Previously called hypochondriasis or hypochondria, illness anxiety disorder (IAD) is a mental health condition in which a person strongly believes they have or will develop a serious or life-threatening illness, though they show little to no symptoms. This feeling persists even when tests or examinations show they do not have this serious condition.
Illness anxiety disorder is part of a group of clinically significant health anxiety disorders that affect up to 13% of the general adult population.
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Understanding Illness Anxiety Disorder
Hypochandriasis was removed from the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) in part because of the stigma attached to the words hypochandriasis and hypochandria. Upon hearing the word hypochandriac, there is often a false assumption that the person living with the condition is “faking it” and other harmful misconceptions that lead to the illness being dismissed or stigmatized.
Not “Faking It”
Though a person experiencing illness anxiety disorder does not show significant symptoms of the illness they believe they have, they are not faking being sick. Their beliefs in their illness are very real to them, and their worry is genuine and often frightening to the point of being debilitating.
What was previously labelled hypochariasis in the DSM-4 has been separated into two distinct conditions in the DSM-5:
- Illness anxiety disorder
- Somatic symptom disorder
Illness Anxiety Disorder
Symptoms of illness anxiety disorder include:
- Intense anxiety that you may have a serious, undiagnosed medical condition. You may spend excessive time and energy focused on health concerns, often researching them obsessively.
- Not easily reassured when given evidence that you do not have this serious medical condition.
- A significant disruption in your life, and a great deal of mental distress.
- No symptoms or insignificant symptoms of the illness(es) you think you have.
Somatic Symptom Disorder
Somatic symptom disorder is similar to illness anxiety disorder, except that people with somatic symptom disorder do exhibit at least one somatic (related to the body, not the mind) symptom. They may obsess over these symptoms.
Other anxiety disorders have symptoms that overlap with or are similar to illness anxiety disorder, but with some key differences.
Symptoms
People with illness anxiety disorder may experience:
- Excessive worrying that they have or may contract a serious illness or condition
- High levels of anxiety and hypervigilance about their health and changes in their body or health status
- Repeated, excessive behaviors such as frequently checking their body for signs of illness, frequently taking their blood pressure, or excessively taking their body temperature
- Avoidance behaviors such as avoiding doctors’ appointments and hospitals, or overuse/misuse of medical care
- Lack of physical symptoms to support their fear of the illness, or mild symptoms such as sweating or a slight increase in heart rate
- Disproportionate concern and anxiety over an existing illness or a real risk of contracting an illness
- Excessively talking about their health
- Frequently researching their symptoms, particularly online
- Believing tests that rule out illness are incorrect and have missed their illness, rather than feeling reassured by negative tests
- Avoiding places or people for fear of contracting an illness
- Worrying about and/or obsessing about the health of loved ones
People with illness anxiety disorder can be worried that they have any illness, but commonly focus on cancer, HIV/AIDS, and memory loss.
Which condition or illness a person with illness anxiety disorder becomes hyper-focused on can change over time.
Diagnosis
Primary health care providers play a key role in the identification of illness anxiety disorder. Having a relationship with the same health care provider over time allows for patterns to be noticed, and a record of visits, tests, and procedures to be kept in the same place.
A person with this condition may not see a health care provider with the aim of treating their illness anxiety disorder, as they may be unaware they have it. More often, they will seek a diagnosis and treatment for the illness or condition they believe they have, usually from a primary health care provider.
The process of determining a diagnosis of illness anxiety disorder is usually initiated by the health care provider after observing symptoms and suspecting the presence of the disorder.
To explore whether or not a person has illness anxiety disorder, the provider may:
- Review the person’s current and previous medical complaints
- Take and review the person’s medical history, including mental health disorders
- Perform a physical exam
- Run tests such as blood labs, and possibly imaging tests such as an MRI or CT scan to rule out a physical cause for the person’s behavior
- Explore the possibility that the person may be experiencing a different mental health disorder either instead of or in addition to illness anxiety disorder
A primary health care provider who suspects illness anxiety disorder may refer the person to a mental health professional for a more in-depth exploration of a diagnosis and for treatment. People with illness anxiety disorder often refuse to go, believing they have a real physical disorder, not a mental health disorder.
A diagnosis is made based on the criteria set out by the DSM-5 for illness anxiety disorder and by the observations of care providers who examine and speak with the person.
What Does the DSM-5 Say?
To meet the criteria of an illness anxiety disorder diagnosis, a person must exhibit all of the following:
- Preoccupation 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 (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate.
