Illness anxiety disorder (formerly: hypochondriasis and illness anxiety disorder) indicates a preoccupation with having or developing a serious undiagnosed general medical condition. Physical complaints are not present and if they are, only to a mild extent. If there are clear physical complaints, this is a somatic symptom disorder. People with illness anxiety disorder are particularly concerned by the idea that they are ill. In the DSM-5, this disorder falls under ‘somatic symptom disorder and related disorders’.
- What is Illness Anxiety Disorder?
- Symptoms of illness anxiety disorder
- Classification criteria DSM-5
- Additional features
- Prevent
- Causes and risk factors
- Comorbidity
- Treatment of illness anxiety disorder
- Cognitive behavioral therapy
- Medication
- Complications
- Prognosis
- Prevention
What is Illness Anxiety Disorder?
Preoccupation with having or developing a serious illness is called illness anxiety disorder and previously called hypochondriasis. This disorder is characterized by the fear of suffering from a serious physical illness, while physical complaints are absent or only present to a limited extent. There are fears of diseases with a serious course and even death, for example cancer, a heart attack or stroke. This preoccupation with illness is present for at least six months, although the specific illness feared may change during that period. This disorder can significantly reduce quality of life. Patients with illness anxiety disorder are usually aware that the extent and nature of their fears do not correspond to reality. They are often ashamed of it and try to keep their fears secret from others. Frequent doctor visits, constant checkups and reassurance that everything is fine are also typical.
Manual for the Classification of Mental Disorders (DSM-5) / Source: DSM-5
Symptoms of illness anxiety disorder
What are the symptoms of an illness anxiety disorder and what are the classification criteria according to DSM-5?
Classification criteria DSM-5
The classification criteria according to DSM-5 are:
- A Preoccupation with having or developing a serious illness.
- B Physical complaints are not present, or, if they are, only to a mild extent. If a general medical condition is present or a high risk of developing a general medical condition (such as when a disease runs in the family), the preoccupation is clearly excessive or disproportionate.
- C There is a high level of anxiety about health, and the person concerned quickly becomes concerned about their own health status.
- D The individual exhibits excessive health-related behavior (e.g., repeatedly checks his or her body for signs of illness) or maladaptive avoidance (e.g., avoids doctor’s appointments and hospitals).
- E The preoccupation with illness is present for at least six months, but the specific illness feared may change during that period.
- F The illness-related preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder, generalized anxiety disorder, morphodysphoric disorder, obsessive-compulsive disorder or delusional disorder, somatic type.
Additional features
The majority of people with an illness anxiety disorder make extensive use of somatic care, but are often not satisfied with it. There are also people with this disorder who are too anxious and avoid somatic care. They generally make more use of somatic care compared to the rest of the population, but less of mental health care (ggz). It often happens that they consult multiple doctors for the same alleged physical problem and are repeatedly told that there is nothing wrong with them. People with this disorder often feel that they are not taken seriously by doctors.
Prevent
Men and women are affected about equally. The disease can begin at any age and will persist unless adequate treatment is given. Low education level, old age, severe expression of the disease, long-term illness and frequent use of the health system are associated with the condition and its course.
Causes and risk factors
The causes of an illness anxiety disorder have not yet been properly researched in 2023. It is believed that a genetic predisposition, the personality trait ‘neuroticism’, insecure attachment and alexithymia (a personality trait in which people have problems recognizing and describing their own emotions) play a role. In addition, the parenting style in which parents pay close attention to physical complaints in themselves and their children, react anxiously and overprotectively to them and reward illness, appears to contribute to development. Experiences with serious illnesses or injuries and other traumatic experiences in childhood and adolescence are also possible causes. Another central aspect seems to be the tendency to pay special attention to bodily sensations, to experience them as intense, harmful and distressing and to regard them as abnormal.
Major events or an initial serious threat to health with ultimately a good outcome can be precipitating factors in the development of the disorder. A history of child abuse or having a serious illness as a child can be predisposing factors.
Preoccupation with having or developing a serious illness can be triggered by stress in daily life and negative experiences with the health system. The latter is, for example, the result of a wrong diagnosis or failure to recognize an illness in the person concerned, people in their immediate environment or celebrities. If this also has serious consequences or leads to death, distrust and fear increase.
Comorbidity
In connection with fear of illness, many patients experience other mental disorders. Up to 40 percent are affected by depression, which can arise as a primary but also as a secondary disease. Up to 20 percent suffer from so-called somatoform disorders: physical complaints without an organic cause. Anxiety disorders are also common.
Treatment of illness anxiety disorder
Cognitive behavioral therapy
Cognitive behavioral therapy (CBT) is often the appropriate treatment. It is a form of psychotherapy that teaches you to look at problematic situations differently and to deal with them differently. In the case of an illness anxiety disorder, we will examine whether your fears are rational and you will be helped to replace your irrational thoughts with healthy thoughts and helpful thoughts. The treatment will improve the quality of life. However, the most important point must be addressed from the beginning: the motivation for therapy. Most patients who suffer from illness anxiety disorder initially doubt whether psychotherapy is really the preferred method for the problem. On the one hand, patients suffer from their fears and feelings of shame due to frequent doctor visits, but on the other hand, they also benefit from the disease. You get a lot of attention and care, you are the center of attention, you always have a topic of conversation and you have an excuse to avoid annoying obligations. That is called disease gain.
Medication
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), can help treat anxiety disorders. Medications to treat mood disorders, if present, can also help.
Complications
Illness anxiety disorder may be associated with:
- Relationship or family problems because excessive worrying can frustrate others.
- Work-related performance problems or excessive absenteeism.
- Problems functioning in daily life.
- Financial problems due to excessive medical visits and medical bills.
- Have another mental disorder, such as somatic symptom disorder, other anxiety disorders, depression, or a personality disorder.
Prognosis
Some patients respond well to medication, psychotherapy or a combination of both. If drug treatment works for a person suffering from anxiety or depression, the prognosis can be quite good. In mild cases, symptoms may be relatively short-lived. If symptoms are severe and the person has other mental disorders, the person may be prone to chronic distress and long-term problems with functioning.
Prevention
In 2023, little is known about the prevention of illness anxiety disorder, but these suggestions may help:
- Seek professional help for anxiety complaints as soon as possible to prevent the symptoms from getting worse and reducing your quality of life.
- Learn to recognize when you are stressed and how this affects your body and learn relaxation techniques.
- Stick to your treatment plan to prevent relapse or worsening of the complaints.
read more
- Depression (DSM-5): symptoms, causes and treatment
- DSM-5: classification, criteria and division of the DSM-5