Illness anxiety disorder

Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn't reveal a serious medical condition.

You may experience extreme anxiety that body sensations, such as muscle twitching or fatigue, are associated with a specific, serious illness. This excessive anxiety — rather than the physical symptom itself — results in severe distress that can disrupt your life.

Illness anxiety disorder is a long-term condition that can fluctuate in severity. It may increase with age or during times of stress. But psychological counseling (psychotherapy) and sometimes medication can help ease your worries.

Hypochondria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, no longer includes hypochondriasis — also called hypochondria — as a diagnosis. Instead, people previously diagnosed with hypochondriasis may be diagnosed as having illness anxiety disorder, in which the focus of the fear and worry is on uncomfortable or unusual physical sensations being an indication of a serious medical condition.

On the other hand, somatic symptom disorder — a related disorder — involves focusing on the disabling nature of physical symptoms, such as pain or dizziness, without the worry that these symptoms represent a specific illness.

Symptoms of illness anxiety disorder involve preoccupation with the idea that you're seriously ill, based on normal body sensations (such as a noisy stomach) or minor signs (such as a minor rash). Signs and symptoms may include:

• Being preoccupied with having or getting a serious disease or health condition
• Worrying that minor symptoms or body sensations mean you have a serious illness
• Being easily alarmed about your health status
• Finding little or no reassurance from doctor visits or negative test results
• Worrying excessively about a specific medical condition or your risk of developing a medical condition because it runs in your family
• Having so much distress about possible illnesses that it's hard for you to function
• Repeatedly checking your body for signs of illness or disease
• Frequently making medical appointments for reassurance — or avoiding medical care for fear of being diagnosed with a serious illness
• Avoiding people, places or activities for fear of health risks
• Constantly talking about your health and possible illnesses
• Frequently searching the internet for causes of symptoms or possible illnesses

When to see a doctor

Because symptoms can be related to health problems, it's important to be evaluated by your primary care provider if this hasn't already been done. If your provider believes that you may have illness anxiety disorder, he or she may refer you to a mental health professional.

Caring for a loved one

Significant health anxiety can cause real distress for the person, and reassurance isn't always helpful. Sometimes, providing reassurance can make things worse. This can be frustrating and cause stress on families and relationships. Encourage your loved one to consider a mental health referral to learn ways to cope with illness anxiety disorder.

The exact cause of illness anxiety disorder isn't clear, but these factors may play a role:

• Beliefs. You may have a difficult time tolerating uncertainty over uncomfortable or unusual body sensations. This could lead you to misinterpret that all body sensations are serious, so you search for evidence to confirm that you have a serious disease.
• Family. You may be more likely to have health anxiety if you had parents who worried too much about their own health or your health.
• Past experience. You may have had experience with serious illness in childhood, so physical sensations may be frightening to you.

Illness anxiety disorder usually begins in early or middle adulthood and may get worse with age. Often for older individuals, health-related anxiety may focus on the fear of losing their memory.

Risk factors for illness anxiety disorder may include:

• A time of major life stress
• Threat of a serious illness that turns out not to be serious
• History of abuse as a child
• A serious childhood illness or a parent with a serious illness
• Personality traits, such as having a tendency toward being a worrier
• Excessive health-related internet use

Illness anxiety disorder may be associated with:

• Relationship or family problems because excessive worrying can frustrate others
• Work-related performance problems or excessive absences
• Problems functioning in daily life, possibly even resulting in disability
• Financial problems due to excessive health care visits and medical bills
• Having another mental health disorder, such as somatic symptom disorder, other anxiety disorders, depression or a personality disorder

Little is known about how to prevent illness anxiety disorder, but these suggestions may help.

• If you have problems with anxiety, seek professional advice as soon as possible to help stop symptoms from getting worse and impairing your quality of life.
• Learn to recognize when you're stressed and how this affects your body — and regularly practice stress management and relaxation techniques.
• Stick with your treatment plan to help prevent relapses or worsening of symptoms.

To determine a diagnosis, you'll likely have a physical exam and any tests your primary care provider recommends. Your provider can help determine if you have any medical conditions that require treatment and set limits on lab testing, imaging and referrals to specialists.

