Illness Anxiety Disorder (previously recorded in the DSM as Hypochondriasis), also known as health anxiety, is a condition characterized by excessive worrying or nervousness about having or developing a serious mental health condition.
Patients experience severe stress related to contracting illnesses which disrupts their daily life and hinders functionality. Diagnostic requirements state that individuals experience this preoccupation for at least six months, while the illnesses suspected may change within that period of time.
There are two types of Illness Anxiety Disorder: the care-seeking type and the care-avoidant type. The care-seeking type refers to individuals who over-utilize medical resources, even in spite of inconclusive or negative tests due to their belief that they are suffering from a disease.
On the other hand, the care-avoidant type are likely to avoid undergoing tests or confronting physicians for the fear of being diagnosed with a disease.
There is a lack of conclusive data concerning the prevalence of Illness Anxiety Disorder, though studies suggest that it proportionately affects males and females, worsens with age, and is commonly seen in unemployed and less educated individuals.
Early diagnosis and intervention is recommended, with modes of treatment involving Cognitive Behavioral Therapy and use of SSRIs (Selective Serotonin Reuptake Inhibitors) to manage symptoms.
Signs and Symptoms
Illness Anxiety Disorder needs a medical diagnosis. Signs of Illness Anxiety Disorder can include:
1. Irrational fears of having or acquiring a serious illness
2. Being easily alarmed upon hearing health-related news pertaining to others
3. Constantly searching the internet for information about the concerned illness
4. Constantly talking about health issues
5. Making doctor’s appointments excessively
6. Heightened awareness about bodily sensations (especially pain)
7. Nervousness over health status
8. Significant distress over health that gets in the way of daily functioning
9. Being unresponsive to medical reassurance or negative tests
There is usually an absence of both physical causes as well as somatic symptoms. In the case of the presence of physical causes, the anxiety is considerably excessive and disproportionate to the severity of the condition.
The prevalence of Illness Anxiety Disorder is based largely on previous prevalence of hypochondriasis, although its epidemiology is largely unclear. The estimated prevalence is 0.75% in medical outpatients and 0.1% in the general population.
Among those previously diagnosed with hypochondriasis, 25% patients meet the criteria for Illness Anxiety Disorder.
Sociodemographic studies have been inconsistent, though a large number of them suggest that Illness Anxiety Disorder evenly affects males and females. The common age of onset is adolescence, with symptoms worsening with age.
It is more common among unemployed and less educated individuals. In some cases, major life stress or serious but ultimately non-threatening situations may precede the disorder. There is also evidence of a history of child abuse among those who develop Illness Anxiety Disorder in adulthood.
While the exact comorbidities of Illness Anxiety Disorder are unknown, hypochondriasis co-occurs with anxiety disorders (especially generalized anxiety disorder, panic disorder, and OCD) and depressive disorders.
An estimated two-thirds of individuals with Illness Anxiety Disorder are likely to have at least one comorbid major mental disorder. Individuals with Illness Anxiety Disorder are also at a higher risk of somatic symptom disorder and personality disorders.
The diagnosis of Illness Anxiety Disorder is concerned mainly with exclusion. Due to the medical concern among patients, they are more likely to be found in medical settings, in which case it is imperative for the primary physicians to rule out any possibility of genuine physical cause prior to considering Illness Anxiety Disorder as a diagnosis, through careful review of medical records.
It is also helpful to seek records from previous institutions that the individual has been concerned with, with consent from the individual.
The DSM-5 criteria for diagnosis of illness anxiety order are:
A. Excessive worry about having or developing a debilitating or life-threatening illness.
B. Somatic symptoms are absent. If somatic symptoms are present, they are only mildly distressing to the patient. If a medical condition is present or a high-risk for developing a medical condition is present (due to family history), the anxiety regarding the medical condition (or potential impending medical condition) is excessive.
C. Excessive concern and anxiety regarding health-related issues.
D. The individual exhibits disproportionate and redundant health-related behaviors, such as repeatedly checking his or her body for indications of disease.
E. Symptoms have been present for at least 6 months
F. The illness-related preoccupation is not better explained by another psychiatric condition
The ICD-10-CM definition also includes preoccupation with presumed “deformity or disfigurement”.
The diagnostic interview will likely include questions about the following:
- Symptoms of other possible underlying psychological ailments
- Level of worrying about the illness
- The specific illness feared (if any)
- Evidence upon which the patient bases their worries
- Checking behaviors that the patient engages in and the time spent on them
- Presence and severity of somatic symptoms
- Functional impairments and limitations
Structured clinical interviews such as the Anxiety Disorder Interview Schedule are also available.
There is also availability of standardized assessments for illness anxiety, such as:
- Whiteley Index (assessing domains of disease fear, disease conviction, and bodily preoccupation)
- Health Anxiety Inventory (full and shortened)
- Illness Attitudes Scale
- H-YBOCS-M (Modified Hypochondriasis Yale-Brown Obsessive Compulsive Rating Scale)
The primary mode of treatment for Illness Anxiety Disorder is therapeutic, with greater focus on helping the individual cope with their health anxiety. Early intervention with regards to Illness Anxiety Disorder is recommended for a plethora of reasons.
- Treatment is more likely to take effect if the condition is caught early
- Chronic somatoform diseases such as Illness Anxiety Disorder are associated with high direct and indirect costs, which early intervention can cut down on, benefitting both the individual as well as the healthcare system
- Less risk of unnecessary treatment and harm
- Owing to the frustrations of medically unexplained symptoms, early diagnosis can be beneficial to the patient/doctor relationship as well
In primary care settings (hospitals or emergency rooms), it is important to take measures such as limiting repetitive testing, avoiding unnecessary treatment, avoiding use of medical jargon, and treating patients with empathy.
Collaborative care models, wherein the primary physicians work together with psychiatrists, has proven to be beneficial in reducing severity of symptoms, improving social functioning, and reducing healthcare use.
There have been two effective modes of treatment for Illness Anxiety Disorder: psychotherapeutic and psychopharmacological. Psychotherapeutic modes utilize Cognitive Behavioral Therapy, which works by modifying dysfunctional thoughts.
Psychopharmacological modes utilize SSRIs (antidepressants), which have proved efficacious not only for Illness Anxiety Disorder but also for the highly comorbid symptoms of depression, anxiety and other somatoform symptoms.
Primary healthcare providers must establish a trust-based relationship with the patient. Upon diagnosis, patients are referred to specialist healthcare providers or psychiatrists, and the primary physician continues regular follow-ups. In addition to reducing visits to the emergency room and other physicians, follow ups from the primary healthcare provider can make way for the assessment of new complaints, associated triggers and stress in a critical manner.
An overwhelming fear of becoming extremely ill or having a serious illness is known as illness anxiety disorder, also referred to as hypochondriasis or health anxiety. You could be symptom-free physically.
Although little is known about how to stop illness anxiety disorders, these recommendations might be useful. Consult a specialist as soon as you can if you are experiencing anxiety-related issues to help prevent symptoms from growing worse and reducing your quality of life.
Learn how your body reacts when you’re anxious and practice stress reduction and relaxation strategies on a daily basis. Maintaining adherence to your treatment plan can help you avoid relapses or symptoms getting worse.
Connect with us and start your counseling sessions with Ananda.