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Hypochondria was once used to describe a kind of anxiety where one believes they have or might develop a serious illness.
You’ve probably heard the term hypochondriac used to describe people who experience such symptoms. But these terms are out-of-date and can make those with this type of anxiety feel that their concerns are being ignored.
In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) no longer recognizes hypochondriasis––or hypochondria––as a diagnosis, in part, because patients often felt their concerns were being dismissed or invalidated by the term (American Psychological Association (APA), 2020).
Instead, the condition is separated into two diagnoses: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). One study found that about 75% of people previously diagnosed with hypochondria have SSD, while 25% have IAD (Bailer, 2015). Together, these conditions are surprisingly common, affecting one in 10 people (D’Souza, 2021).
What is illness anxiety disorder?
People with IAD typically express a few broad behaviors. Some individuals have a high level of anxiety about their health, causing them to check repeatedly for signs of illness. This can involve things like constantly checking their temperature, feeling lymph nodes, or seeking medical attention.
In other cases, IAD manifests the opposite way, such as avoiding routine trips to the doctor.
While we all worry about our health now and again, for people with IAD, these thoughts and behaviors are severe, debilitating, and often constant, persisting for six months or more. Over that time, the condition they suspect they have may change, but the level of anxiety stays the same (SAMHSA, 2013).
Their fears can be disruptive enough to interfere with relationships, work, or school. These fears continue even when medical evaluation repeatedly reveals no illness.
Causes of IAD
It’s unclear what causes IAD, but research suggests that experiencing a severe illness in childhood, or having a parent or sibling with a serious medical condition, can increase the risk of developing IAD (French, 2021).
The same is true if a person was exposed to excessive worrying about health during childhood. People with underlying anxiety disorders and those who are uncomfortable experiencing any bodily changes––even typical ones––are also at a higher risk for IAD (French, 2021).
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What is somatic symptom disorder?
We all may worry that a stitch in our side or sudden discomfort in our chest is a sign of something more serious. But for people with SSD, that fear can be constant and persistent, affecting their ability to function daily.
Rather than obsessively checking for symptoms, people with SSD typically focus on one or more existing physical symptoms. They will overly worry that these symptoms are a sign of a more severe illness, even when a medical evaluation has ruled that out (D’Souza, 2021).
People with SSD have excessive thoughts, feelings, or actions related to health concerns that fit at least one of the following criteria:
- Disproportionate and persistent thoughts about the seriousness of their symptoms
- Persistently high levels of anxiety about health or symptoms
- Excessive time and energy devoted to these symptoms or health concerns
People with SSD are also more likely to experience other anxiety disorders like panic disorder and generalized anxiety disorder (Bailer, 2015).
Causes of SSD
Like IAD, it’s unclear what causes SSD, but here’s what some research suggests could trigger it:
- A history of childhood neglect
- Sexual abuse
- Substance abuse
- Having a chaotic lifestyle
- Certain personality disorders, particularly avoidant, paranoid, and obsessive-compulsive disorders
Sometimes psychosocial stressors, including unemployment or stress at work, can be at play.
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Treatment for anxiety disorders
Because SSD and IAD are categorized as anxiety disorders, working with a mental healthcare professional to diagnose and treat the conditions can help.
Treatment is largely based on identifying triggers and may include medications for anxiety or depression but is not limited to just one type of treatment.
Cognitive behavioral therapy (CBT), a common type of psychotherapy that focuses on honing coping strategies, has also been effective in helping people cope with SSD and IAD.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). (2013). Retrieved from https://www.uptodate.com/contents/illness-anxiety-disorder-treatment-and-prognosis#:~:text=Both%20the%20DSM%2DIV%2DTR,reassurance%20%5B1%2C5%5D.
- American Psychological Association (APA). Dictionary of Psychology. (2020). Hypochondria. Retrieved from https://dictionary.apa.org/hypochondria
- American Psychological Association (APA). Dictionary of Psychology. (2020). Hypochondriasis. Retrieved from https://dictionary.apa.org/hypochondriasis
- Bailer, J., Kerstner, T., Witthöft, M., Diener, C., Mier, D., & Rist, F. (2016). Health anxiety and hypochondriasis in the light of DSM-5. Anxiety Stress Coping, 29(2), 219-39. doi: 10.1080/10615806.2015.1036243. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25846805/
- D’Souza, R. S., & Hooten, W. M. (2021). Somatic Syndrome Disorders. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK532253/
- French, J. H., & Hameed, S. (2021). Illness Anxiety Disorder. StatPearls. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK554399/
- Substance Abuse and Mental Health Services Administration (SAMHSA). (2016). Impact of the DSM-IV to DSM-5 Changes on the National Survey on Drug Use and Health. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t32/
Yael Cooperman is a physician and works as a Senior Manager, Medical Content & Education at Ro.