By Mayo Clinic Staff
Illness anxiety disorder, sometimes called hypochondria or health anxiety, is worrying excessively that you are or may become seriously ill. You may have no physical symptoms. Or you may believe that normal body sensations or minor symptoms are signs of severe illness, even though a thorough medical exam doesn't reveal a serious medical condition.
If you have a medical condition or you're at high risk of developing one, you become consumed with worry. You may experience excessive anxiety that a body sensation associated with a known illness signals a much greater threat than actually exists. This excessive anxiety — rather than the physical symptom itself — results in severe distress that can be disabling.
Illness anxiety disorder is a long-term condition that can fluctuate in severity. It may increase with age or during times of stress. But psychological counseling (psychotherapy) and sometimes medication can help ease your worries.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association, no longer includes hypochondriasis — also called hypochondria — as a diagnosis. Instead, people previously diagnosed with hypochondriasis may be classified as having one of these disorders:
- Illness anxiety disorder, especially if there are no physical symptoms or they're mild
- Somatic symptom disorder, especially if there are multiple or major physical symptoms
Symptoms of illness anxiety disorder involve preoccupation with the idea that you're seriously ill, based on normal body sensations (such as a noisy stomach) or minor symptoms (such as a minor rash). Signs and symptoms may include:
- Being preoccupied with having or getting a serious disease or health condition
- Worrying that minor symptoms or body sensations mean you have a serious illness
- Being easily alarmed about your health status
- Finding little or no reassurance from negative test results or a doctor's reassurance that you're healthy
- Worrying excessively about a specific medical condition or your risk of developing a medical condition because it runs in your family
- Having so much distress about possible illnesses that it's hard for you to function
- Repeatedly checking your body for signs of illness
- Frequently making medical appointments for reassurance — or, avoiding medical care for fear of being diagnosed with a serious illness
- Avoiding people, places or activities for fear of health risks
- Constantly talking about your health and possible illnesses
- Frequently searching the Internet for causes of symptoms or possible illnesses
When to see a doctor
Because symptoms can be related to health problems, it's important to be evaluated by your health care provider if this hasn't already been done. If your provider believes that you may have illness anxiety disorder, he or she may refer you to a mental health provider.
Caring for a loved one
Significant health anxiety can cause real distress for the person, and reassurance isn't always helpful. Sometimes, providing reassurance can make things worse. This can be frustrating and cause stress on families and relationships. Encourage your loved one to consider a mental health referral to learn ways to cope with illness anxiety disorder.
The exact cause of illness anxiety disorder isn't clear, but these factors may play a role:
- Beliefs. You don't understand the meaning of body sensations or you have a poor understanding of diseases, or both. This could lead you to think that all body sensations are serious, so you search for evidence to confirm that you have a serious disease.
- Family. You may be more likely to have health anxiety if you had parents who worried too much about their own health or your health.
- Past experience. You may have had experience with serious illness in childhood, so physical sensations are frightening to you.
Illness anxiety disorder usually begins in early or middle adulthood and may get worse with age. Often for older individuals, health-related anxiety may focus on the fear of losing their memory.
Risk factors for illness anxiety disorder may include:
- A time of major life stress
- Threat of a serious illness that turns out not to be serious
- History of abuse as a child
- A serious childhood illness or a parent with a serious illness
- A personality that includes being a worrier
- Excessive health-related Internet use
Illness anxiety disorder may be associated with:
- Relationship or family problems because excessive worrying can frustrate others
- Work-related performance problems or excessive absences
- Problems functioning in daily life, possibly even resulting in disability
- Financial problems due to too many health care visits
- Having another mental health disorder, such as somatic symptom disorder, other anxiety disorders, depression or a personality disorder
As part of your medical evaluation, your primary care provider may refer you to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment.
Here's some information to help you prepare for your appointment and what to expect from your doctor or mental health provider.
What you can do
Before your appointment, make a list of:
- Your symptoms, including when they first occurred and how they impact your daily life
- Key personal information, including traumatic events in your past and any stressful major events
- Medical information, including other physical or mental health conditions that you have
- Medications, vitamins and other supplements you take, and the doses
- Questions to ask your doctor
Ask a trusted family member or friend to go with you to your appointment, if possible, to lend support and help you remember information.
Questions to ask a mental health provider
Ask your provider questions such as:
- Do I have illness anxiety disorder?
- What treatment approach do you recommend?
- Would therapy be helpful in my case?
- If you're recommending therapy, how often will I need it and for how long?
- If you're recommending medications, are there any possible side effects?
- For how long will I need to take medication?
- How will you monitor whether my treatment is working?
- Are there any self-care steps I can take to help manage my condition?
- Are there any brochures or other printed material that I can have?
- What websites do you recommend?
Don't hesitate to ask any other questions.
What to expect from your doctor
A doctor or mental health provider may ask:
- What are your symptoms, and when did they first occur?
- How do your symptoms affect your life, such as at school, at work and in personal relationships?
- Have you or any of your close relatives been diagnosed with a mental health disorder?
- Have you been diagnosed with any medical conditions?
- Do you use alcohol or recreational drugs? How often?
- Do you get regular physical activity?
To determine a diagnosis, you'll likely have a physical exam and any tests your doctor recommends. Your doctor or other health care provider can help determine if you have any medical conditions that require treatment.
