps to intervene with the doctors to protect them.
Can Illness Anxiety Be Prevented?
Although to date there isn’t really an established method for preventing illness anxiety disorder, there are some things that could decrease your risk of developing it or reduce symptom severity. Here are some possible preventive measures you can take:2
- IAD can be triggered or worsened by life-problems, so managing your stress effectively is key.
- Seek mental health treatment sooner rather than later– the prognosis for IAD is better for people in therapy.
- Educate yourself on IAD so you can differentiate between a genuine health concern vs the anxiety from the idea of having an illness.
For Further Reading
Illness anxiety disorder may not get as much time, attention, or funding as other mental health conditions, but even still, great organizations are working hard to identify issues with IAD and better forms of treatment.
Some organizations include:
Illness Anxiety Disorder Infographics
