What is illness anxiety disorder?
People with illness anxiety disorder are overrun with invasive worries about health problems they think they have, and these thoughts often persist despite repeated tests and scans that rule out any illness. Physical symptoms may or may not be present, but if they are, they’re usually mild yet extremely preoccupying.
People may spend hours every day googling disease symptoms, fixate on benign body reactions (like sweating) as possible signs of illness, and obsessively read every side effect listed for a medication, sure they have every one. They experience health-related rumination too, which is having obsessive and repetitive thoughts.
“I had a patient once describe it like a merry-go-round of doom,” Gallagher said. “You’re going around and around, but you’re not actually resolving anything.”
And it’s usually not just one specific illness a person with IAD dwells on (that’s called nosophobia), it’s several over time that may change on a weekly basis, Gallagher said. It’s also possible to feel health anxiety for others, usually one’s children, parents, or romantic partners.
Put simply, IAD is not just something people have, it’s something people do, according to clinical psychologist Kirren Schnack, like excessive googling of symptoms, body scanning for unusual lumps or marks, and visiting multiple doctors — or none, because you fear an actual diagnosis — for the same concerns.
“A person who has normal health concerns will check out their symptoms with a doctor then continue with their life,” said Kirren, who prefers to be referred to by her first name. “But people with health anxiety just can’t let go of the idea that there’s something very wrong with them.”
In severe cases, some people will even make arrangements for their eventual death, like preparing their will or picking out a casket.
To be diagnosed, all of these symptoms must be present for at least six months, according to the Diagnostic and Statistical Manual of Mental Disorders, the diagnosis guidelines used by all mental health professionals.
IAD got a makeover in the 2013 DSM update when its name changed from hypochondriasis to illness anxiety disorder, namely because of the stigma associated with being labeled a “hypochondriac.” Because IAD is a relatively new diagnosis, its true prevalence is largely unknown, although one 2017 study suggested that it’s less than 1% of the population.
COVID, however, is filling therapists’ offices with new and existing patients to address concerns about long COVID, death — particularly dying alone, as thousands did early on in the pandemic — and fears about overwhelmed hospitals having few resources to treat them if they get sick, according to Karen Cassiday, clinical psychologist and owner of the Anxiety Treatment Center of Greater Chicago.
“I’ve had patients that haven’t been in for 20 years. They were doing great and then they started getting symptoms of their illness anxiety again,” Cassiday said. “I’m hearing the same thing from others who have specialty clinics like mine.”
In order to have a clear understanding of what IAD is, it’s also important to know what it is not, said Cassiday, who was the former president of the Anxiety and Depression Association of America.
A common misconception is that people with health anxiety want to be sick or are crying out for attention. (It’s not the same thing as Munchausen syndrome, which involves faking or exaggerating one’s own illness for attention or other reasons, or Munchausen by proxy, when doing the same for someone else, like a child.)
“People who have [IAD] desperately do not want to have the illnesses that they imagine might be taking place,” Cassiday said. “What we know from research is their lives are ruined by it. They’re anxious all the time. They have trouble sleeping, trouble thinking, trouble focusing.”
It also is different from somatic symptom disorder, a condition in which anxiety can manifest as a physical problem, like back pain, and conversion disorder, in which a person has neurological or sensory problems that can’t be explained by a medical condition.
Who’s most likely to develop illness anxiety disorder?
Unlike other health conditions, IAD doesn’t have unique risk factors, such as race, sex, ethnicity, or socioeconomic status, that make a person more likely to develop the disorder.
Anxiety disorders in general have been on the rise in young adults. One 2020 study published in the Journal of Psychiatric Research found that reports of anxiety increased from about 8% in 2008 to about 15% in 2018 among people ages 18–25.
IAD diagnoses specifically tend to peak around the late teen years into the early 20s, Cassiday said.
Children have their fair share of health anxiety too. Cassiday said she’s had a patient in kindergarten who was afraid they were going to have a heart attack, and a second grader who believed they were going to develop a brain tumor and die.
It’s particularly common among children with sick loved ones because they don’t understand why or how people come down with different illnesses, according to Gallagher, who said COVID has been adding to the confusion.
She said one of her pediatric patients asked if they were going to die because they sometimes bite their nails and pick their nose; the child’s parents specifically told not them not to do that because of the risk of coronavirus infection.
“Kids can have fears just like the rest of us, and a lot of times there’s more unknown as a child,” Gallagher said. “Things can feel overwhelming or concerning.”
Growing up with parents or families that are anxious either generally or about their health can make one more likely to have health anxiety “because that’s what they’ve been taught to worry about,” Gallagher said.
Anyone who experiences health-related trauma, such as a medical event like a heart attack or an STD scare, may also face a greater likelihood of being diagnosed with IAD because these experiences have “led a person to believe that they don’t have safety, stability, or security,” Kirren said.
“Health anxiety is literally feeling unsafe and unstable in your body, [placing] a big question mark over your own existence,” she added.
