Illness Anxiety Disorder: What does it mean to have Hypochondriasis?
Hypochondriasis, which is now referred to as illness anxiety disorder, is a psychological disorder characterized by excessive worry about having an undiagnosed and often severe medical condition in the absence of signs and symptoms or in the presence of minor symptoms, and with physical examinations and medical tests proving the absence of the disease. The anxiety over the disease is often so severe that it disrupts normal functioning and daily activities of the individual.
The hallmark of illness anxiety disorder is an excessive worry about having a health issue which is not present. However, in 10-20% of healthy people, occasional unfounded concern and worry about a presumed medical illness occurs and is normal. Hypochondriasis is chronic and involves a constant fear or preoccupation with having a severe medical condition.
It is also known by other names such as hypochondria and health anxiety.
Illness anxiety disorder occurs equally in men and women and can develop at any age, but it most frequently begins in early adulthood. The disorder has a prevalence rate that ranges from 1.3 percent to 10 percent of the general population.
Several studies have also shown that illness anxiety disorder is more common among people with low educational level, low-income levels, and previous history of traumatic childhood experience.
What Causes Hypochondria?
Although the exact cause of illness anxiety disorder is not clearly understood, a number of factors contribute to its development:
- Personal Beliefs – Personal misunderstanding of one’s physical symptoms may lead one to misinterpret them and link them to serious medical illnesses.
- Family History – Individuals who have close relatives or family members with a history of excessive anxiety over their health are likely to develop health anxiety later in life.
- Personal experience – A childhood experience with a severe medical condition may lead an individual to develop anxiety and excessive concern about any physical symptom they develop later on.
- Other Psychological disorders – Depression and obsessive-compulsive disorder (OCD) have been linked to the development of hypochondriasis.
Signs and Symptoms of Illness Anxiety Disorder
The main feature of illness anxiety disorder is an excessive preoccupation with an idea that one has an unconfirmed severe illness and typically, the individual displays certain symptoms on that basis:
- Worrying that minor symptoms indicate an ongoing severe medical condition
- Being easily frightened by any symptoms
- Excessive worry about developing a certain medical illness in the presence of a risk factor
- Repeatedly checking the body for signs of disease
- Having severe life disruptions and dysfunctional daily activities as a result of the anxiety about the illness
- Avoiding certain activities, people, or places for fear of increased risks of having the disease.
- Constantly seeking for information on the internet about causes and symptoms of the presumed illness
- Constantly talking to friends and loved ones about the possibility of having such health challenges.
- Making frequent hospital visits for confirmation or reassurance, and in some cases, avoiding hospital visits for fear of being diagnosed with a severe medical condition
- Having no respite from worry and anxiety despite medical tests and physical examinations proving the absence of a severe medical condition.
Diagnostic Criteria for Illness Anxiety Disorder (DSM-5)
The following are the criteria for diagnosing illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).
- The individual is preoccupied with having or acquiring a serious illness.
- Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (for example, strong family history is present), the preoccupation is clearly excessive or disproportionate.
- The individual has a high level of anxiety about health, and is easily alarmed about personal health status.
- The individual performs excessive health-related behaviors or exhibits maladaptive avoidance.
- The individual has been preoccupied with illness for at least 6 months.
- The individual’s preoccupation is not better explained by another mental disorder.
Illness Anxiety Disorder and Other Conditions
Illness Anxiety Disorder vs. Hypochondriasis
Hypochondriasis is no longer considered a diagnosis according to DSM-5. It is now, instead subsumed under the category of Somatic Symptom Disorder for individuals with illness anxiety who have physical symptoms, those without any somatic symptoms are classified as having the actual illness anxiety disorder. Both of these conditions are contained under the category of Somatic Symptom and Related Disorders in DMS-5.
Illness Anxiety Disorder vs. Somatic Symptom Disorder
Somatic symptom disorder differs from illness anxiety disorder in the individual’s focus on real symptoms, unlike in illness anxiety disorder where the individual is excessively preoccupied with having a disease in the absence of signs or symptoms of the disease.
