2nd February 2024

Illness Anxiety Disorder

Background

Illness anxiety disorder is an illness where an individual is preoccupied with himself or herself either having or acquiring a grave undiagnosed medical illness. Somatic symptoms may or may not exist. Illness anxiety is similar to a generalised anxiety disorder that is focused exclusively on health concerns.

Individuals with illness anxiety disorder are more often seen in GP surgery and medical unit than in psychiatric settings. They have some medical illnesses that they are worried about.

Various comorbidities can coexist with illness anxiety disorders. It includes anxiety disorders, generalised anxiety disorders, OCD, panic disorder, somatic symptom disorder, and personality disorder.

Criteria for Diagnosis

Persistent preoccupation or fear about the possibility of having one or more serious, progressive or life-threatening illnesses.

The preoccupation is accompanied by either:

• Repetitive and excessive health-related behaviours, such as repeatedly checking the body for evidence of illness, spending inordinate amounts of time searching for information about the feared illness, repeatedly seeking reassurance (e.g., arranging multiple medical consultations); or
• Maladaptive avoidance behaviour related to health (e.g., avoiding medical appointments).

The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

The course of illness anxiety disorder is uncertain. It is a longstanding relapsing condition. It can start usually in early and middle adulthood.

Risk factors

• Major stress
• Threatening life changes
• Childhood abuse
• Serious childhood illness
• Complex illness in the family

The diagnosis should be made with thoughtfulness in individuals whose thoughts about the disease are consistent with widely held, culturally endorsed beliefs. 

Signs and symptoms

• In illness anxiety disorder, a detailed assessment fails to identify a serious medical condition that accounts for the individual’s apprehensions.
• The individual’s anguish principally comes not from the physical issue itself but rather from the anxiety about the meaning, significance, or cause of the suspected medical diagnosis.
• The worry about undiagnosed disease does not respond to medical reassurance, negative diagnostic tests, or benign course.
• They may research their suspected disease disproportionately (e.g. – in Library, on the Internet, asking other people and researching) and repeatedly seek reassurance from family, friends, or physicians. This can cause frustrations for them as it can cause interpersonal strain.

References

• Noyes Jr., R. (2012). Hypochondriasis (health anxiety). New Oxford Textbook of Psychiatry, [online] pp.1022–1029. doi:10.1093/med/9780199696758.003.0131.
• Kenyon, F.E. (1964). Hypochondriasis: A Clinical Study. The British Journal of Psychiatry, [online] 110(467), pp.478–488. doi:10.1192/bjp.110.467.478.
• Starcevic, V. (2013). Hypochondriasis and health anxiety: conceptual challenges. British Journal of Psychiatry, 202(1), pp.7–8. doi:10.1192/bjp.bp.112.115402.
• Magariños, M., Zafar, U., Nissenson, K. and Blanco, C. (2002). Epidemiology and Treatment of Hypochondriasis. CNS Drugs, 16(1), pp.9–22. doi:10.2165/00023210-200216010-00002.
• Howes, O. (1999). Hypochondriasis: an overview with reference to medical students. BMJ, 319(Suppl S5), p.9911410. doi:10.1136/sbmj.9911410.