Older people can be at risk for health anxiety as more friends, partners, or family members die from illness or age-related accidents too, Gallagher said. “Illness anxiety can be really triggering at that point because those things can exacerbate your fears about the truth that we’re all going to die someday,” she said.
Illness anxiety disorder can come with other health conditions
IAD isn’t always accompanied by other medical conditions, but when it is, it’s commonly alongside obsessive-compulsive disorder because of the ruminating nature of one’s thoughts and depression.
“People get very down because they get stuck in the loop of not being able to master their symptoms and thinking that they’re dying of a horrible disease every day,” Kirren said. “It completely drains the life out of people so they withdraw into themselves.”
Panic disorder is another common condition that some people with IAD share.
A smaller percentage of people with IAD will have body dysmorphic disorder, which is the obsessive focus on an imagined or minor flaw in appearance. These patients could believe they have a lump in their breast, for example, and constantly monitor it despite nothing being there.
Some people may have substance abuse disorders, but this is rare, Kirren said, because “most patients are scared of losing control, so they don’t take medications as they’re not sure what it’ll do to their body.”
Then there’s the fear of death, medically known as thanatophobia.
Death anxiety is not a recognized disorder in the DSM, but psychologists say many IAD patients’ core fear is death itself. For others, it’s suffering.
“What they’re doing with this worry is they’re trying to get rid of uncertainty,” Cassiday said. “Because they can’t tolerate it, they want to handle that with a ‘better safe than sorry’ strategy by just focusing on the worst outcome.”
How is illness anxiety disorder treated?
Anxiety disorders in general are highly treatable, according to the Anxiety and Depression Association of America. Yet only about 37% of people with them receive the treatment they need.
Treatment for IAD is no different. Kirren said many patients end up taking medications, usually antidepressants like SSRIs (which include Prozac and Zoloft), as their first line of treatment just because therapy can be difficult to access. Medication can certainly be helpful for some people with IAD, particularly if they have OCD or other conditions that intensify their symptoms.
People with IAD also more commonly visit primary care centers rather than mental health clinics, researchers say, which results in delays in appropriate treatment that can worsen their mental health.
In an ideal scenario, a person with IAD will undergo cognitive behavioral therapy specifically designed for health anxiety, which targets the actions people do that feed their rumination. Essentially people learn how to manage and eventually replace their scary thoughts with more productive and healthy behaviors.
Another rare yet highly successful type of therapy is eye movement desensitization and reprocessing. Patients are asked to think of a specific memory or traumatic experience as they follow a therapist’s moving fingers with their eyes, which switches on the brain’s processing system. This activation allows the memory to be properly processed “so it cannot cause disturbance in the here and now anymore,” Kirren said.
“I’m blown away by the results,” she said, adding that sometimes people’s anxiety disappears after just two or three sessions.
Some advice if you’re dealing with health anxiety
A piece of good news for people with health anxiety: You cannot manifest an illness by thinking it into existence. At least there’s no evidence of that happening, experts told us.
Even in the medical community, this is called “magical thinking,” Kirren said, and should be considered another symptom of IAD.
The first step in addressing your health anxiety is realizing your thoughts are taking up more space in your brain than you’d like. Then it may be time for a trip to your primary care doctor to rule out any actual illness.
“Ultimately treatment requires patients to accept the problem is an emotional one, not a physical one,” Kirren said, “and we can’t get to that point unless we treat the symptoms seriously and perform the checks.”
Next, you should see a mental health professional who may diagnose you with IAD. If so, you’ll have access to the appropriate treatments. Kirren said it’s OK to ask your therapist about their experience treating health anxiety to ensure you’re getting the right care.
Those questions include:
Do you have expertise in health anxiety?How many patients have you treated with health anxiety?What types of intervention do you normally use for health anxiety, and how do those work?How long can I expect my treatment to take?
Kirren’s last piece of advice: “You don’t need years and years of therapy. If you are receiving the right treatment, you should make progress pretty efficiently,” likely within eight to 20 sessions.
In the meantime, Cassiday suggests you recognize that “your big enemy is worry, not your health.”
This means you should absolutely avoid researching your symptoms online; just make a doctor’s appointment if you’re that concerned. “If your friends are calling you a hypochondriac or telling you you’ve got a problem, you need to believe them,” Cassiday said.
And if you have a loved one who appears to be struggling with health anxiety, it’s important to bring your concern to their attention and suggest they seek medical attention.
Getting a serious or terminal illness is “one possible outcome that happens to quite a few of us where we do get sick and die. Worry won’t change those random events,” Cassiday said. “The most precious thing is to live well now so that worry doesn’t hijack the present moment.”
And just think about all the uncertainties you already tolerate, Gallagher said, like the potential for an accident every time you get in your car.
“Sometimes it’s about tolerating that uncertainty and expanding your attention to the here and now,” Gallagher said. “We’re all going to die. We’re probably all going to get some sort of health condition if we live long enough. So enjoy your life and stay present.
“Do you want to spend your time on Earth really focusing on that?”