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Home » Illness Anxiety Disorder

  • Clinical Disorders

Illness Anxiety Disorder

  • - Written by admin
  • on August 3, 2021
illness anxiety disorder

Table of Contents

Overview

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 doctorโ€™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.

Risk Factors

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.

Diagnosis

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.ย ย 

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 โ€œdeformity or disfigurementโ€.

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)

Treatment

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.

Specialist

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.

In Conclusion:

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.

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Illness Anxiety Disorder

Table of Contents

Frequently Asked Questions

How is Illness Anxiety Disorder different from Somatic Symptom Disorder?

In Somatic Symptom Disorder, the individuals are preoccupied with their symptoms and try to find an explanation for what they are experiencing. On the other hand, individuals with Illness Anxiety Disorder are preoccupied with the existence of an illness, and correlate every bodily function to that illness.

Are people with Illness Anxiety Disorder likely to have other conditions?

Patients diagnosed with Illness Anxiety Disorder are unlikely to have physical conditions, and even if they do, they are not severe and the patientsโ€™ concern is often disproportionate. However, Illness Anxiety Disorder patients almost always have underlying mental disorders, such as anxiety, depressive, or personality disorders.

How long does Illness Anxiety Disorder last?

Illness Anxiety Disorder is a chronic illness and can be lifelong. Early diagnosis and treatment can be effective in managing symptoms.

What is cyberchondria?

Cyberchondria refers to illness anxiety that is brought about or worsened due to medical information found through internet searches.

How can Illness Anxiety Disorder be disruptive?

Patients of Illness Anxiety Disorder may constantly be worried about symptoms and talk about them extensively, which can be frustrating for close friends and family. Moreover, they may take leaves from work in order to seek out medical tests and consults, which can negatively affect occupational functioning and also cause financial burdens.

Do patients of Illness Anxiety Disorder experience medical symptoms?

While Illness Anxiety Disorder patients might experience symptoms, these usually are not the cause of the illness they fear they have contracted. Symptoms such as excessive sweating, headaches, or body aches may have other explainable causes, but patients of Illness Anxiety Disorder worry about them disproportionately and perceive them as causes of life-threatening illnesses.

Can Illness Anxiety Disorder be helped by showing the patient inconclusive test results?

Patients of Illness Anxiety Disorder are unlikely to believe negative test results. In such cases, they might either be assured for a while but suspect the illness again shortly, or immediately look for a second opinion.

Is Illness Anxiety Disorder common?

Illness Anxiety Disorder is rare and only affects about 0.01% of the general population.

Can Illness Anxiety Disorder be worsened by environmental causes?

Patients of Illness Anxiety Disorder are extremely worried about their health, and may be unreasonably concerned about environmental threats to their health. This can be exacerbated with the obvious presence of environmental threats such as a friend or family member being sick or an ongoing endemic or pandemic.ย ย 

If someone has a physical health condition, does that rule out Illness Anxiety Disorder?

Illness Anxiety Disorder can be comorbid with physical conditions. However, in such cases, the health-related anxieties are significantly excessive relative to the physical condition.

How long does Illness Anxiety Disorder treatment last?

Treatment for Illness Anxiety Disorder can be extensive, and depends on factors such as patient cooperation and early intervention. If the patient is tolerant and hopeful, the prognosis can be fair/good. However, if the patient does not cooperate with treatment, Illness Anxiety Disorder can have a poor prognosis.

Should patients of Illness Anxiety Disorder be kept away from primary physicians after diagnosis?

On the contrary, the primary physician should continue follow-ups even after diagnosis in order to ensure that the patient does not seek treatment elsewhere, and to detect possible new issues.

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5ยฎ). American Psychiatric Pub.
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  1. French JH, Hameed S. Illness Anxiety Disorder. [Updated 2021 May 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554399/
From <https://www.ncbi.nlm.nih.gov/books/NBK554399/>
  1. Espiridion ED, Fuchs A, Oladunjoye AO. Illness Anxiety Disorder: A Case Report and Brief Review of the Literature. Cureus. 2021;13(1):e12897. Published 2021 Jan 25. doi:10.7759/cureus.12897
From <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7903926/>
  1. Tamas, R. L., & McAndrews, C. (2020). Illness Anxiety Disorder/somatic symptom Disorder. Psychiatry Morning Report: Beyond the Pearls E-Book, 65.
From <https://scholar.google.com/scholar?hl=en&as_sdt=0%2C5&as_ylo=2020&q=illness+anxiety+disorder+prevalence&btnG=#d=gs_cit&u=%2Fscholar%3Fq%3Dinfo%3Ans_F6JZQ_PwJ%3Ascholar.google.com%2F%26output%3Dcite%26scirp%3D2%26hl%3Den>
  1. Harding, K. J., Skritskaya, N., Doherty, E., & Fallon, B. A. (2008). Advances in understanding illness anxiety. Current psychiatry reports, 10(4), 311-317.
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  1. Scarella, T. M., Boland, R. J., & Barsky, A. J. (2019). Illness Anxiety Disorder: psychopathology, epidemiology, clinical characteristics, and treatment. Psychosomatic medicine, 81(5), 398-407.
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