Hypochondria, Illness Anxiety

Hypochondria

Person sitting in window looks up symptomsHypochondria, or hypochondriasis, is a diagnosable anxiety condition. People with hypochondria have a fear of injury or illness that others may consider irrational. They may make frequent trips to the doctor, for example, or become convinced they have serious undiagnosed illnesses. In some cases, individuals even manifest symptoms psychosomatically through their worry. The Diagnostic and Statistical Manual (DSM-5), lists hypochondria as illness anxiety disorder (IAD), and people with hypochondria may receive this diagnosis.

Those who find their illness anxiety is serious enough to impact typical function may find it benefical to seek support from a therapist or counselor. 

Understanding Illness Anxiety and Hypochondria

It’s considered natural to want to avoid contracting illnesses or experiencing injury. Most people tend to habitually avoid those things by washing their hands, taking vitamins, or not sharing the company of people who are ill. But people with health anxiety or hypochondriasis are preoccupied with their present or future health to a point where their everyday life is affected. 

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If someone with illness anxiety already has a chronic health condition, they might worry it’s worsening or developing complications. Others who are physically healthy may believe they have some ailment or condition that needs medical attention. The DSM categorizes illness anxiety as a somatic symptom disorder, meaning somatic (bodily) indications are likely to be present along with the significant impairment and distress caused by the condition. People with illness anxiety may be care-seeking (undergoing tests and procedures or frequently visiting physicians) or care-avoidant (choosing to avoid doctors and clinics out of fear of being diagnosed with a serious concern).

There is no one cause of hypochondria. Factors such as major life stress, history of childhood abuse or childhood illness, or a co-occurring mental health issue may contribute to illness anxiety.

What Are the Symptoms of Hypochondria?

The DSM-V lists the following symptoms as indications of hypochondriasis:

  • Persistent fear of contracting a serious disease or the belief one has such a disease
  • Ongoing worry despite receiving medical and diagnostic care
  • Preoccupation is not caused by delusion or by body dysmorphia
  • Symptoms interfere with at least one area of normal functioning
  • Symptoms have persisted for at least six months
  • Symptoms are best explained by a diagnosis of illness anxiety and not by a mental health condition (generalized anxiety, obsessions and compulsions, etc.)

Illness anxiety can produce its own physical and physiological symptoms. In some cases, people might actually manifest symptoms, such as pain, dizziness, or stomach aches, as a result of their anxiety.

Therapy for Health Anxiety

Symptoms of illness anxiety can dramatically reduce a person’s quality of life and may also significantly impact friends and family members. Working with a mental health professional may help people identify and build coping mechanisms that reduce symptoms of hypochondria and address any underlying issues contributing to it. Therapists and counselors treating illness anxiety will generally first rule out the possibility of a serious medical condition. Some people with illness anxiety avoid medical treatment, and many of the behaviors associated with this avoidance can superficially manifest as hypochondria.

Psychotherapy and, in some cases, psychotropic medication can be highly effective at treating hypochondria. Cognitive behavioral therapy, bibliotherapy, and behavioral stress management have been proven to successfully address the roots of health anxiety. If there are co-occurring physical or mental health issues, such as OCD, depression, diabetes, or cancer, a treatment plan should accommodate these conditions.

Hypochondria in the 21st Century

The prevalence of internet medical advice has given people a platform to research symptoms and receive free information about health concerns. But looking into real or imagined symptoms can only fuel worry and distress over perceived illness in people with health anxiety.

Some people report that researching symptoms online results in feelings of overwhelming anxiety or fears that a headache is caused by a brain tumor or a cough indicates cancer. This particular behavior is sometimes informally referred to as cyberchondria. Doctors increasingly caution against spending too much time researching symptoms or illnesses online.

Like other mental health issues, hypochondria is a condition often tossed around lightly in conversation; it is not uncommon to hear someone called a “hypochondriac.” This pejorative term can undermine the potential severity of illness anxiety, however, like other instances of casual self-diagnosis or labeling of others.

Case Example

  • Cognitive behavioral therapy for illness anxiety: Harry has always been very careful about her health and does not have a family history of serious medical issues. However, she is preoccupied by the worry that at 36 she is developing arthritis in her hands, due to pain in two of her knuckles. Doctors have assured her she does not have arthritis, but she continues to be consumed by the thought and sees other medical professionals. Her visits are not very helpful, and she begins to wonder whether her symptoms indicate another condition. After a psychiatrist assigns a diagnosis of illness anxiety, Harry works with a psychotherapist to identify the sources and factors contributing to her anxiety. Though she still feels something is “off” about her health and experiences strange aching in her finger joints, the therapist encourages her to resist the urge to visit more doctors and asks Harry to instead examine what else is happening in her life during the times when the pain and temptation to visit doctors is strongest. She gradually begins to notice patterns of significant stress–a daunting project at work, a visit from her sister, or her best friend’s wedding–precipitating her pain and many medical visits. As Harry pays more attention to her general stress and anxiety levels and develops better coping skills and habits with the help of her therapist, her constant worry is eased. She still notices pain from time to time, but it’s far less severe and she does not rush to see a doctor when it happens.

References:

  1. Brakoulias, V. (2014). Two disorders introduced for better diagnoses. Anxiety.org. Retrieved from https://www.anxiety.org/hypochondriasis-replaced-by-two-new-disorders-in-dsm-5
  2. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  3. Goodman, K. (2016). Understand the facts: Health anxiety. Anxiety and Depression Association of America. Retrieved from https://adaa.org/understanding-anxiety/related-illnesses/health-anxiety
  4. Health anxiety (hypochondria). (2015). NHS.uk. Retrieved from http://www.nhs.uk/conditions/hypochondria/Pages/Introduction.aspx
  5. Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B. (2016). Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: Randomised controlled trial. The British Journal of Psychiatry, 209(5), 407-413. Retrieved from http://bjp.rcpsych.org/content/209/5/407
  6. Phillips, K. A., & Stein, D. J. (Eds.). (2015). Handbook on obsessive-compulsive and related disorders. Arlington, VA: American Psychiatric Pub.
  7. Starcevic, V., & Berle, D. (2013). Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert Review of Neurotherapeutics, 13(2), 205-213. Retrieved from http://www.tandfonline.com/doi/abs/10.1586/ern.12.162
  8. White, R. W., & Horvitz, E. (2009). Cyberchondria: studies of the escalation of medical concerns in web search. ACM Transactions on Information Systems (TOIS), 27(4), 23. Retrieved from http://dl.acm.org/citation.cfm?id=1629101

 

Last updated: 12-05-2017

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