What is Illness Anxiety Disorder (Hypochondriasis)?
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“Hypochondriac,” a common term in our modern vocabulary, denotes people who obsess over their health and constantly worry that they may be sick. This ‘pop psychology’ understanding is actually not very far off from the older psychiatric diagnosis of the same name, Hypochondriasis. Illness Anxiety Disorder is one of two new disorders (the other being Somatic Symptom Disorder) that are meant to replace the older disorder, Hypochondriasis, with a modern and more nuanced understanding.
These people see doctors very often but are usually unsatisfied with the results. They report multiple medical encounters for the same concerns with repeated tests turning up nothing. People become increasingly frustrated with each unproductive visit. They may think the doctors are dismissing their concerns, which leads them to find new doctors who are unfamiliar with their cases. This creates a cycle of symptoms and worry, clean bills of health and reassurance, followed by irritation and doctor-shopping. Unfortunately, all this medical care is for physical ailments. Years may pass before these people see a mental health provider.
Bridging this gap from physical healthcare to mental healthcare is incredibly difficult. When a provider suggests that the problem may be mental rather than physical, these people feel betrayed, humiliated, and angry. It takes delicate work and a close relationship with a doctor for this to go well, but it is the most crucial step in ending the years of suffering.
Causes and Risk Factors
Because Illness Anxiety Disorder is a new, rethought version of an older disorder, so prevalence rates are not well defined. Most studies put the percentage of people with this disorder under 10%, with no difference between men and women.
Some people with Illness Anxiety Disorder experienced a serious illness in childhood. However, plenty of people get sick as kids and do not end up with this disorder. Parental attitudes towards the illness play a role in how children process these experiences. Children can internalize parental anxiety and excess focus on symptoms, but no major studies have confirmed this.
People with this disorder tend to pay close attention to their body’s sensations. They hyper-focus on minor aches and pains that most people ignore as part of their everyday lives. Sometimes this focus can make the symptom worse when people persistently examine, touch, or otherwise aggravate the body part in question. This evolves into a spiral of preoccupation and worry that is very difficult to break. Additionally, people with Illness Anxiety Disorder are much more likely than others to assume minor symptoms are the warning signs of a devastating illness. As a rule of thumb, most people believe they are healthy unless proven otherwise. However, people with this disorder have it the other way around. They are constantly worried about their health, and it takes a lot of convincing to quell those fears.
Roughly two out of three people with Illness Anxiety Disorder have at least one other mental disorder. Depression and anxiety disorders like Panic Disorder and Obsessive Compulsive Disorder are the most common culprits. Medical conditions that affect multiple areas of the body, such as hormonal or neuromuscular issues, can also mimic the diverse symptoms that concern people with Illness Anxiety Disorder. These serious possibilities should not be brushed off lightly and need a proper medical work-up.
Diagnosing Illness Anxiety Disorder
People with Illness Anxiety Disorder spend a lot of mental energy worrying about having or potentially developing a medical problem. They usually have no physical symptoms at all. If they do, they are mild and are usually normal aspects of the human body, like gut sounds or hiccups. A key part to the diagnosis is that a thorough medical examination does not discover any major illnesses. Despite this, people continue to suffer a great deal of anxiety about a possible medical issue. If a physician does discover a real illness is present, people with this disorder experience much more anxiety and emotional distress than is appropriate.
People focus on any symptoms or illnesses that appear not only in themselves but also in family and friends. The possibility of sickness in others makes these people even more anxious about their own health. Even reading or viewing news articles about health problems can bring up these similar stressful thoughts. Concerns about sickness deplete their energy and dominate their minds every day.
In the most extreme cases, being sick becomes part of who they are, an identity of someone who is ailing, fragile, or weak. They express their worries to anyone who will listen, which becomes exhausting for friends and family and creates emotional divisions. People spend endless hours examining themselves for signs of medical maladies, getting obsessed with spending time in front of a mirror. The internet is a double-edged sword. The abundance of health information creates a potential rabbit hole of illness research for these people that can fuel their worry.
Treating Illness Anxiety Disorder
Stick with your family doctor
One of the most important aspects of dealing with Illness Anxiety Disorder is to stay in regular contact with a single primary care physician. Not only does this help maintain a faithful connection between doctor and client but it also helps keep an individual’s unnecessary medical tests to a minimum. One family doctor can best keep track of a client’s situation and help them decide if they need to see a specialist.
Cognitive Behavioral Therapy
CBT is the main type of therapy for treating Illness Anxiety Disorder. In this therapy, people learn to take a more objective view of their convictions and fears, a process that works especially well for anxiety. Therapists guide people in practicing how to challenge their worries about potential health problems by sticking to the facts. That last x-ray showed nothing. The blood tests were clean. They have a clean bill of health. People learn to confront and control their persistent health worries and eventually reach a less anxious state of mind.
Psychiatric medication is neither a first-choice option nor is it a stand-alone treatment. No medications specifically treat Illness Anxiety Disorder. However, they can offer a relief from many of the other symptoms that tend to coincide. These might be a lack of energy, feeling on-edge, feeling guilty or hopeless, problems with sleep, panic attacks, or irritability. These are also some of the dreaded aspects of anxiety and depression. The best medications are anti-depressants like Prozac (fluoxetine), Zoloft (sertraline), and Paxil (paroxetine).
Managing Illness Anxiety Disorder
Getting the right care
The irony that befalls people with Illness Anxiety Disorder is that they spend a lot of time in the health care system. Unfortunately, very little of that time is spent on illness that they actually have. They spend most of their time in the care of doctors, nurses, and other health professionals chasing any of several diagnoses that dominate their worries. These peoples’ primary care physicians have the best opportunities to steer them in the right direction. People with this disorder have trouble accepting that the numerous tests, lab work, and imaging exams all turn up nothing. This can be incredibly frustrating both for the people and the doctors, but a close, trusting relationship with a primary care physician may be a saving grace. A good bond helps them direct these people to the correct mental health care that they truly need.
Too much of a good thing
Any time anyone interacts with the medical system it carries a risk of injury. A blood draw could lead to infection, a CT scan exposes people to radiation, or a medication could cause an unforeseen reaction. These are called “iatrogenic” illnesses, and they are one of the biggest threats to people with Illness Anxiety Disorder. These illnesses are also the third leading cause of death in the United States, taking over 250,000 lives every year. Every test, exam, or drug carries a risk that doctors and patients must balance against the risks of a medical condition that may be present. However, when people with Illness Anxiety Disorder get unnecessary medical care, they are getting all the risk and none of the possible benefit.
Disability and money woes
All these excess procedures, tests, exams, and treatments can lead to massive economic burdens for people and their families. This is from the direct cost to the individual that comes from copays, deductibles, and the higher prices of seeing specialists and other providers out of the insurance network. Costs covered by insurance companies get passed on to other consumers as well in the form of higher premiums. All these interactions with the health care system create sick days from work and unpaid leave, which spreads the financial effects to peoples’ families.