Your doctor may also refer you to a mental health provider. He or she may:
- Conduct a psychological evaluation to talk about your symptoms, stressful situations, family history, fears or concerns, relationship problems, and other issues affecting your life
- Have you fill out a psychological self-assessment or questionnaire
- Ask you about alcohol, drug or other substance use
Criteria for diagnosis
The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, emphasizes these points in the diagnosis of illness anxiety disorder:
- You're preoccupied with having or getting a serious illness.
- You're easily alarmed about your personal health status.
- You don't have physical symptoms, or if you do, they're only mild.
- If you have another medical condition or a strong family history of a medical condition, your preoccupation about this is excessive.
- You perform excessive health-related behaviors, such as repeatedly checking your body for signs of disease, or you avoid medical appointments for fear of being diagnosed with a serious illness.
- Your illness preoccupation has lasted for at least six months, even though the specific illness you fear may change during that time.
- Your illness preoccupation is not better explained by another mental disorder, such as somatic symptom disorder, panic disorder or generalized anxiety disorder.
The goal of treatment is to improve your symptoms and your ability to function in daily life. Psychotherapy, in particular cognitive behavioral therapy, can be helpful for illness anxiety disorder. Sometimes medications may be added.
Because physical sensations can be related to psychological distress and health anxiety, psychotherapy — also called talk therapy — can be effective for illness anxiety disorder. A type of psychotherapy called cognitive behavioral therapy (CBT) can be effective in learning skills to manage illness anxiety disorder. CBT can be provided individually or in a group.
CBT can help you:
- Identify your fears and beliefs about having a serious medical disease
- Learn alternate ways to view your body sensations by working to change unhelpful thoughts
- Become more aware of how your worries affect you and your behavior
- Change the way you respond to your body sensations and symptoms
- Learn skills to cope with and tolerate anxiety and stress
- Reduce avoidance of situations and activities due to physical sensations
- Reduce behaviors of frequently checking your body for signs of illness and repeatedly seeking reassurance
- Improve daily functioning at home, at work, in relationships and in social situations
- Address other mental health disorders, such as depression
Other therapies such as behavioral stress management and exposure therapy also may be helpful.
Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may help treat illness anxiety disorder. Medications to treat mood or anxiety disorders, if present, also may help.
Talk with your doctor about medication options and the possible side effects and risks.
While illness anxiety disorder benefits from professional treatment, you can take some self-care steps:
- Work with your provider. Work with your doctor or mental health provider to determine a regular schedule for visits to discuss your concerns and build a trusting relationship. Discuss setting reasonable limits on tests, evaluations and specialist referrals. Avoid seeking advice from multiple doctors or emergency room visits that can make your care harder to coordinate and may subject you to duplicate testing. With your provider's help, find different ways to manage your worries other than excessive medical testing or avoidance of medical care.
- Practice stress management and relaxation techniques. Learning stress management and relaxation methods, such as progressive muscle relaxation, may help reduce anxiety.
- Get physically active. A graduated activity program may have a calming effect on your mood, reduce your anxiety and help improve your physical functioning.
- Participate in activities. Stay involved in work, social and family activities.
- Avoid alcohol and recreational drugs. Substance use can make your care more difficult. Talk to your health care provider if you need help quitting.
- Avoid searching the Internet for possible diseases. The vast amount of health information that may or may not be related to your situation can cause confusion and anxiety. If you have symptoms that concern you, talk to your doctor at your next scheduled appointment.
Little is known about how to prevent illness anxiety disorder, but these suggestions may help.
- If you have problems with anxiety, seek professional advice as soon as possible to help stop symptoms from getting worse and impairing your quality of life.
- Learn to recognize when you're stressed and how this affects your body — and regularly practice stress management and relaxation techniques.
- Stick with your treatment plan to help prevent relapses or worsening of symptoms.
July 02, 2015
- Illness anxiety disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed May 14, 2015.
- Levenson JL. Hypochondriasis: Epidemiology, clinical presentation, assessment, and diagnosis. http://www.uptodate.com/home. Accessed May 14, 2015.
- Levenson JL. Hypochondriasis: Treatment and prognosis. http://www.uptodate.com/home. Accessed May 14, 2015.
- Illness anxiety disorder. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-disorders/somatic-symptom-and-related-disorders/illness-anxiety-disorder. Accessed May 16, 2015.
- Singh K, et al. From headache to tumour: An examination of health anxiety, health-related Internet use and 'query escalation.' Journal of Health Psychology. In press. Accessed May 16, 2015.
- Isaac ML, et al. Medically unexplained symptoms. Medical Clinics of North America. 2014;98:663.
- Starcevic V. Hypochondriasis and health anxiety: Conceptual challenges. British Journal of Psychiatry. 2013;202:7.
- Health anxiety (hypochondria). NHS Choices. http://www.nhs.uk/conditions/hypochondria/Pages/Introduction.aspx. Accessed May 16, 2015.
- Stonnington CM (expert opinion). Mayo Clinic, Scottsdale, Ariz. June 13, 2015.
- Craner JR (expert opinion). Mayo Clinic, Rochester, Minn. June 12, 2015.
- Sawchuk CN (expert opinion). Mayo Clinic, Rochester, Minn. June 12, 2015.