Furthermore, in symptom somatic disorder, the patient has one or more somatic symptoms such as pain, headache, or fatigue which cannot be traced to a medical condition, and develops an excessive anxiety about the symptoms resulting in significant distress which interferes with the patient’s daily life, as well as their social activities and relationships.
Other Related Conditions
Other psychological disorders related to illness anxiety include conversion disorder and body dysmorphic disorder.
Conversion disorder is characterized by the development of paralysis, muscle weakness, seizures, blindness or other neurologic symptoms which cannot be explained by a medical or neurological condition and often results from a psychological conflict induced by a stressful life experience. Unlike in illness anxiety disorder, patients do not express an overwhelming concern or worry over their symptoms.
Body dysmorphic disorder (BDD) is characterized by a preoccupation with one or more perceived distortions in one’s physical appearance that are not detectable or appear inconsequential to others. Often, this preoccupation causes significant distress which impairs the patient’s daily life including their social and occupational activities. Unlike patients with illness anxiety disorder, concerns are only restricted to physical appearance in patients with BDD.
Illness Anxiety Disorder in Adults/Children
Illness anxiety disorder typically begins in early adulthood and is relatively infrequent in children. This is because children are largely oblivious of symptoms and signs of specific disorders, therefore, do not develop concerns over their symptoms or the presence of specific diseases.
However, children may develop somatic symptoms, such as headaches or recurrent abdominal pain, as a result of psychological stress. A childhood history of somatic symptoms and psychological stress increases a child’s risk of hypochondriasis later in life.
Example Case of Illness Anxiety Disorder
A 35-year-old man presents to his primary care physician with fears that he might have cancer. On questioning about how long he had been having such concerns, he notes that for over two years, he has had a deep belief that he has lung cancer.
He notes that he does not smoke nor stay around a smoker for a long time. When asked about his symptoms, he notes that he has infrequent episodes of cough (usually about two episodes a year), intermittent chest pain, no night sweats, no weight loss, and no blood in sputum when he coughs.
He further states that he’s had multiple chest radiographs and bronchoscopies done which revealed no finding suggestive of lung cancer. He also mentioned that his father died of lung cancer at the age of 55 and thinks that that may affect his risk of the disease.
After being enlightened by the doctor on cigarette smoking and frequent exposure to second-hand smoke being the main risk factor for lung cancer, the patient is counseled on a less invasive procedure to check again. Physical examination was unremarkable, the patient’s chest is clinically clear.
However, the patient requests for a chest CT scan and mediastinoscopy and a “more detailed chest examination”. After many frustrating attempts to convince the doctor otherwise, the patient requests to see a “more experienced doctor”.
How to Deal with Illness Anxiety Disorder
Hypochondriasis occurs in episodes that last from a few months to a few years with symptom-free intervals of the same length. Although many patients with hypochondriasis generally improve over time, the prognosis is tied to a patient’s socioeconomic status, the presence of an enabling personality disorder, and absence of related medical conditions.
Hypochondria may lead to the following complications which require urgent therapy.
- Dysfunctional social and personal relationships as a result of the emotional distress
- Impaired work-related performance
- Physical disability which impedes how effectively a patient carries out their daily activities.
- Financial problems caused by excessive hospital visits and cost of unnecessary medical procedures and treatments
Factors which make a patient prone to developing these complications include:
- Previous history of a stressful life event such as a divorce.
- History of child abuse – physical, sexual, emotional.
- A severe childhood illness or a parent with or who died of a severe medical illness.
- Personality types which are prone to excessive worry.
Patients with hypochondriasis are usually treated by mental health professionals who conduct an extensive psychological evaluation regarding the patient’s symptoms, past medical and psychiatric history, as well as family history, to diagnose the illness and assess the extent to which it has affected the patient’s life.
