Previously called hypochondriasis or hypochondria, illness anxiety disorder (IAD) is a mental health condition in which a person strongly believes they have or will develop a serious or life-threatening illness, though they show little to no symptoms. This feeling persists even when tests or examinations show they do not have a serious condition.
Individuals with illness anxiety disorder typically do not have physical symptoms, but they do have a high level of anxiety about their health. They are easily alarmed by illness, whether it be their own or others’ , and may have persistent, abnormal reactions to their own normal bodily sensations, regarding them with much greater seriousness than others would, and pursuing a diagnosis even where none is appropriate.
Hearing about someone else’s illness, or reading about conditions in the news, can fuel their anxiety and lead them to perform excessive health-related behaviors, such as repeatedly checking their body for signs of illness. The person’s fixation does not need to be the same medical illness; the imagined or threatened condition may change, but the illness anxiety symptoms may still persist.
The estimated prevalence is 0.75% in medical outpatients and 0.1% in the general population. Sociodemographic studies have been inconsistent, though a large number of them suggest that Illness Anxiety Disorder evenly affects males and females. The common age of onset is adolescence, with symptoms worsening with age. It is more common among unemployed and less educated individuals. In some cases, major life stress or serious but ultimately non-threatening situations may precede the disorder. Individuals with illness anxiety may or may not have a diagnosed medical condition, but typically no serious disease is present in most cases. In cases when the person actually does have a medical condition, their anxiety about it and its progression is distracting and clearly excessive.
The prognosis for illness anxiety disorder is better for those persons who were referred early for psychiatric evaluation, as opposed to those who only received general medical care. Additionally, studies reveal that the persons who are cooperative, tolerant, and hopeful typically have better outcomes.If a person responds well to psychotherapy, medication, or both, the prognosis for IAD may be fair to good. However, if the person is experiencing severe symptoms of IAD, which are refractory to psychiatric medications and psychotherapy, the prognosis becomes poor.
The primary mode of treatment for Illness Anxiety Disorder is therapeutic, with greater focus on helping the individual cope with their health anxiety. Early intervention with regards to Illness Anxiety Disorder is recommended for a plethora of reasons. Firstly, treatment is more likely to take effect if the condition is caught early. Secondly, chronic somatoform diseases such as Illness Anxiety Disorder are associated with high direct and indirect costs, which early intervention can cut down on, benefitting both the individual as well as the healthcare system.
In primary care settings (hospitals or emergency rooms), it is important to take measures such as limiting repetitive testing, avoiding unnecessary treatment, avoiding use of medical jargon, and treating patients with empathy.
Collaborative care models, wherein the primary physicians work together with psychiatrists, has proven to be beneficial in reducing severity of symptoms, improving social functioning, and reducing healthcare use.
There have been two effective modes of treatment for Illness Anxiety Disorder: psychotherapeutic and psychopharmacological. Psychotherapeutic modes generally utilize Cognitive Behavioral Therapy, which works by modifying dysfunctional thoughts. Psychopharmacological modes utilize SSRIs (antidepressants), which have proved efficacious not only for Illness Anxiety Disorder but also for the highly comorbid symptoms of depression, anxiety and other somatoform symptoms.