Illness Anxiety Disorder or Hypochondria – Types, and Treatment

Definition

Illness anxiety disorder or Hypochondria is a chronic psychiatric disorder characterized by a persistent fear of having or developing a serious medical condition. In general, individuals with illness anxiety disorder display a dysfunctional degree of concern regarding their health, which is also known as health anxiety. This fear usually persists even after physical examination and laboratory test results show no indication of a medical condition.

Often, individuals with an illness anxiety disorder may misinterpret typical physical sensations, bodily functions, and mild physical symptoms as evidence of severe medical illness. Individuals with a long-term illness anxiety disorder may experience negative impacts on their mental health, relationships, and careers.

Epidemiology

Efforts have been made to quantify international rates of illness anxiety disorder and other somatic symptom disorders. Those rates are heavily influenced by the diagnostic criteria involved (ie, somatization disorder versus abridged somatization disorder) and how studies are conducted. Within the US, researchers have also worked to define how culture and ethnicity interact to determine “idioms” of distress and also how these factors influence the physician-patient relationship. This research has included the formulation of patterns of presentations that can be classified as “culture bound syndromes.” A selective literature review recommends that culture be considered in idiopathic somatic symptom presentations, but also that caution be taken to not be overly generalizing about ethnicity.

Types of Illness Anxiety Disorder

There are two types of illness anxiety disorder: care-seeking and care-avoidant.

Care-Seeking Type

Some people with illness anxiety disorder react with a need for constant reassurance. They may visit the doctor regularly despite tests showing that everything is normal. They may also frequently complain of their symptoms to friends and family members.5

Care-Avoidant Type

Others with IAD react in the opposite extreme. They may avoid visiting the doctor for fear of learning bad news. They may be reluctant to share their fears with loved ones, either because they are afraid of having their fears confirmed or because they believe that they will not be taken seriously.

Illness Anxiety Disorder risk factors

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

Causes of Illness Anxiety Disorder

What makes someone have illness anxiety disorder isn’t very clear, but researchers have explored various theories, many of which are related to early life experiences and personality traits. Examples of possible risk factors include:

• Having overly worried or anxious parents
• Witnessing parents suffering from a serious health condition
• Having had a serious illness as a child
• Having experienced childhood abuse or neglect
• Experiencing extreme stress or witnessing a major trauma
• Having had serious symptoms, whether or not it threatened their health
• Being overly concerned about body sensations or changes to the body
• Having a general tendency to worry
• Having a habit of looking for health-related information on the internet
• Having another mental health disorder (e.g., depression, generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder)
• Having certain genes (though there is very limited research to confirm this)

Ultimately, these theories point to a common theme among people with illness anxiety disorder: a misunderstanding of illness and good health. For example, if you suffered from a serious childhood illness, you might believe that it’s more common than it is, and you may not fully know how you got it or how it was treated. This could lead to an unrealistic belief that it’s really easy to get a serious disease.

Illness Anxiety Disorder Symptoms

Symptoms of hypochondria can include:

• Conviction that a disease is present even though symptoms are either nonexistent or very mild
• Frequent trips to doctors or a fear of visiting the doctor
• Constantly checking one’s body for signs of illness
• Intense anxiety during doctor’s appointments
• Requesting to see multiple doctors for the same minor issue and becoming increasingly frustrated and anxious at the repeated lack of diagnosis
• Feeling or expressing severe alarm upon reading or hearing about illnesses and health issues
• Excessive Internet research about the suspected disease
• Avoiding activities that could jeopardize their health, such as visiting sick relatives or exercising

Complications

Constant fear and worry can cause stress that impacts your physical and mental well-being. Illness anxiety disorder can harm your relationships and life. You may miss out on time with loved ones because you’re concerned about your health. Some people become severely depressed and even suicidal.

Illness anxiety disorder also puts you at risk for:

• Financial struggles due to medical bills and missed work.
• Medical disability and unemployment.
• Unnecessary medical tests and potential test complications.

Diagnosis and test

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.

Treatment and medications

The best psychological treatments combine therapy and medication. The interventions aim to manage both present and future symptoms.

These therapies should be used in combination with a long-term goal. The specific therapeutic intervention chosen depends on a patient’s severity level and health history. Sometimes therapists combine several treatments at once.

Here are the various types of treatments for people with Illness Anxiety Disorder:

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.

Cognitive behavioural therapy 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.

Mindfulness

Being mindful emphasizes being at peace with the present moment. This enables you to reflect on your thoughts without reacting. Being mindful can serve as an alarm when your anxious thoughts spring up so that you treat them as mere thoughts and nothing more. That way,  these thoughts lose their power over you.

It is not hard to attain a mindful state. Even if you are busy at work,  you can become mindful simply by focusing on the present.

Here are some mindfulness techniques that may be beneficial to you:

• Simply relaxing and breathing as in meditation. Just be aware of your thoughts without judging them.
• Feeling your senses: Be aware of seeing, smelling, touching, hearing, and tasting.
• Feel what your body is experiencing when an anxious thought comes on and then passes.
• Practice naming the emotions so that there is no judgment involved. Name your moods as joy, sadness, or happiness so you can understand your emotions better.

 Interpersonal Therapy (IPT)

Interpersonal therapy provides patients with the tools to work on their interpersonal relationships and address unresolved issues, experiences such as grief or conflict, or changes in social or work roles, which can contribute to a build-up of anxiety.

In ITP, a therapist works with patients to improve their emotions and how they communicate about them. Anxiety-related disorders have often been treated with ITP; however, ITP was originally used primarily for depression.

Psychoanalytic Therapy

Therapy with this approach aims to help patients better understand the unconscious fears that impact their thoughts, behaviors, and emotions.

Psychoanalytic therapy is based on Sigmund Freud’s theories, an influential thinker who contributed significantly to understanding the human mind’s functioning.

The sessions involve patients discussing their lives with their psychoanalytic therapists, which leads to the method’s coined name, “the talking cure”.

A therapy provider will assess your current difficulties based on recent patterns or recent significant events. Psychoanalysts try to expose how early childhood events and unconscious emotional states trigger mental illness and disruptive behaviors.

Art Therapy

This nonverbal therapy employs creativity to cultivate awareness and mindfulness. It has become quite popular in recent years. Arts-based therapy can be of any form, particularly visual arts like painting, drawing, and photography.

In creating art, you may begin to examine what you have made and what it feels like to you. When you explore your art, you can unravel themes related to the way you behave, feel or think.

People of all ages, including children, teens, and adults, can participate in art therapy, and they do not need to be artistic or have a special talent to benefit from it.

Medications

In addition to therapy, medication may be prescribed. Selective serotonin reuptake inhibitors (SSRIs) are a type of medication that can help to treat illness anxiety disorder. These drugs are generally known as antidepressants and work by affecting the levels of serotonin in the brain. Examples include Zoloft (sertraline), Paxil (paroxetine) and Prozac (fluoxetine).

Prevention of Illness Anxiety 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.