Possible Medications for Illness Anxiety Disorder
Medications which may be prescribed for patients with illness anxiety disorder include antidepressants such as Prozac and Paxil, anti-anxiety drugs such as benzodiazepines, and antipsychotic medications including Risperidone. Drugs to treat specific symptoms that are present may also be prescribed.
Home Remedies to Help Illness Anxiety Disorder
Activities which help improve hypochondria include engaging in stress management techniques such as body massage and yoga, as well as limiting foods and drinks that exacerbate anxiety such as caffeine and alcohol. Some anti-inflammatory foods such as grass-fed beef, salmon, tuna, white fish, and mackerel also help lower the symptoms of anxiety.
Living with Illness Anxiety Disorder
Hypochondriasis can significantly impair an individual’s daily activities and cause serious complications. However, a few tips for improving the quality of life of patients living with illness anxiety disorder include:
- Cooperating with healthcare Provider – This is important for good treatment response, setting limits on unnecessary medical tests and avoiding visits to different doctors. The patient and mental health professional meet at prearranged schedules to discuss the patient’s concerns, monitor their treatment progress, and help build stronger relationships.
- Get active – Patients with hypochondria should engage in exercise programs to help improve their mood and physical function, and reduce anxiety symptoms.
- Avoid recreational drugs – These drugs may impair treatment effectiveness, exacerbate the symptoms, and increase the patient’s risk of developing severe complications of the condition.
- Avoid searching the internet or inquiring about medical illness one presumes to have. The vast amount of information related to health on the internet, if not well explained or interpreted, may cause confusion which often worsens a patient’s worry and distress over having the illness.
- Maintain participation in work and social activities – This provides the needed support and leaves little time for worry about the presumed medical illness.
Insurance Coverage for Illness Anxiety Disorder
Check your plan benefits for coverage of mental or behavioral health services. You may inquire through your human resources unit for employer-sponsored health coverage for treatment of this condition or you may contact your health insurance company directly. Also, find out about out-of-pocket costs and deductibles you will pay to access the mental health services under your insurance plan.
How to Find a Therapist
Your primary care physician, after a thorough psychological evaluation of your symptoms, will refer you to a psychiatrist or clinical psychologist for therapy. You may also check through online resources and directory to find the right therapist for you.
What should I be looking for in a Licensed Mental Health Professional (LMHP)?
Qualities you should look for in an LMHP include:
- Good Communication Skills: Your LMHP should be able to effectively communicate their expert ideas and thoughts about your symptoms clearly, as well as listen carefully to your thoughts before making conclusions.
- Empathy: You do not want a counselor who would rush through medical facts and treatment protocols without considering your emotional needs. You need an LMHP that is considerate, patient, calm, and compassionate with you.
- Problem-Solving Skills: Your chosen LMHP must be knowledgeable enough to help you through to a satisfactory resolution of your symptoms. While your complete relief is not entirely up to your counselor, they must demonstrate ample ability to help manage your symptoms effectively.
- Good multicultural Relationship: Your counselor must be able to strike a strong patient-therapist relationship with you regardless of any racial, ethnic, or cultural differences. Therapy must be devoid of such prejudices which may hamper on the effectiveness of treatment.
Questions to ask a Potential Therapist
You should ask your therapist the following questions to help you gain more insight into your symptoms and the scope and potential effectiveness of available treatment options.
- Do I have illness anxiety disorder?
- What is the treatment approach you recommend?
- Is therapy necessary?
- How long will therapy be for, if necessary?
- What medications will I be on?
- What side effects should I expect from those drugs?
- Are there effective home remedies I can employ?
- How will you monitor my treatment progress?
- Are there any resources or websites you recommend?
Illness anxiety disorder is a psychological disorder characterized by excessive worry about an idea of having a medical illness, usually in the absence of signs and symptoms or presence of minimal signs with diagnostic tests and physical examination proving the absence of the disease. The hallmark of the disorder is the patient’s overt preoccupation with the idea of having an illness that it causes significant distress and impairment of daily activities.