What Is Hypochondria (Illness Anxiety Disorder)?
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Medically reviewed by Kathleen Daly, MD
Illness anxiety disorder (IAD)—previously known as hypochondriasis and sometimes informally referred to as hypochondria—is a mental health disorder that involves an intense fear of having or developing a serious illness.
People with illness anxiety disorder are hyper-focused on their physical health. For instance, they might be more aware of normal bodily functions like sweating and consider them signs of an undiagnosed serious disease. People with IAD also spend a lot of time thinking about their physical health. The anxiety and fear they have about their health can negatively affect their everyday life.
Even when a physical examination or tests prove there are no signs of physical disease, the fear or anxiety that people with IAD experience continues.
It's estimated that about .1% of the population has illness anxiety disorder. It's unclear why IAD develops, but there are certain factors that puts people at greater risk for developing it. Thankfully, there is treatment available. How successful the treatment can depend on how severe the IAD symptoms are.
Types of Illness Anxiety Disorder
People may have one of two types of illness anxiety disorder. The two types differ in how someone with IAD deals with their fear and anxiety. The two types of IAD are care-seeking and care-avoidant.
Someone with care-seeking IAD makes frequent visits to their healthcare providers. They might not be satisfied with what their providers tell them and so continue to switch providers. In an attempt to get relief of their anxiety, they ask providers to run tests and provide treatment for their physical health.
Someone with care-avoidant IAD doesn't seek medical care. Because they are so anxious of what an examination or test might find, such as the diagnosis of a life-threatening disease, they avoid going to healthcare providers.
Illness Anxiety Disorder Symptoms
People with illness anxiety disorder experience overwhelming anxiety about having an illness or becoming seriously ill. They may feel worried about a specific illness, such as cancer, or about their health status in general.
In addition to a preoccupation with having or acquiring an illness, symptoms of IAD include:
Having anxiety that is out of proportion to the actual or perceived medical problem
Being hypervigilant, which may include looking all over your body for possible symptoms
Performing repetitive behaviors to ease health-related distress, such as constantly researching health conditions or taking your blood pressure multiple times a day
Experiencing heightened physical sensations or being very aware of your bodily functions
Having health-related fears that last for six months or more and affect your quality of life
Seeking medical care excessively for reassurance (care-seeking IAD)
Avoiding medical care out of fear (care-avoidant IAD)
People with IAD often don't have any physical symptoms. If they do, only the person with the IAD would find the symptoms distressing. For instance, they might have mild or vague sensations like sweating or a heart rate that's a bit faster than normal. Both of these might actually be physical symptoms of anxiety caused by IAD; but to someone with IAD, the symptoms would indicate a serious physical issue.
It's also possible for someone to have both IAD and a diagnosed medical condition. IAD would come into play when the anxiety or time spent on the condition is out of proportion to the seriousness of the condition.
If you have IAD, you might also be anxious about your loved one's physical health.
What Causes Illness Anxiety Disorder?
It's not known what exactly causes illness anxiety disorder. Psychosocial factors have been studied more than any other cause. Psychosocial refers to the relationship between psychological and social factors.
For instance, someone might believe a disease is more prevalent or more easily spread than it actually is and so worry about it more than necessary. Or, someone's way of thinking might have been impacted after having been ill as a child. You may also develop IAD if you spend a lot of time reading about medical issues, such as those that a celebrity or friend might have.
Genetic and biological causes of not been studied as much. There have been a couple small studies that suggest that people with IAD have differences in certain parts of the brain compared to those without the condition, but more research would be needed to say for sure what role genes or biology has in the development of IAD.
Risk Factors
While the exact cause of illness anxiety disorder is unknown, there are known risk factors. Anyone can develop illness anxiety disorder, but you more likely to develop the condition if you've experienced any of the following:
An anxiety disorder like generalized anxiety disorder
An immediate family member with IAD
A personal experience with a serious or chronic illness or having a family member go through such an experience
A negative experience with the medical system that makes you distrust your healthcare providers
A major health scare that turned out to not be a problem
Sexual, physical, or child abuse
Dicomfort with normal bodily sensations, such as sweating
How Is Illness Anxiety Disorder Diagnosed?
Your primary healthcare provider is usually one of the first people to suspect you have illness anxiety disorder. This is because they are the ones who would most likely be doing physical examinations and lab tests, finding the results are normal, but then repeatedly hearing about your worries that there is something wrong even though they are assuring you everything is OK.
