Hypochondria: What is illness anxiety disorder?
Someone who lives in fear of having a serious illness, despite medical tests never finding anything wrong, may have somatic symptom disorder, also known as illness anxiety disorder. The condition has also been known by other names, including hypochondria, or hypochondriasis.
- The main symptom of hypochondria is excessive worrying about health.
- Causes may vary, and could be related to other legitimate health conditions.
- For most people, it is a temporary experience.
- The term as defined by the DSM-5 manual is somatic symptom disorder.
What is hypochondria?
The most common symptom of hypochondria is excessive worrying about health.
A study published in JAMA defines somatic symptom disorder as "a persistent fear or belief that one has a serious, undiagnosed medical illness."
The authors note that it affects up to 5 percent of medical outpatients. In short, the disorder is a mental health condition where a person worries excessively that they are sick, to the point where the anxiety itself is debilitating. Worrying about health becomes an illness.
Somatic symptom disorder is a chronic condition.
How severe it is can depend on age, a person's tendency to worry, and how much stress they are facing.
Fearing normal functions - for a person with hypochondria, normal bodily functions, such as heartbeats, sweating, and bowel movements can seem like symptoms of a serious illness or condition.
Fear of minor abnormalities - a runny nose, slightly swollen lymph nodes, or a small sore, can feel like serious problems.
Checking - regularly checking the body for signs of illness.
Hypochondria's focus depends on the individual:
- Some people's attention may focus on one particular organ, such as the lungs.
- They may just focus on one disease, such as cancer.
- Or, they may fear one disease after another.
Regularly talking about illness - somatic symptom disorder might cause people to talk excessively about their health.
Doctor visits - they may make frequent visits to their physician.
Infatuation - they can spend a lot of time searching the Internet for symptoms of possible illnesses.
No relief from test results - if tests come back negative, the person may find no relief. In fact, it can make things even worse - the patient's fears grow that no one believes them, and that the problem might never be successfully diagnosed and treated.
Avoiding the doctor - some individuals with the disorder avoid medical attention through fear of finding out that they have a serious illness.
Avoidance - they may avoid people, places, and activities that they believe could pose a health risk.
An overwhelming fear of disease that lasts for more than 6 months can be a sign of somatic symptom disorder.
Having a related psychological disorder, such as OCD or depression, increases the risk of somatic symptom disorder.
The exact causes are not known, but certain factors are probably involved:
Belief - a misunderstanding of physical sensations, linked with a misunderstanding of how the body works.
Family - people who have a close relative with hypochondria are more likely to develop it themselves.
Personal history - people who have had bad health experiences in the past may be more prone to develop a disproportionate fear of growing ill again.
Links to other conditions - other psychiatric disorders have been linked to somatic symptom disorder. A high percentage of patients with hypochondria also have major depression, panic disorder, obsessive-compulsive disorder, or generalized anxiety disorder.
Research, published in the British Journal of Psychiatry, points out that, like obsessive-compulsive disorder (OCD), somatic symptom disorder involves a need for continuous checking, as the person seeks reassurance.
These "safety behaviors," say the authors, aim "to restore a sense of wellbeing and a degree of certainty about the future." However, they can end up worsening the problems they are supposed to reduce.
Through keeping anxiety levels high and preventing fears from being dissolved, these behaviors keep the person's attention focused on some dreaded potential disaster.
Since most patients tend to approach their family doctor about the health conditions they fear, rather than seeing a mental health specialist, they may never receive a diagnosis of somatic symptom disorder.
A person with hypochondria can spend months or years worrying about being ill, but they may also spend long periods in between not thinking about it.
Patients whose disorder is transient are less likely to have psychiatric problems or severe anxiety disorder, and more likely to have medical issues.
Recovery is more common among people with a higher socio-economic status. If a patient has depression or anxiety, and these respond well to treatment, they, too, are more likely to see a good outcome.
There is evidence that people with a personality disorder might find it harder to recover, but more research is needed to confirm this.
Since somatic symptom disorder is a relatively new disorder, few statistics are available.
When does hypochondria start?
Somatic symptom disorder usually starts in early adulthood. It may appear during recovery from a serious illness, or after a loved one or close friend becomes ill or dies.
An underlying medical condition can trigger somatic symptom disorder. A patient who has a heart condition, for example, may assume the worst each time they experience something that could potentially be related to heart disease.
Other factors include increased stress or a greater exposure to information about a disease in the media. Sometimes, a person starts worrying excessively about their health as they approach the age at which one of their parents died, especially if the parent's death was premature.
Psychologists note that people with the condition are often self-critical or perfectionist, or both. They may perceive "health" to mean a complete absence of pain or discomfort, whereas some aches and pains are normal for most people.
It has been suggested that people with hypochondria may have a low threshold for pain, and that they may notice internal sensations earlier than other people do.
Research published in JAMA has indicated that cognitive behavioral therapy (CBT) and the use of selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine and paroxetine, can be helpful in treating hypochondria.
CBT can help the patient to rationalize their fears, and SSRIs can reduce the level of anxiety through medication.
The University of Maryland Medical Center (UMM) suggests a number of alternative therapies that might relieve symptoms, while cautioning that these are not yet supported by research.
They include avoiding stimulants such as coffee, alcohol, and tobacco, practicing mindfulness meditation, and eating healthily.
Herbs purported to reduce anxiety include St. John's Wort, kava kava, and bacopa. UMM warn, however, that patients should speak with a physician before using herbs, because some herbal remedies may react with medications or have other side effects.