Understanding Illness Anxiety Disorder

Formerly known as hypochondria, illness anxiety disorder (IAD) is a mental health condition where an individual worries excessively about having or getting a serious illness–even when there’s no medical evidence to support it.^[1] People with IAD misinterpret normal body sensations as symptoms of illness and become health anxious and distressed. This constant fear leads to multiple doctor visits, unnecessary tests, and hours spent researching online.

It can interfere with daily life, cause emotional pain, and lead to avoidance behaviors, like averting certain activities or places because of fear of illness. Over time, IAD can affect personal relationships, work productivity, and overall well-being.

What Is Illness Anxiety Disorder?

IAD is a mental health condition where an individual is excessively preoccupied with the fear of having a serious illness or being at high risk of becoming ill, even when there’s little to no medical evidence.^[1][2] To medical professionals and others around people with IAD, their concerns might seem unjustified or unreasonable. But for people with IAD, their fears are very real.

Illness anxiety disorder is a type of health anxiety. It was formerly called hypochondria, but that term fell out of clinical use because of the stigmas and negative connotations associated with it. Hypochondria was more broadly used to describe a preoccupation with health without as much attention to the specific psychological elements that were later recognized in IAD.

People with IAD have several key characteristics:

• Persistent worry about health
• Frequent checking for signs of illness
• Seeking reassurance from healthcare providers often without relief
• Misinterpreting normal body sensations (like a headache or stomach ache) as symptoms of a serious medical condition

Unlike typical health concerns, which are brief and based on genuine medical symptoms, IAD involves overwhelming, persistent fears that interfere with daily life and are not relieved by medical evaluation or negative test results. It can lead to significant distress, avoidance behaviors, and reduced quality of life.

Symptoms of Illness Anxiety Disorder

For those with illness anxiety disorder, symptoms generally manifest physically and psychologically. Common illness anxiety disorder symptoms include:

• Worrying excessively about having a serious illness even when there are no symptoms
• Avoiding certain activities, places, or people because of fear of getting exposed to germs or illness
• Constantly researching diseases and symptoms
• Misinterpreting normal body sensations (like a headache or muscle ache) as symptoms of a serious illness, such as cancer
• Talking to others about health incessantly
• Excessively checking the body for signs of illness (like temperature, blood pressure, pulse, or skin changes)
• Exaggerating symptoms and their severity
• Requesting or obtaining lots of medical tests or second opinions
• The fear of being seriously ill causes significant distress and interferes with daily life

Causes of Illness Anxiety Disorder

Healthcare professionals haven’t identified one specific cause of IAD, with a combination of psychological, biological, and environmental factors influencing its development^[2]. Here are the potential causes and risk factors that have been identified:

1. Psychological Factors

Psychological factors play a significant role in the development of IAD. People with IAD often experience cognitive distortions, such as catastrophizing, where they believe minor symptoms are signs of serious illness. Certain personality traits, like heightened anxiety or a tendency to ruminate, can increase susceptibility to health anxiety.

Past experiences, particularly with illness or medical trauma, can also contribute to developing IAD, as they may heighten sensitivity to bodily sensations.^[3] Stress and trauma, including significant life changes or emotional abuse, can trigger or worsen health-related fears. Additionally, individuals with IAD may have learned unhealthy coping mechanisms, such as excessive reassurance-seeking, which reinforces the cycle of anxiety.

2. Biological Factors

Biological factors contribute to the development of IAD through genetic, neurobiological, and physiological mechanisms. A family history of anxiety disorders or mental health conditions can increase the risk of developing IAD, suggesting a genetic predisposition. Imbalances in neurotransmitters like serotonin and dopamine, which regulate mood and anxiety, may also play a role in the disorder.

People with IAD may have an overactive nervous system, making them more sensitive to normal bodily sensations and encouraging them to overreact to minor symptoms. Brain structure and function may be part of the disorder, specifically how the brain processes fears and threats. An individual’s physical health history, especially if they’ve had a serious illness in the past, can also increase the risk of IAD.

3. Environmental Factors

Growing up in an environment where illness is often discussed or where a family member has had a serious health condition may increase health anxiety. Exposure to media or online information that sensationalizes diseases or medical conditions can also fuel excessive worry about health. Stressful life events, such as trauma, loss, or significant life changes, can also trigger or worsen health anxiety.

4. Cultural and Social Factors

In cultures where physical health is highly valued or where illness is stigmatized, people may feel pressure to be healthy, which can increase anxiety. Exposure to sensationalized health information in the media, especially about serious diseases, can heighten health concerns. Social influences, such as the prevalence of health anxiety in one’s environment or online communities, can also reinforce irrational fears.

5. Family Dynamics

Overprotective or anxious parents can model health fears and (sometimes unknowingly) teach their children to be health-obsessed. Conversely, neglectful responses to a child’s health issues or a lack of attention to their well-being can also make a child hypervigilant about their health. Children can internalize health anxieties if they grow up in an environment where illness is constantly discussed or feared.

Impact of Illness Anxiety Disorder

IAD can cause emotional, social, and functional problems in those who are affected. The constant fear of having or developing a serious illness can be overwhelming and interfere with relationships, work, and overall quality of life.

1. Personal Relationships

IAD individuals may become too dependent on their loved ones for reassurance and ask or demand validation about their health all the time. This can create tension and frustration in relationships, as family members or partners feel helpless or exhausted by the constant need for reassurance.

Partners or family members may also feel stressed because of the uncertainty and worry about the individual’s health, especially when medical tests show nothing wrong. This can strain communication, reduce emotional intimacy, and lead to misunderstandings.