- There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.
- The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
- Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.
- The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder.
Causes
Researchers have not yet determined an exact cause of illness anxiety disorder, but some factors appear to put a person at an increased risk of developing the disorder.
Age
Illness anxiety disorder can develop at any age, and symptoms may come and go, but it usually first appears in early to middle adulthood, around age 25 to 35.
Illness anxiety disorder may get worse with age.
Stress
Symptoms of illness anxiety disorder can appear or worsen following a major life stressor, such as the death of a loved one.
Other Conditions or Symptoms
The presence of a serious symptom such as chest pain or memory loss that the person believes may be life-threatening might increase the risk of developing illness anxiety disorder.
Having another mental health disorder such as depression, anxiety disorders, or psychotic disorders, also puts a person at a higher risk of developing illness anxiety disorder.
Childhood Trauma
A history of physical, sexual, emotional child abuse or neglect appears to be a risk factor for illness anxiety disorder, as is a history of frequent or serious childhood illness.
Personal and Family Health History
Having a first-degree family member who has illness anxiety disorder may be a risk factor for developing the condition. It is thought this is the result of observational learning, meaning observing, memorizing, and mimicking behaviors, commonly by children to close adults.
Having personal or family history of chronic or serious illness can also put a person at risk of developing illness anxiety disorder, as can a personal or familial experience with the medical system that resulted in diminished trust or confidence in healthcare and/or health care providers.
Types
Illness anxiety disorder can be divided into two classifications:
- Care-seeking type
- Care-avoidant type
Care-Seeking Type
- Frequent seeking of medical care
- Overuse of the medical system, sometimes considered abuse of the system
- Requests for and undergoing frequent and/or unnecessary tests and diagnostic procedures
- Goes from doctor to doctor seeking a diagnosis when previous doctors have not found one
- May have anxiety briefly alleviated by reassurance that they do not have the condition about which they are worried, but the reassurance doesn’t last and the anxiety returns
- May acknowledge that their anxiety is exaggerated, but refuse to believe that there is nothing physically wrong at all
- May undergo unnecessary, elective surgeries
Care-Avoidant Type
- Feels anxiety over a perceived illness, but also feels anxiety about having that illness confirmed
- Avoids seeing a doctor or health care provider
- May resist discussing their concerns with health care providers, loved ones, or other people, for fear of ridicule or dismissal
Treatment
The goals of treatment for illness anxiety disorder include:
- Return functioning to as normal as possible and maintain it
- Relieve mental distress
- End and/or prevent the overuse of the medical system and resources
As in the case of diagnosis, a person’s primary health care provider plays a significant role in their treatment.
Primary care providers can:
- Provide a “hub” for people with illness anxiety disorder, giving consistent, regular care and discouraging “doctor shopping” (going from one doctor to another, seeking the desired diagnosis).
- Perform a gatekeeping role in terms of specialists, determining which referrals are needed and which are not, and reducing unnecessary medical care.
- Determine if a mental health specialist or other mental health resources are needed as part of a treatment plan, and connect the person with these resources.
- Offer regular “check-ins” to allow the person to discuss symptoms and relieve some anxiety—care providers must take the person’s symptoms seriously and not be dismissive, but should only suggest further action if necessary, as they would with any other patient
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a type of psychotherapy that helps people learn to identify negative, destructive, and maladaptive thoughts and behaviors. Once identified, CBT treatment involves techniques such as distraction, confrontation, and relaxation to change these unhealthy thoughts and behaviors into productive ones.
For people with illness anxiety syndrome, CPD and other types of psychotherapy treatments can reinforce methods to reduce anxiety such as body checking and doctor seeking usually fail to relieve anxiety in a meaningful way.
By replacing these thoughts and behaviors (i.e. the symptoms of illness anxiety disorder) with more effective stress management techniques, the person with illness anxiety disorder learns to focus on and target their anxiety instead of deflecting it or projecting it.
These techniques can be applied to anything that causes the person to feel anxiety in addition to the worry about a specific illness. This is particularly helpful if a person is experiencing other mental health conditions alongside illness anxiety disorder.
Medication
Medication is often beneficial to people who are living with illness anxiety disorder, particularly if they have other mental health illnesses such as OCD, depression, or generalized anxiety disorder as well.
