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Illness Anxiety Disorder

by Joel E. Dimsdale, MD

Illness anxiety disorder is preoccupation with and fear of having or acquiring a serious disorder. Diagnosis is confirmed when fears and symptoms (if any) persist for 6 mo despite reassurance after a thorough medical evaluation. Treatment includes establishing a consistent, supportive physician-patient relationship; cognitive-behavioral therapy and serotonin reuptake inhibitors may help.

Illness anxiety disorder (previously called hypochondriasis, a term that has been abandoned because of its pejorative connotation) most commonly begins during early adulthood and appears to occur equally among men and women.

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).

Symptoms and Signs

Patients are so preoccupied with the idea that they are or might become ill that their illness anxiety impairs social and occupational functioning or causes significant distress. Patients may or may not have physical symptoms, but if they do, their concern is more about the possible implications of the symptoms than the symptoms themselves. 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 physicians frequently (care-seeking type); others rarely seek medical care (care-avoidant type).

The course is often chronic—fluctuating in some, steady in others. Some patients recover.

Diagnosis

  • Clinical evaluation

The diagnosis is suggested by the history and confirmed when fears and symptoms

  • Persist ≥ 6 mo despite appropriate medical evaluation that excludes a general medical disorder and despite reassurance

  • Are not better accounted for by depression or another mental disorder

Patients who have significant somatic symptoms and are primarily concerned about the symptoms themselves are diagnosed with somatic symptom disorder (see Somatic Symptom Disorder).

Treatment

  • Sometimes serotonin reuptake inhibitors or cognitive-behavioral therapy

Patients can benefit from having a trustful relationship with a caring, reassuring physician. If symptoms are not adequately relieved, patients may benefit from a psychiatric referral while they continue under the care of the primary physician.

Treatment with serotonin reuptake inhibitors may be helpful, as may cognitive-behavioral therapy.

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