2. Work

The health obsession can distract an individual from focusing at work, reducing productivity and causing anxiety during daily tasks. Frequent absences from work due to health worries or seeking medical attention can also impact job performance.

Employees with IAD may constantly seek medical evaluations or accommodations for perceived health issues, creating tension with supervisors or colleagues. In extreme cases, the fear of illness can prevent the person from performing at their best or even going to work regularly.

3. Physical Health

IAD-associated anxiety can manifest physically as tension, headaches, muscle pain, fatigue, and digestive issues, which can further reinforce health fears. In some cases, individuals may even experience psychosomatic symptoms (physical symptoms caused by psychological stress), which can create a cycle of worry and discomfort.

4. Overall Quality of Life

The chronic health worry can reduce overall quality of life, as IAD individuals may find it hard to enjoy daily activities or pursue goals because of the constant health anxiety. This preoccupation can overshadow other essential parts of life, such as hobbies, personal growth, and relationships. The cycle of health anxiety, seeking reassurance, and visiting doctors can lead to frustration and feelings of helplessness or depression.

Diagnosing Illness Anxiety Disorder

IAD is diagnosed by carefully evaluating a person’s symptoms, behaviors, and medical history using clinical interviews and standardized assessment tools. The diagnosis is primarily based on the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and additional psychological evaluations. The criteria for IAD according to the DSM-5 include:

• Excessive worrying about becoming ill despite minimal or no medical evidence
• Having minimal or no symptoms
• Frequent checking for signs of illnesses or seeking repeated medical evaluations
• Preoccupation with illness, which has lasted for at least 6 months
• Health anxiety that causes significant distress or impairment in daily functioning^[4]

The clinician will ask about the onset, duration, and intensity of health worries and any past health experiences that might be contributing to the anxiety. They will also consider if the symptoms are better explained by other medical or psychological conditions, such as generalized anxiety disorder, obsessive-compulsive disorder, or a somatic symptom disorder, which may have similar features.

Mental health professionals often use specific questionnaires and self-report tools to assess the severity of health anxiety. Some of these tools are:

• Illness Anxiety Disorder Scale (IAD-7): A 7-item questionnaire used to assess the presence and severity of health anxiety.
• Health Anxiety Inventory (HAI): A validated tool that measures the level of anxiety related to health concerns.
• Somatic Symptom Disorder–B Criteria Scale (SSD-12): An assessment that helps to differentiate IAD from somatic symptom disorder, which involves more physical symptoms.

Treatment for Illness Anxiety Disorder

Treatment for IAD usually involves a combination of therapeutic and pharmacological approaches to reduce anxiety and help individuals develop healthier coping mechanisms. Here are some common treatment options:

1. Cognitive-behavioral therapy (CBT): CBT aims to change distorted thinking patterns and unhealthy behaviors related to health anxiety.^[1][2][4] The therapist works with the person to identify cognitive distortions, such as catastrophizing (thinking the worst will happen), and challenge these beliefs.
2. Medication: Medications may be used in combination with therapy, especially when the anxiety is severe or when there are co-occurring conditions, like depression or generalized anxiety disorder. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, may be prescribed to help reduce anxious and depressive symptoms associated with IAD.^[2]
3. Benzodiazepines (lorazepam or alprazolam): These medications are sometimes prescribed over a short term for immediate relief from acute anxiety. However, they are not typically used long-term, as they can cause dependence.
4. Psychoeducation and Support: Learning about IAD, what causes it, and how anxiety amplifies health concerns can help affected individuals understand their condition better and reduce the fear of being sick. Joining a support group with others who have similar health anxieties can provide a shared understanding, validation, and coping skills.
5. Lifestyle Changes: Making life changes can significantly help with IAD. These changes improve mental health, reduce stress, and offer a sense of control over well-being. For example, regular exercise can help with anxiety, improve mood, and reduce stress. Stress management, having a regular sleep schedule, and eating a healthy, balanced diet can reduce the physical and psychological impact of anxiety.

Living with Illness Anxiety Disorder

If you have been diagnosed with IAD, you may want to know how to manage the condition. This requires specific strategies to cope with anxiety, reduce health worries, and promote overall well-being. Here are some tips and strategies you may find helpful:

• Practice mindfulness and relaxation: Use mindfulness, deep breathing, and relaxation techniques to manage anxiety and stay present without overreacting to bodily sensations.
• Engage in regular exercise: Physical activity can reduce anxiety, improve mood, and help differentiate between normal physical sensations and anxiety-induced symptoms.
• Challenge health-related thoughts: Replace catastrophic thinking with balanced, realistic thoughts and practice reality testing to assess if health worries are based on evidence.
• Limit reassurance-seeking: To break the reassurance and excessive worry cycle, reduce doctor visits and health-related conversations with loved ones.
• Establish healthy routines: To reduce stress and improve overall well-being, prioritize sleep hygiene, a balanced diet, and regular activities that bring joy.
• Seek support and professional help: If you haven’t already, consider using therapy (e.g., CBT), joining support groups, and journaling to build confidence in managing health anxiety.

Final Words

If you are worried about getting sick, you need to see a health professional and get treatment. First, see your primary care physician about any physical symptoms. If your physician says you don’t have a physical illness, you may benefit from talking to a professional about your constant fear of illness.

IAD that remains untreated can impact daily life, personal relationships, work performance, and overall well-being. With the proper support and strategies, however, you can live a full life, manage your health anxiety, and maintain mental and emotional balance.