The most commonly prescribed types of medications to treat illness anxiety disorder are:
- Selective serotonin reuptake inhibitors (SSRIs)
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
SSRIs are a class of antidepressants. They work by inhibiting the reuptake of serotonin (a neurotransmitter), thus increasing the amount of serotonin in the brain.
Examples of SSRIs include:
- Prozac (fluoxetine)
- Celexa (citalopram)
- Lexapro (escitalopram)
- Luvox (fluvoxamine)
- Paxil (paroxetine)
- Zoloft (sertraline)
- Trintellix (vortioxetine)
- Viibryd (vilazodone)
Potential side effects of SSRIs include:
- Nausea
- Vomiting
- Diarrhea
- Weight gain
- Dry mouth
- Headaches
- Anxiety
- Sleepiness
- Decrease in sex drive
- Jittery or restless feeling
- Sleep difficulties
Side Effects
Side effects from antidepressants can range from mild or non-existent to severe. They often get better with time or can be managed by a dosage adjustment. If the side effects of your anti-depressant are bothersome, check in with your prescribing health care professional about switching medications or trying a new treatment plan.
SNRIs are another class of antidepressants. They work similarly to SSRIs, except that they inhibit the reuptake of both serotonin and another neurotransmitter called norepinephrine.
Examples of SNRIs include:
- Cymbalta (duloxetine)
- Effexor (venlafaxine)
- Fetzima (levomilnacipran)
- Pristiq (desvenlafaxine)
- Savella (milnacipran)
Side effects of SNRIs include:
- Nausea
- Drowsiness
- Dizziness
- Nervousness or anxiety
- Fatigue
- Loss of appetite
- Sexual problems
- Increased blood pressure (with higher dosages)
Which medication is prescribed, or in what combinations, depends on the person’s symptoms, medical history, coexisting conditions (if any), tolerance for side effects, and what is agreeable to both the person and their care provider.
Never Stop an Antidepressant “Cold Turkey”
Stopping or changing antidepressants suddenly can be dangerous and cause withdrawal symptoms.
Always check with your health care provider before stopping any medication or changing treatment plans.
Lifestyle Medicine
Research suggests that lifestyle medicine is an effective treatment for some people with illness anxiety disorder, particularly when started early on.
Lifestyle medicine can be used alongside, and in cooperation with, traditional treatments.
A lifestyle medicine approach involves:
- Treating lifestyle causes, instead of individual risk factors, with the goal of disease prevention
- The person undergoing treatment is an active participant and partner in their care, rather than passively receiving care
- Making subtle transitions and changes
- A focus on long-term treatment
- Emphasis on motivation and adherence with responsibility falling mainly on the person undergoing treatment instead of the health care provider
- Medication used when needed alongside lifestyle medicine treatment
Coping
In addition to formal treatment plans, coping strategies that can help relieve the symptoms of illness anxiety disorder may be practiced in everyday life.
- Keep track of your anxieties, symptoms, and other behaviors related to illness anxiety disorder—a journal, diary, or app may be helpful with this task
- Work on changing your thought patterns by writing out your anxious thoughts and placing healthier alternative thoughts beside them
- Distract yourself from intrusive thoughts and urges to check your body or search for symptoms online by doing something you enjoy such as taking a walk or listening to music
- Practice breathing and relaxation exercises
- Incorporate stress management techniques
- Avoid researching medical conditions and symptoms online
- Shift your focus to hobbies and activities you enjoy
- Spend time outside
- Avoid substances such as alcohol and recreational drugs
- Eat a healthy, balanced diet
- Work on learning what normal body sensations feel like and label them when you experience them
- Get plenty of exercise and sleep
- Join a support group for people with illness anxiety disorder, or a more general one for people with anxiety disorders—your health care provider is an excellent resource for information on support groups and organizations, both in-person and online, that may be of use to you
A Word From Verywell
The word hypochondriac can conjure a stereotype of someone faking illness, or elicit a dismissive reaction to a person’s symptoms—but as the proper name of the condition indicates, illness anxiety disorder is a valid condition, recognized by the DSM-5.
The fears of being or becoming ill feel very real to people living with illness anxiety disorder, and they are in no way “faking it”.
The symptoms of illness anxiety disorder can be very intrusive, and make daily life complicated. They can also be quite frightening and disturbing for the person living with them.
If you meet the criteria for illness anxiety disorder and/or suspect you may have the condition, book an appointment with your health care provider to discuss the next steps. With treatment, illness anxiety disorder can be successfully managed.
Help Is Available
If you or a loved one are struggling with illness anxiety disorder contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.