If IAD is suspected, a diagnosis would be made using the criteria laid out in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the diagnosis tool used for mental health conditions. To fit the diagnosis, you will have had to been experiencing IAD symptoms for at least six months.
For the diagnosis, your healthcare provider will likely review your medical history, current symptoms, and family history. They'll also make sure your symptoms aren't due to another mental health condition.
IAD is a relatively new diagnosis. It was added to the DSM-5 in 2013. Before that, in the DSM-4, the term used was hypochondriasis. Because that wasn't an empathetic term—and to be more accurate—hypochondriasis was separated into two different conditions. IAD is one. The other is somatic symptoms disorder, which is when a person's anxiety stems from a chronic physical symptom that is truly present.
Treatments for Illness Anxiety Disorder
Treatment for illness anxiety disorder typically involves psychotherapy, medication, or both.
Therapy might be in the form of cognitive behavioral therapy (CBT). CBT has been found to help people with illness anxiety disorder identify and deal with irrational thoughts and worries about their health. It may also help you develop healthier coping skills and allow you to interpret your bodily sensations more accurately.
You can also practice mindfulness-based stress reduction. This is a program that teaches techniques that can reduce the effects of chronic and acute stress and help you relax more often and more deeply. Besides basic relaxation and breathing techniques, you might also be encouraged to perform meditation and yoga and to keep a gratitude journal and a positive events log.
Antidepressants—specifically selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Paxil (paroxetine)—can work to manage the psychological symptoms of illness anxiety disorder.
Medications might be prescribed if therapy alone is not as effective as you or your provider had hoped. Most people with IAD need a combination of therapy and medication.
You might also want to consider having only one primary healthcare provider. This way, the provider can get to know you and your situation. Plus, having only one provider can prevent you from getting too many tests and procedures since they'll be the only one to be performing or prescribing them.
How to Prevent Illness Anxiety Disorder
There’s no clear way to prevent illness anxiety disorder. However, you may be able to cope more effectively with your anxiety and fears by:
Practicing mindfulness techniques, such as meditation and yoga
Using deep breathing exercises and/or grounding techniques to relax
Journaling about your fears
Spending time with loved ones and engaging in hobbies to get your mind off of your health status
Taking care of your health by exercising regularly, getting enough sleep, and managing stress
Joining a peer support group for people with illness anxiety disorder
Related Conditions
Many people with illness anxiety disorder have other mental health conditions. In fact, some estimates suggest that nearly 65% of people with IAD have at least one other mental disorder.
Some of the most common mental disorders that frequently occur alongside IAD include:
Obsessive-compulsive disorder (OCD): Many symptoms of IAD and OCD overlap, such as engaging in repetitive behaviors and thoughts to cope with stress.
Generalized anxiety disorder (GAD): GAD is a feeling of anxiety or dread that doesn't go away, lasting for months or years.
Panic disorder: This is when you frequently have panic attacks out of nowhere. During the attacks, you'd suddenly feel intense fear or discomfort.
Living With Illness Anxiety Disorder
Illness anxiety disorder is usually a chronic condition. However, symptoms can often be effectively managed with psychotherapy and/or medication. If not treated, symptoms may get worse over time.
Treatment may also be more effective if started earlier, so don't delay getting care for IAD. Some people with illness anxiety disorder are apprehensive about seeking help because they're afraid of being judged or misunderstood. However, health-related anxiety is not uncommon. Find a healthcare provider with whom you feel comfortable so you can discuss your concerns. They can help find the right treatment options and coping mechanisms for you.
Frequently Asked Questions
Does hypochondria go away?
Hypochondria, or illness anxiety disorder, doesn’t typically go away on its own. However, it can be effectively treated with psychotherapy. Antidepressants, such as SSRIs, have also been found to reduce the symptoms of illness anxiety disorder.
Can having illness anxiety cause physical symptoms?
People with illness anxiety disorder can experience a lot of anxiety, and that anxiety can cause physical symptoms like heart palpitations, excessive sweating, and nausea. Someone with IAD likely wouldn't accept these symptoms were caused by anxiety and would instead think there is a serious physical issue.
Does hypochondria get worse with age?
If not treated, hypochondria may get worse with age. This could be because people tend to have a higher risk of chronic health conditions as they age or new risks of certain conditions, like dementia. The sooner someone with illness anxiety disorder is evaluated by a mental health provider, the better their outcome might be.
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