Illness Anxiety Disorder
(See also Overview of Somatization.)
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).
Patients with illness anxiety disorder 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.
The diagnosis of illness anxiety disorder is based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), including the following:
The patient is preoccupied with having or acquiring a serious illness.
The patient has no or minimal somatic symptoms.
The patient is highly anxious about health and easily alarmed about personal health issues.
The patient repeatedly checks health status or maladaptively avoids doctor appointments and hospitals.
The patient has been preoccupied with illness for ≥ 6 months, although the specific illness feared may change during that time period.
Symptoms 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.
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.