What is Illness Anxiety Disorder (Hypochondriasis)?
Illness anxiety disorder, previously known as hypochondriasis but renamed due to its derogatory implication, is a mental health disorder. It’s characterized by an extreme worry about having or getting a severe medical condition that’s not yet diagnosed. People who suffer from this disorder are constantly anxious or fearful that they have or will develop a serious illness, and this fear significantly disrupts their daily life.
This anxiety or fear continues even when medical tests and physical examinations show that they’re healthy. Individuals with illness anxiety disorder tend to focus excessively on normal bodily functions like digestion or sweating, and wrongly believe that these are signs of severe illness. It is usually a long-term condition.
What Causes Illness Anxiety Disorder (Hypochondriasis)?
The exact cause of illness anxiety disorder, also known as health anxiety, isn’t fully understood. But, different factors are believed to contribute to it.
* People with this disorder may easily worry about their health and could interpret normal physical feelings or minor changes in their body as signs of serious illness.
* If someone grew up in a household where health worries were often talked about, or the parents were overly worried about health issues, the person is more likely to develop this health anxiety.
* The chance of getting this disorder can increase for people who were seriously ill as kids or those whose parents or siblings had a serious health condition.
If people are already dealing with different anxiety disorders, such as generalized anxiety disorder, they have a higher risk of developing health anxiety. Additionally, people might be more at risk if they spend a lot of time looking at health information on the internet, which could lead to more health-related worries.
Risk Factors and Frequency for Illness Anxiety Disorder (Hypochondriasis)
Illness anxiety disorder, also known as IAD, is a fairly recent development in the health world. Its first official record appeared in the 2013 version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Therefore, we don’t have a lot of information about how many people suffer from it. To estimate the prevalence of IAD, researchers look at the data for hypochondriasis, a now outdated term that used to describe a similar condition. They found that around 25% of those previously diagnosed with hypochondriasis meet the criteria for IAD.
The prevalence of IAD also varies greatly depending on where it’s being studied, such as in a medical clinic or the wider community. For example, in a medical outpatient context, approximately 0.75% have IAD, whereas in the general population this number drops to around 0.1%. IAD is also frequently diagnosed in teenagers, with no clear difference between males and females. However, it usually gets worse as people get older. Additionally, people who are jobless or don’t have much education are seen to have IAD more frequently.
- Illness anxiety disorder is a relatively new diagnosis from 2013.
- The number of people with IAD is estimated from previous diagnoses of hypochondriasis.
- About 25% of patients who were previously diagnosed with hypochondriasis now meet the criteria for IAD.
- The prevalence of IAD is around 0.75% in a medical outpatient setting and 0.1% in the general population.
- IAD is common in teenagers and generally worsens with age.
- Unemployed and less educated individuals are more frequently diagnosed with IAD.
Signs and Symptoms of Illness Anxiety Disorder (Hypochondriasis)
Illness Anxiety Disorder (IAD) is a condition where people are excessively worried about having a serious illness, despite having no or only mild symptoms and being repeatedly reassured by medical tests and doctors. Often, these individuals first seek help from their regular doctor, rather than a mental health specialist. Even after thorough examinations and repeated assurances that they are healthy, they continue to be greatly stressed over the fear of having a serious illness.
Patients with IAD usually aren’t convinced by negative test results and may consult numerous doctors for the same concern. They often believe that their previous doctors missed a significant medical condition due to incompetence or inattention. They might also frequently check their bodies for changes like skin lesions, hair loss, or other physical alterations and obsess about dying or becoming disabled. This constant worry about their health can significantly affect their social life and job performance.
There are typically two types of patients with IAD:
- The care-seeking type: These patients repeatedly use the health care system, often changing doctors and requesting numerous tests and treatments.
- The care-avoidant type: These patients avoid seeking medical care out of extreme fear that tests will reveal a life-threatening illness, like cancer.
Having a general medical condition doesn’t exclude a diagnosis of IAD. Both can exist together. In such cases, IAD is diagnosed when the patient’s worry about their health is far more than what’s usual or reasonable for their existing medical condition.
Testing for Illness Anxiety Disorder (Hypochondriasis)
Illness anxiety disorder, also known as IAD, is a complex condition where a person is excessively anxious or worried about having or developing a serious illness. This happens despite having no or only mild physical symptoms. Experts typically consider this diagnosis when there’s no medical explanation for a patient’s health concerns.
Diagnosing IAD is a meticulous process. It requires a thorough medical check-up and appropriate testing based on the patient’s symptoms. This step is crucial to exclude other medical disorders before a diagnosis of IAD is made.
The Diagnostic and Statistical Manual of Mental Disorders, known as DSM-5, provides specific criteria that help in the diagnosis of IAD. Here are the key points:
1. The patient is excessively worried about having or developing a serious or life-threatening illness.
2. The patient doesn’t have physical symptoms, or if they do, they are mild.
3. The patient is overly concerned and anxious about health-related issues.
4. The patient demonstrates extreme and repeated health-related behaviors, such as continually checking their body for signs of sickness.
5. The patient has been experiencing symptoms for at least six months.
6. The fear and obsession with illness cannot be better explained by another mental health condition.
Additionally, patients can be classified as:
* Care-seeking type: These patients tend to go to the doctor or undergo tests and procedures quite frequently.
* Care-avoidant type: These patients hardly ever or never seek medical care.
There’s a structured interview tool called “The Health Preoccupation Diagnostic Interview” that’s helpful in diagnosing IAD. However, it’s used less frequently because it’s a time-consuming and labor-intensive process, making it ideal for research purposes.
