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ILLNESS ANXIETY DISORDER

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Illness anxiety disorder (previously called hypochondriasis, a term that has been abandoned because of its pejorative connotation) most commonly begins during early adulthood and appears to occur equally among men and women.

ILLNESS.1jpg
ILLNESS.1jpg

The patient’s fears may derive from misinterpreting nonpathologic physical symptoms or normal bodily functions (eg, borborygmi, abdominal bloating and crampy discomfort, awareness of heartbeat, sweating).

you may have no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn’t reveal a serious medical condition.

You may experience extreme anxiety that body sensations, such as muscle twitching or fatigue, are associated with a specific, serious illness. This excessive anxiety — rather than the physical symptom itself — results in severe distress that can disrupt your life.

Illness anxiety disorder is a long-term condition that can fluctuate in severity. It may increase with age or during times of stress. But psychological counseling (psychotherapy) and sometimes medication can help ease your worries.

 

On the other hand, somatic symptom disorder ― a related disorder ― involves focusing on the disabling nature of physical symptoms, such as pain or dizziness, without the worry that these symptoms represent a specific illness.

Symptoms

Symptoms of illness anxiety disorder involve preoccupation with the idea that you’re seriously ill, based on normal body sensations (such as a noisy stomach) or minor signs (such as a minor rash). Signs and symptoms may include:

  • Being preoccupied with having or getting a serious disease or health condition
  • Worrying that minor symptoms or body sensations mean you have a serious illness
  • Being easily alarmed about your health status
  • Finding little or no reassurance from doctor visits or negative test results
  • Worrying excessively about a specific medical condition or your risk of developing a medical condition
  • because it runs in your family
  • Having so much distress about possible illnesses that it’s hard for you to function
  • Repeatedly checking your body for signs of illness or disease
  • Frequently making medical appointments for reassurance — or avoiding medical care for fear of being diagnosed with a serious illness
  • Avoiding people, places or activities for fear of health risks
  • Constantly talking about your health and possible illnesses
  • Frequently searching the internet for causes of symptoms or possible illnesses
  • When to see a doctor
  • Because symptoms can be related to health problems, it’s important to be evaluated by your primary care provider if this hasn’t already been done. If your provider believes that you may have illness anxiety disorder, he or she may refer you to a mental health professional.

The main symptom of hypochondria is excessive worrying about health.
Causes may vary, and could be related to other legitimate health conditions.
For most people, it is a temporary experience.
The term as defined by the DSM-5 manual is somatic symptom disorder.

Fearing normal functions – for a person with hypochondria, normal bodily functions, such as heartbeats, sweating, and bowel movements can seem like symptoms of a serious illness or condition.

Fear of minor abnormalities – a runny nose, slightly swollen lymph nodes, or a small sore, can feel like serious problems.

Checking – regularly checking the body for signs of illness.

Hypochondria’s focus depends on the individual:

Some people’s attention may focus on one particular organ, such as the lungs.
They may just focus on one disease, such as cancer.
Or, they may fear one disease after another.
Regularly talking about illness – somatic symptom disorder might cause people to talk excessively about their health.

Doctor visits – they may make frequent visits to their physician.

Infatuation – they can spend a lot of time searching the Internet for symptoms of possible illnesses.

No relief from test results – if tests come back negative, the person may find no relief. In fact, it can make things even worse – the patient’s fears grow that no one believes them, and that the problem might never be successfully diagnosed and treated.

Avoiding the doctor – some individuals with the disorder avoid medical attention through fear of finding out that they have a serious illness.

Avoidance – they may avoid people, places, and activities that they believe could pose a health risk.

An overwhelming fear of disease that lasts for more than 6 months can be a sign of somatic symptom disorder.

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ILLNESS2

Causes

Having a related psychological disorder, such as OCD or depression, increases the risk of somatic symptom disorder.
The exact causes are not known, but certain factors are probably involved:

Belief – a misunderstanding of physical sensations, linked with a misunderstanding of how the body works.

Family – people who have a close relative with hypochondria are more likely to develop it themselves.

Personal history – people who have had bad health experiences in the past may be more prone to develop a disproportionate fear of growing ill again.

Links to other conditions – other psychiatric disorders have been linked to somatic symptom disorder. A high percentage of patients with hypochondria also have major depression, panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder.

Research, published in the British Journal of Psychiatry, points out that, like obsessive-compulsive disorder (OCD), somatic symptom disorder involves a need for continuous checking, as the person seeks reassurance.

These “safety behaviors,” say the authors, aim “to restore a sense of wellbeing and a degree of certainty about the future.” However, they can end up worsening the problems they are supposed to reduce.

Through keeping anxiety levels high and preventing fears from being dissolved, these behaviors keep the person’s attention focused on some dreaded potential disaster.

Since most patients tend to approach their family doctor about the health conditions they fear, rather than seeing a mental health specialist, they may never receive a diagnosis of somatic symptom disorder.

Beliefs. You may have a difficult time tolerating uncertainty over uncomfortable or unusual body sensations. This could lead you to misinterpret that all body sensations are serious, so you search for evidence to confirm that you have a serious disease.
Family. You may be more likely to have health anxiety if you had parents who worried too much about their own health or your health.
Past experience. You may have had experience with serious illness in childhood, so physical sensations may be frightening to you.
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
Complications
Illness anxiety disorder may be associated with:

Relationship or family problems because excessive worrying can frustrate others
Work-related performance problems or excessive absences
Problems functioning in daily life, possibly even resulting in disability
Financial problems due to excessive health care visits and medical bills
Having another mental health disorder, such as somatic symptom disorder, other anxiety disorders, depression or a personality disorder

Diagnosis

Clinical evaluation
The diagnosis of illness anxiety disorder is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including the following:

The patient is preoccupied with having or acquiring a serious illness.
The patient has no or minimal somatic symptoms.
The patient is highly anxious about health and easily alarmed about personal health issues.
The patient repeatedly checks health status or maladaptively avoids doctor appointments and hospitals.
The patient has been preoccupied with illness for ≥ 6 mo, although the specific illness feared may change during that time period.
Symptoms are not better accounted for by depression or another mental disorder.
Patients who have significant somatic symptoms and are primarily concerned about the symptoms themselves are diagnosed with somatic symptom disorder.

Treatment

Sometimes serotonin reuptake inhibitors or cognitive-behavioral therapy
Patients can benefit from having a trustful relationship with a caring, reassuring physician. If symptoms are not adequately relieved, patients may benefit from a psychiatric referral while they continue under the care of the primary physician.

Treatment with serotonin reuptake inhibitors may be helpful, as may cognitive-behavioral therapy.

The three goals of treatment for people with IAD are to:

Continue to function as normally as possible
Ease mental distress
Stop overuse of medical services
The best way to achieve these goals depends a lot on the patient’s preferences, and on the presence or absence of other illnesses commonly associated with IAD.

In most if not all cases of IAD, the patient’s primary doctor should continue to play an important role. Reasons for this:

The primary doctor can schedule regular office visits if necessary (e.g., every three to six months) to address the patient’s ongoing concerns. Patients are advised to stick with one doctor rather than “doctor-shop” (go from one specialist to another).
The primary doctor can help the patient decide if referral to a specialist is needed. This helps limit the number of tests with their potential problems and side effects.
Relying on one doctor who knows the patient well helps reduce costs and risks of too many office visits and tests.
Some people with IAD have severe psychological distress that needs treatment by a mental health professional. The primary doctor can suggest these services, making sure to clarify the reason for the referral and how it might help.

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