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Illness anxiety disorder

Illness anxiety disorder, sometimes called hypochondriasis or health anxiety, is worrying excessively that you are or may become seriously ill. 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.

Hypochondria

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, no longer includes hypochondriasis — also called hypochondria — as a diagnosis. Instead, people previously diagnosed with hypochondriasis may be diagnosed as having illness anxiety disorder, in which the focus of the fear and worry is on uncomfortable or unusual physical sensations being an indication of a serious medical condition.

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 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:

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.

Caring for a loved one

Significant health anxiety can cause real distress for the person, and reassurance isn’t always helpful. Sometimes, providing reassurance can make things worse. This can be frustrating and cause stress on families and relationships. Encourage your loved one to consider a mental health referral to learn ways to cope with illness anxiety disorder.

The exact cause of illness anxiety disorder isn’t clear, but these factors may play a role:

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:

Illness anxiety disorder may be associated with:

Little is known about how to prevent illness anxiety disorder, but these suggestions may help.

To determine a diagnosis, you’ll likely have a physical exam and any tests your primary care provider recommends. Your provider can help determine if you have any medical conditions that require treatment and set limits on lab testing, imaging and referrals to specialists.

Your primary care provider may also refer you to a mental health professional. He or she may:

The goal of treatment is to help you manage anxiety about your health and improve your ability to function in daily life. Psychotherapy — also called talk therapy — can be helpful for illness anxiety disorder. Sometimes medications may be added.

Psychotherapy

Because physical sensations can be related to emotional distress and health anxiety, psychotherapy — particularly cognitive behavioral therapy (CBT) — can be an effective treatment. CBT helps you learn skills to manage illness anxiety disorder and find different ways to manage your worries other than excessive medical testing or avoidance of medical care.

CBT can help you:

Other therapies such as behavioral stress management and exposure therapy also may be helpful.

Medications

Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may help treat illness anxiety disorder. Medications to treat mood or anxiety disorders, if present, also may help.

Talk with your doctor about medication options and the possible side effects and risks.

In addition to profession treatment for illness anxiety disorder, these self-care steps can help:

In addition to your medical evaluation, your primary care provider may refer you to a mental health professional, such as a psychiatrist or psychologist, for evaluation and treatment.

Here’s some information to help you prepare for your appointment and what to expect from your primary care provider or mental health professional.

What you can do

Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.

Questions to ask your mental health professional may include:

Don’t hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your primary care provider or mental health professional may ask:

Your primary care provider or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your appointment time.

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