Your primary care provider may also refer you to a mental health professional. He or she may:

• Conduct a psychological evaluation to talk about your symptoms, stressful situations, family history, fears or concerns, and ways that your anxiety is negatively affecting your life
• Have you fill out a psychological self-assessment or questionnaire
• Ask you about alcohol, drug or other substance use
• Determine whether your illness preoccupation is better explained by another mental disorder, such as somatic symptom disorder or generalized anxiety disorder.

The goal of treatment is to help you manage anxiety about your health and improve your ability to function in daily life. Psychotherapy — also called talk therapy — can be helpful for illness anxiety disorder. Sometimes medications may be added.

Psychotherapy

Because physical sensations can be related to emotional distress and health anxiety, psychotherapy — particularly cognitive behavioral therapy (CBT) — can be an effective treatment. CBT helps you learn skills to manage illness anxiety disorder and find different ways to manage your worries other than excessive medical testing or avoidance of medical care.

CBT can help you:

• Identify your fears and beliefs about having a serious medical disease
• Learn alternate ways to view your body sensations by working to change unhelpful thoughts
• Become more aware of how your worries affect you and your behavior
• Change the way you respond to your body sensations and symptoms
• Learn skills to cope with and tolerate anxiety and stress
• Reduce avoidance of situations and activities due to physical sensations
• Reduce behaviors of frequently checking your body for signs of illness and repeatedly seeking reassurance
• Improve daily functioning at home, at work, in relationships and in social situations
• Address other mental health disorders, such as depression

Other therapies such as behavioral stress management and exposure therapy also may be helpful.

Medications

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may help treat illness anxiety disorder. Medications to treat mood or anxiety disorders, if present, also may help.

Talk with your doctor about medication options and the possible side effects and risks.

In addition to profession treatment for illness anxiety disorder, these self-care steps can help:

• Work with your provider. Work with your primary care provider or mental health professional to determine a regular schedule for visits to discuss your concerns and build a trusting relationship. Discuss setting reasonable limits on tests, evaluations and specialist referrals. Avoid seeking advice from multiple doctors or emergency room visits that can make your care harder to coordinate and may subject you to duplicate testing.
• Practice stress management and relaxation techniques. Learning stress management and relaxation methods, such as progressive muscle relaxation, may help reduce anxiety.
• Get physically active. A graduated activity program may have a calming effect on your mood, reduce your anxiety and help improve your physical functioning.
• Participate in activities. Staying involved in your work, as well as social and family activities, can provide you with support.
• Avoid alcohol and recreational drugs. Substance use can make your care more difficult. Talk to your primary care provider if you need help quitting.
• Avoid searching the internet for possible diseases. The vast amount of health information that may or may not be related to your situation can cause confusion and anxiety. If you have symptoms that concern you, talk to your primary care provider at your next scheduled appointment.

In addition to your medical evaluation, your primary care provider may refer you to a mental health professional, such as a psychiatrist or psychologist, for evaluation and treatment.

Here's some information to help you prepare for your appointment and what to expect from your primary care provider or mental health professional.

What you can do

• Your symptoms, including when they first occurred, how they impact your daily life and what you do to try to manage them
• Key personal information, including traumatic events in your past and any stressful major events
• Medical information, including other physical or mental health conditions that you have
• Medications, vitamins, herbs and other supplements you take and the dosages
• Questions to ask your doctor

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask your mental health professional may include:

• Do I have illness anxiety disorder?
• What treatment approach do you recommend?
• Would therapy be helpful in my case?
• If you're recommending therapy, how often will I need it and for how long?
• If you're recommending medications, are there any possible side effects?
• For how long will I need to take medication?
• How will you monitor whether my treatment is working?
• Are there any self-care steps I can take to help manage my condition?
• Are there any brochures or other printed material that I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional may ask:

• What are your symptoms, and when did they first occur?
• How do your symptoms affect your life, such as at school, at work and in personal relationships?
• Have you or any of your close relatives been diagnosed with a mental health disorder?
• Have you been diagnosed with any medical conditions?
• Do you use alcohol or recreational drugs? How often?
• Do you get regular physical activity?

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.