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Illness anxiety disorder

  • Definition
    • Illness anxiety disorder is a preoccupation that physical symptoms are signs of a serious illness, even when there is no medical evidence to support the presence of an illness.

  • Alternative Names
    • Somatic symptom disorder; Somatic symptom and related disorders; Hypochondriasis

  • Causes
    • People with illness anxiety disorder (IAD) are overly focused on, and always thinking about, their physical health. They have an unrealistic fear of having or developing a serious disease. This disorder occurs equally in men and women.

      The way people with IAD think about their physical symptoms can make them more likely to have this condition. As they focus on and worry about physical sensations, a cycle of symptoms and worry begins, which can be hard to stop.

      It is important to realize that people with IAD do not purposely create these symptoms. They are unable to control the symptoms.

      People who have a history of physical or sexual abuse are more likely to have IAD. But this does not mean that every person with IAD has a history of abuse.

  • Symptoms
    • People with IAD are unable to control their fears and worries. They often believe any symptom or sensation is a sign of a serious illness.

      They seek out reassurance from family, friends, or health care providers on a regular basis. They feel better for a short time and then begin to worry about the same symptoms or new symptoms.

      Symptoms may shift and change, and are often vague. People with IAD often examine their own body.

      Some may recognize that their fear of having a serious disease is unreasonable or unfounded.

      Illness anxiety disorder is different from somatic symptom disorder. With somatic symptom disorder, the person has physical pain or other symptoms, but the medical cause is not found.

  • Exams and Tests
    • The doctor or nurse will examine you and may order tests to look for illness. A psychiatric evaluation may be done to look for other related disorders.

  • Treatment
    • It is important to have a supportive relationship with a health care provider. You should have only one primary care provider to avoid having too many tests and procedures.

      The health care provider should tell you that you do not have a disease, and continued medical follow-up will help control the symptoms. People with IAD feel real distress, so their symptoms should not be denied or challenged.

      Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) can help reduce the worry and physical symptoms of this disorder.

      Finding a mental health provider who has experience treating this disorder with talk therapy (psychotherapy) can be helpful. Cognitive behavioral therapy (CBT), a kind of talk therapy, can help you deal with your symptoms. During therapy, you will learn:

      • To recognize what seems to make the symptoms worse
      • To develop methods of coping with the symptoms
      • To keep yourself more active, even if you still have symptoms
  • Outlook (Prognosis)
    • The disorder is usually long-term (chronic), unless psychological factors or mood and anxiety disorders are treated.

  • Possible Complications
      • Complications from invasive testing to look for the cause of symptoms
      • Dependence on pain relievers or sedatives
      • Depression and anxiety or panic disorder
      • Lost time from work due to frequent appointments with health care providers
  • When to Contact a Medical Professional
    • Call your health care provider if you or your child has symptoms of IAD.

  • References
    • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.5th ed. Arlington, VA: American Psychiatric Publishing, 2013.

      Feinstein RE, deGruy FV. Difficult patients: personality disorders and somatoform complaints. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 46.

      Greenberg DB, Braun IM, Cassem NH. Functional somatic symptoms and somatoform disorders. In: Stern TA, Rosenbaum JF, Fava M, et al, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, PA: Elsevier Mosby; 2008:chap 24.