What is Illness Anxiety?

Illness Anxiety Disorder is a fairly new condition that was added to the DSM-V under the section of somatic symptom and related disorders. It is the preoccupation with having or acquiring a serious illness, generally in the absence of somatic symptoms. This is accompanied by a high level of anxiety about health, and individuals who have this condition perform excessive health-related behaviors such as checking for abnormalities on the body. . This condition can be care-seeking (where the individual is seeking physician visits, tests, and procedures at an unnecessary rate) or care-avoidant (where the individual avoids physician visits, tests, or procedures in fear of discovering an illness).

Illness Anxiety and Hypochondriasis

Prior to somatic symptom and related disorders being acquired, people fitting these criteria were generally referred to as hypochondriacs. Now, about 75% of those individuals have a somatic symptom disorder diagnosis. The other 25% are diagnosed with illness anxiety. Hypochondriasis is not considered an anxiety disorder and may have somatic symptoms present; illness anxiety is considered an anxiety disorder related to somatic symptom disorders due to the physical checking and specified anxiety related to ones health.

Illness Anxiety Comorbidities

As a newer condition, comorbidities to illness anxiety are not well understood. Currently it is expected that two-thirds of individuals with illness anxiety also are likely to have at least one other major mental health issue. Hypochondriasis is commonly seen to co-occur with anxiety disorders such as generalized anxiety, panic disorder, OCD, as well as depression. Since these conditions share similarities, these could be reasonable comorbidities to be aware of.

First Line Treatments

Treatment options for this condition focus on the ability to manage anxiety symptoms. This can include both psychotherapy and pharmaceutical therapy. The most common psychotherapy used is cognitive behavioral therapy (CBT). Mayo Clinic outlines the following as the goals of CBT in regard to illness anxiety disorder.

Psychotherapy Objectives

• Identify your fears and beliefs about having a serious medical disease
• Learn alternate ways to view your body sensations by working to change unhelpful thoughts
• Become more aware of how your worries affect you and your behavior
• Change the way you respond to your body sensations and symptoms
• Learn skills to cope with and tolerate anxiety and stress
• Reduce avoidance of situations and activities due to physical sensations
• Reduce behaviors of frequently checking your body for signs of illness and repeatedly seeking reassurance
• Improve daily functioning at home, at work, in relationships and in social situations
• Address other mental health disorders, such as depression

Pharmaceuticals

The next option for treatment is selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). These medications work well for anxiety disorders as well as depressive disorders, and have shown efficacy in the treatment of illness anxiety. They also have lower rates of side effects and higher rates of tolerability. They offer safe options for a variety of patients, including patients that are pregnant.

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REFERENCES:

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

French JH, Hameed S. Illness Anxiety Disorder. [Updated 2022 Apr 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554399/

Mayo Clinic:https://www.mayoclinic.org/diseases-conditions/illness-anxiety-disorder/diagnosis-treatment/drc-20373787