Finally, it’s worth noting that even when a patient has a general medical condition, they can still have IAD. This occurs when a patient’s anxieties or worries about their health are excessive or disproportionate to their actual medical condition.
Treatment Options for Illness Anxiety Disorder (Hypochondriasis)
The main goal in treating someone with illness anxiety disorder, otherwise known as health anxiety, is helping patients manage their fears about their health. It’s important for healthcare providers to build a strong, trusting relationship with the patient, ensuring that they feel at ease discussing their health concerns. Dismissing their worries as “all in the head” should be avoided. Sometimes, it may be necessary to refer the patient to a specialist for further assessment.
After the patient has been evaluated and serious medical conditions have been ruled out, it’s important to refrain from ordering unnecessary tests, specialist referrals, or excessive use of medical services. If illness anxiety disorder is diagnosed, the patient should ideally be referred to a mental health professional or a psychiatrist. This referral should be done with tact and without judgement, so as not to make the patient feel dismissed or neglected.
Regular follow-up appointments with the primary healthcare provider and the psychiatrist are advisable. This can not only minimize unnecessary emergency department visits or consultations with other doctors but also provide an opportunity for the healthcare provider to evaluate any new complaints and associated triggers or stresses.
Psychotherapy, specifically cognitive-behavioral therapy (CBT), is considered the first course of action for treating illness anxiety disorder. CBT works by targeting and changing unhelpful patterns of thinking and behavior. The therapy can help patients change their habits of consistently checking their bodies for signs of illness and educate them about normal bodily sensations and the natural variations that occur. Other therapies, such as mindfulness-based cognitive therapy, group therapies, and acceptance and commitment therapy could also be beneficial.
If therapy isn’t enough, medication such as antidepressants can be used. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have proven effective in treating this condition. If a patient responds well to the medication, it’s recommended to continue the treatment for at least 6 to 12 months. Often, a combination of psychotherapy and medication proves most effective.
What else can Illness Anxiety Disorder (Hypochondriasis) be?
During the first check-up, doctors aim to rule out any general medical conditions. After doing so, other diagnoses that could be relevant include somatic symptom disorder, obsessive-compulsive disorder, generalized anxiety disorder, and body dysmorphic disorder.
Somatic symptom disorder is a condition related to mental health in which a person has multiple persistent physical symptoms that cause a lot of worry or anxiety. However, people suffering from Illness Anxiety Disorder (IAD) usually have minimal physical symptoms. They are mainly concerned with the idea that they might be sick or have a disease.
Obsessive-compulsive disorder (OCD) is another mental health issue where individuals experience repetitive, unwanted thoughts that only go away when they do certain behaviors or actions. These actions often involve repeating certain tasks, like rechecking door locks. While patients with IAD might also have repeated thoughts about illness and act out certain behaviors, such as frequently checking their bodies or constantly seeking reassurance, their concerns are solely focused on health and disease.
People with generalized anxiety disorder (GAD) will often feel excessive worry and fear about a broad range of everyday life matters. They might seem anxious, tense, or excessively worried. However, people with IAD specifically focus their anxiety on health, while GAD patients’ concerns can span across their social, romantic, and work lives.
Body dysmorphic disorder (BDD) is a mental health condition where individuals become overly focused on imagined flaws in their physical appearance. People with BDD might constantly check their bodies or their appearance in the mirror. However, unlike IAD patients, their main concern is not about being sick, but about being physically unattractive.
Other mental health disorders that one needs to be aware of include:
- Anxiety disorders
- Body dysmorphic disorder
- Conversion disorders
- Delusional disorder
- Depression
- Generalized anxiety disorder
- Obsessive-compulsive disorder
- Personality disorders
- Schizophrenia
- Somatic symptom disorder
What to expect with Illness Anxiety Disorder (Hypochondriasis)
The outlook for people with illness anxiety disorder is typically better for those who seek mental health evaluation earlier on, compared to those who solely rely on general medical care. Furthermore, research indicates that patients who are cooperative, patient, and optimistic generally have better outcomes.
If a person responds positively to therapies such as talk therapy, medication, or a combination of both, the outlook for their illness anxiety disorder can be somewhere between fair to good. However, those experiencing severe symptoms of the disorder, that don’t get better with medication or therapy, may have a poor outlook.
Possible Complications When Diagnosed with Illness Anxiety Disorder (Hypochondriasis)
Illness anxiety disorder is a serious health problem that can greatly disturb a person’s daily life and relationships. It can make normal routines difficult and lead to serious disability. Fearing that they are ill, individuals with this disorder often take frequent time off work, which can lead to job-related challenges. Another problem is the financial stress from regular doctor’s visits and medical bills. This disorder can also make the person more susceptible to other mental health issues like major depressive disorder, other anxiety disorders, or a personality disorder.
Common Issues:
- Disturbance in daily life and relationships
- Difficulty in performing normal routines
- Potential for serious disability
- Frequent leave from work
- Financial stress from doctor’s visits and medical bills
- Increased risk of other mental health issues like major depressive disorder, anxiety disorders, or a personality disorder
Preventing Illness Anxiety Disorder (Hypochondriasis)
Educating the patient is the key to successfully managing Irritable Anus Syndrome (IAS). It’s a delicate balance of acknowledging the patients’ worries about their health while also reassuring them and teaching about the normal functions of the body. Doctors and healthcare givers should always use empathetic words to strengthen their trust and relationship with the patients.