Health anxiety (also referred to as hypochondriasis or illness anxiety) is best described as an excessive fear of and preoccupation with having or developing a serious medical issue or disease. People with illness anxiety often misinterpret benign symptoms or sensations (e.g. normal bodily sensations or symptoms of anxiety itself) as serious, detrimental medical issues. This occurs despite receiving medical reassurance about the symptoms. The disorder often causes significant distress for the individual and interferes considerably with their daily functioning (impairing social and occupational functioning).
Health anxiety disorder can start at any age; however, it commonly starts in adolescence or young adulthood. Research shows that the usual course of illness anxiety is to come and go throughout life depending on various stresses and it occurs equally in men and women.
Somatic symptoms do not need to be present, but if they are they are disproportionate with the individual’s meaning, significance or cause of the complaint. If a there is an actual diagnosable medical condition, the individual’s anxiety and preoccupation are clearly excessive and disproportionate to the severity of the condition.
The range of illnesses that are feared does vary, but the illnesses that individuals are concerned about having are usually chronic illnesses such as cancer and AIDs. People also often have anxiety about certain illnesses that are ‘topical’ (e.g., Ebola, SARS) and the specific illness that is feared often changes over time.
Common signs and symptoms of Illness Anxiety Disorder
- Constant seeking of reassurance from family and friends and health care providers
- Constantly seeking help with multiple doctor visits, medical tests (care-seeking individuals) or avoiding doctors appointments and hospitals etc. (care-avoidant type)
- Spending excessive time worrying and talking about symptoms and their meaning
- Being easily alarmed by health status (e.g. blood test results) and benign somatic symptoms (e.g. headache is a tumour; minor chest pain is a heart attack)
- Repetitive checking of the relevant parts of the body (lumps, rashes, freckles/moles)
- Repetitive avoiding contact with objects or situations for fear of exposure to illness or disease
- Over-researching different symptoms and conditions – e.g. habitual internet searching (‘Dr Google’) for information about illnesses and their symptoms
Illness anxiety shares a number of similarities with Obsessive Compulsive Disorder (OCD), particularly if individuals develop unhelpful behavioural rituals to relieve anxiety (e.g. continually checking their body for signs and symptoms). It also shares similarities with Somatic Symptom Disorder, which is a condition in which an individual experiences pain or discomfort without medical explanation.
Treatment for Health Anxiety
It is important to note that individuals with illness anxiety are often unaware of the underlying psychological issue associated with their symptoms and distress and they continue to firmly believe that they have physical ailments associated with a medical issue/disease.
Similar to other anxiety disorders, research shows that the best treatment for illness anxiety is Cognitive Behavioural Therapy (CBT). In severe cases, medication may also need to be considered to help reduce worry and physical symptoms.
Typical CBT techniques used for illness anxiety include:
- Education about anxiety (i.e., the causes of anxiety, factors that keep the anxiety going, and what treatment will involve and why)
- Identifying and changing thoughts about health and illness that fuel anxiety
- Identifying and changing unhelpful behaviours that are keeping the anxiety going (e.g., avoiding certain situations that are reminders of the anxiety; excessively seeking reassurance about health and signs of illness from friends, family and health professionals; repetitive checking of signs of a health problem on the body, such as lumps or rashes)
It is important for treatment to focus on reducing behaviours such as ‘avoidance’ and ‘checking’ as these behaviours can become extremely disruptive to the individual’s functioning. These behaviours are generally treated using a technique called ‘exposure and response prevention’ (ERP). As the name suggests, this technique involves ‘exposing’ the individual to their fears (e.g., imagining that they have cancer) whilst refraining at the same time from engaging in behaviours they have developed to reduce their anxiety (e.g. repeatedly checking for lumps or visiting the doctor to seek reassurance that they are healthy). These techniques at the outset can often seem very difficult or confronting for individuals with anxiety. Psychologists working with anxiety understand this, and use a very gradual, understanding, and supportive approach when working with individuals with anxiety, and ensure that the client is agreeable and ready to tackle each step at a time.
If you would like to find out more about our treatment for health anxiety, or to book an appointment with one of our clinical psychologists who provides treatment for this condition, please email or call the clinic on 0405 430 530.