Definition and Diagnosis
Illness anxiety disorder is characterized by a preoccupation with having or acquiring a serious illness, in the absence of significant somatic symptoms (or, if present, symptoms are only mild in intensity), with high health-related anxiety and either excessive health-related behaviors or maladaptive avoidance.
Epidemiology
Illness anxiety disorder is estimated to affect around 1-5% of the general population and a higher proportion of medical outpatients, with onset possible at any age but often in early to middle adulthood.
Risk Factors
Risk factors include a history of serious illness in childhood, exposure to illness or death of a close family member, co-occurring anxiety disorders, and a tendency toward heightened interpretation of normal bodily sensations.
Symptoms and Subtypes
Individuals experience persistent worry about having a serious undiagnosed condition, frequently check their body for signs of illness or repeatedly seek reassurance through medical visits, or, alternatively, avoid medical care and appointments due to anxiety.
Diagnosis
DSM-5-TR criteria require preoccupation with having or acquiring a serious illness for six months or more, high anxiety about health, and either excessive health-related behaviors or maladaptive avoidance, with symptoms not better explained by another mental disorder.
Treatment
Cognitive behavioral therapy targeting misinterpretation of bodily sensations and health anxiety is first-line; a consistent primary care relationship, scheduled rather than symptom-driven visits, and limiting unnecessary testing are also important components of management.
Prognosis
With CBT and consistent medical management, many individuals experience significant reduction in health anxiety, though the disorder can follow a chronic, fluctuating course without treatment.
Reference
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).