Illness anxiety disorder is preoccupation with and fear of having or acquiring a serious disorder. The diagnosis is confirmed when fears and symptoms (if any) persist for ≥ 6 months despite reassurance after a thorough medical evaluation. The treatment includes establishing a consistent, supportive physician-patient relationship; cognitive-behavioral therapy and serotonin reuptake inhibitors may help.
Illness anxiety disorder (previously called hypochondriasis or hypochondria, terms that have been abandoned because of their pejorative connotation) commonly begins during early adulthood and appears to occur equally among men and women (1).
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).
General reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022.
Symptoms and Signs of Illness Anxiety Disorder
Patients with illness anxiety disorder are so preoccupied with the idea that they are or might become ill that their thoughts impair social and occupational functioning or cause significant distress. Patients may or may not have physical symptoms, but if they do, symptoms are only mild in intensity, and their concern is more about the possible implications of the symptoms than the symptoms themselves (eg, their stomach discomfort itself is less distressing to them than the possibility that it might be cancer).
Some patients examine themselves repeatedly (eg, looking at their throat in a mirror, checking their skin for lesions). They are easily alarmed by new somatic sensations. Some patients visit clinicians frequently (care-seeking type); others rarely seek medical care (care-avoidant type).
The course is often chronic, fluctuating in some and steady in others.
Diagnosis of Illness Anxiety Disorder
Psychiatric assessment
General medical evaluation
The diagnosis of illness anxiety disorder is based on criteria from the DSM-5-TR, including the following (1):
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 medical appointments and hospitals.
The patient has been preoccupied with illness for ≥ 6 months, although the specific illness feared may change during that time period.
Symptoms are not better explained by depression or another psychiatric disorder.
In illness anxiety disorder, somatic symptoms are either not present or mild in intensity. Patients who have significant somatic symptoms and are primarily concerned about the symptoms themselves are diagnosed with somatic symptom disorder instead.
Diagnosis reference
1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision. American Psychiatric Association Publishing; 2022.
Treatment of Illness Anxiety Disorder
Supportive, trustful relationship with clinician
Sometimes selective serotonin reuptake inhibitors or cognitive-behavioral therapy
Patients can benefit from having a trustful relationship with a caring, reassuring clinician. If symptoms are not adequately relieved, patients may benefit from a psychiatric referral while they continue under the care of the primary clinician.
Treatment with selective serotonin reuptake inhibitors may be helpful, as may cognitive-behavioral therapy (1).
Treatment reference
1. Scarella TM, Boland RJ, Barsky AJ. Illness anxiety disorder: Psychopathology, epidemiology, clinical characteristics, and treatment. Psychosom Med. 81(5):398-407, 2019. doi: 10.1097/PSY.0000000000000691
