Illness Anxiety Disorder

A person experiencing illness anxiety disorder may feel that they either currently have a serious or life-threatening medical condition, or that they are at high risk for such an illness. Though an illness or condition might not be present, certain symptoms¹ may appear to arise.

Someone with illness anxiety disorder might interpret commonplace bodily sensations or minor symptoms as indicators of grave illness. For example, they might experience intense anxiety regarding bodily sensations such as muscle twitches or fatigue, associating these feelings with specific illnesses. However, rather than the physical symptoms themselves, this excess anxiety can lead to further distress and disrupt daily functioning.

Those experiencing illness anxiety disorder may exhibit the following symptoms:

• A persistent and excessive worry about having or developing a serious or life-threatening illness
• Anxiety and excessive concern over health-related issues
• An absence of physical symptoms. If a physical symptom is present, it is generally only mildly distressing to the individual, while concern over having a medical condition or a family history of one is excessive
• Redundant and disproportionate health-related behaviors, which may include a continual scanning of the body for signs of disease (i.e., listening to heart, checking skin for lesions, hyper focusing on breathing patterns)
• Oversharing health status or symptoms with others
• Exaggeration of symptoms. For example, they may attribute a minor stomach ache to cancer rather than see it as a temporary gastrointestinal problem
• In care-seeking types, an excessive amount of doctor’s appointments, testing, hospitalizations may be observed
• In care-avoidant types, medical care is typically avoided or only sought rarely

For these symptoms to qualify for a diagnosis of illness anxiety disorder, they must be present for at least six months. A health professional must also rule out the presence of another mental health condition that would better explain the symptoms. 

A similar disorder called somatic symptom disorder² presents with similar symptoms to illness anxiety, with the key difference being that a person with somatic symptom disorder presents with true physical symptoms. However, even with somatic symptom disorder, a person’s symptoms cannot be pinpointed by medical testing. 

The cause of illness anxiety disorder is currently unknown. Illness anxiety disorder is a recent addition to the DSM-5, only present since 2013. Of the individuals diagnosed with the previous, obsolete diagnosis hypochondria, only a fraction meet criteria for illness anxiety disorder. Therefore, more research is needed to determine the cause. 

Risk factors

Despite not understanding the cause of illness anxiety disorder, researchers have determined that there are some common risk factors³ for developing the disorder, including:

• Experiencing other mental health conditions such as anxiety or depression
• Traumatic experience such as assault or abuse
• A childhood experience with serious illness, or serious illness in a family member or other loved one
• High levels of stress
• Health anxiety or other types of anxiety disorder present in family members

Treatment for illness anxiety disorder typically involves psychotherapy as a first line treatment, with medication prescribed in some cases. 

Medication

As a second-line of treatment after or during psychotherapy, for some individuals with illness anxiety disorder, a health professional may prescribe a medication such as an antidepressant. Antidepressants include medications like a selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). Medications for illness anxiety disorder are mostly used in combination with psychotherapy. 

It is important to consult with a doctor or medical professional before beginning or changing any medication plan. The information provided in this article is not intended as medical advice; please consult a qualified healthcare professional for personalized guidance. 

Other Treatment Options

Some self-care practices can be a helpful addition to professional treatment for illness anxiety disorder. These include:

• Learn and practice relaxation techniques such as meditation, breathing exercises, or progressive muscle relaxation
• Be honest with your medical healthcare provider regarding your mental health status. Work together to limit medical testing, establish a relationship with your doctor through regularly scheduled visits, and avoid seeking advice from multiple sources without guidance from your primary care physician
• Regular exercise may help reduce anxiety, and help regulate mood
• Stay socially active—friends and family can be an excellent support system
• Avoid internet research on physical symptoms, there is too much information that may not be related to your problem at all. Speak to your doctor instead. 

Illness anxiety disorder is a chronic⁴ condition that may fluctuate in severity, potentially worsening with age or during periods of heightened stress. However, psychotherapy, such as cognitive behavioral therapy (CBT) and in some cases, medication, can offer relief and aid in the treatment process. 

CBT is the most common and effective treatment for illness anxiety disorder. For many, long term therapy can be helpful, as symptoms can decrease for a period of time, and then recur during times of stress. 

CBT can help individuals with illness anxiety disorder by challenging and changing their patterns of thinking and behavior related to health concerns. Through this therapy, patients learn to recognize irrational beliefs about their health, develop coping strategies, and reduce excessive behaviors such as frequent medical consultations or body-checking rituals. 

By providing practical tools and promoting a more balanced perspective on physical sensations, CBT empowers individuals to regain control over their anxiety and improve their overall quality of life.

Because it is a relatively new diagnosis, literature on illness anxiety disorder is not robust. Many are smaller studies or individual case studies that recommend further research, along with offering advice to the medical community. 

A case report and brief literature review published in 2021 determined that the majority of illness anxiety cases can be found in medical establishments, rather than in a therapy setting. They concluded that the best way to promote healthy outcomes and avoid costly and unnecessary testing is for physicians to build a therapeutic alliance with their patients.

Another case report from 2019 agrees with the 2021 study, with the recommendation to integrate psychotherapy into medical care milieu to help identify those who are experiencing illness anxiety disorder, as well as differential diagnoses. 

Here are some key statistics on illness anxiety disorder:

• Among patients who had been previously diagnosed with the now-obsolete condition hypochondria, only around 25% met the criteria for the newly developed illness anxiety disorder diagnosis.
• Illness anxiety disorder is a fairly rare condition, with researchers estimating a prevalence of around 0.1% in the general population and 0.75% in the medical outpatient environment.
• Illness anxiety disorder is more commonly found in those who have less education or are unemployed.
• This disorder can be more commonly found in adolescents, and typically will get worse with age.