Illness Anxiety Disorder

1 What is Illness Anxiety Disorder?

Illness anxiety disorder is a somatoform disorder characterized by the preoccupation with the idea that one has a serious disease or the fear of having a serious disease. The preoccupation is based on the misinterpretation of one or more bodily signs or symptoms (e.g. "I have a headache, I must have a brain tumor.")

CRITERIA

The current psychiatric diagnostic manual (DSM-IV), indicates the following diagnostic criteria:

  • Preoccupation with fears of having, or the idea that one has, a serious disease based on the person's misinterpretation of bodily symptoms.
  • The preoccupation persists despite appropriate medical evaluation and reassurance.
  • The belief criterion A is not of delusional intensity (as in Delusional Disorder, somatic Type) and is not restricted to a circumscribed concern about appearance (as in Body Dysmorphic Disorder).
  • The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  • The duration of the disturbance is at least 6 months.
  • The preoccupation is not better accounted for by Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Panic Disorder, a Major Depressive Episode, Separation Anxiety, or another Somatoform Disorder.

Complaints tend to focus on the head, neck, and trunk, often in the form of pain. Hypochondriasis is somewhat similar to obsessive compulsive disorder, because of the obsession with illness and the compulsion to do something to reduce their anxiety. An estimated 75 to 85% of people who have hypochondriasis also have anxiety, depression, or another mental disorder.

2 Symptoms

Symptoms of illness anxiety disorder may include:

  • Excessive worry over having or getting a serious illness.
  • Physical symptoms are not present or if present, only mild. If another illness is present, or there is a high risk for developing an illness, the person’s concern is out of proportion.
  • High level of anxiety and alarm over personal health status.
  • Excessive health-related behaviors (e.g., repeatedly checking body for signs of illness) or shows abnormal avoidance (e.g., avoiding doctors’ appointments and hospitals).
  • Fear of illness is present for at least six months (but the specific disease that is feared may change over that time).
  • Fear of illness is not due to another mental disorder.
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3 Causes

The cause is not known, but certain factors may increase the risk of developing illness anxiety disorder (IAD):

  • Major life stress
  • A severe symptom believed to threaten one’s health (e.g., chest pain, memory issues)
  • History of childhood abuse (physical, sexual, emotional) or neglect
  • History of childhood illness
  • Having another mental disorder (e.g., major depression, anxiety, obsessive compulsive disorders, psychotic disorders)

4 Making a Diagnosis

Your doctor may consult with a trained specialist, such as a psychologist or a psychiatrist, to aid in the diagnosis and treatment of illness anxiety disorder.

Your health care provider will perform a physical examination along with other tests to determine whether a physical disease is responsible for your reported symptoms.

Your health care provider will also ask specific questions and use psychological tests to rule out the possibility of other related disorders, such as anxiety or obsessive compulsive disorder.

5 Treatment

Studies show group therapy, behavior modification, and cognitive therapy work particularly well to treat illness anxiety disorder.

In addition to regular visits with a health care provider who will take physical symptoms seriously, people with hypochondriasis may also benefit from psychotherapy.

Preliminary research also suggests that mindfulness based cognitive therapy may help patients with health anxiety.

People with hypochondriasis often have other mental health conditions, such as anxiety and depression, and treatment of these conditions is important in treating symptoms of hypochondriasis. Your health care provider may recommend limiting reading medical books and websites.

Drug Therapies

Doctors typically do not use drugs to treat hypochondriasis, but they may prescribe medication for associated mental health conditions. Such medications may improve symptoms of hypochondriasis.

Doctors may prescribe selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, fluvoxamine, or paroxetine. At least one study found that patients tolerated fluoxetine well, and that the drug was moderately effective for hypochondriasis.

Surgical and Other Procedures

Several types of psychotherapy may help:

  • Cognitive behavioral therapy helps identify thoughts that contribute to fears about illness, and to correct the misinterpretation of body sensations. This type of therapy teaches people to concentrate less on thoughts and fears of illness and to use relaxation and distraction techniques.
  • Behavioral stress management therapy teaches stress management and relaxation techniques to help people avoid focusing on illness during stressful situations. Doctors may use it in conjunction with cognitive behavioral therapy.

6 Prevention

Unfortunately, there is no known prevention against illness anxiety disorder (IAD).

However, providing the IAD patient with support and understanding may help reduce severity of the symptoms, and help the patient cope with the disorder.

7 Alternative and Homeopathic Remedies

A few alternative and homeopathic remedies exist for illness anxiety disorder.

Nutrition:

No scientific studies have examined the effect of nutrition on hypochondriasis.

Herbs:

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to diagnose your problem before starting treatment.

You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerin extracts), or tinctures (alcohol extracts). Unless otherwise indicated, make teas with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. You may use tinctures alone or in combination as noted.

No herbs are specifically used to treat hypochondriasis, but certain herbs used to relieve stress or anxiety may help a person with hypochondriasis become less preoccupied with disease (which tends to worsen during stressful times).

Other herbs may help lessen symptoms of hypochondriasis. Because many herbs interact with prescription antidepressants and anxiety medications, make sure your doctor is aware of all medications, herbs, and supplements you take.

  • St. John's wort (Hypericum perforatum) standardized extract, 300 mg, 2 to 3 times per day, for depression. St. John's wort has serious drug interactions, including, but not limited to, birth control pills. Check with your health care provider if you are taking prescription medications for possible drug interactions with St. John's wort.
  • Kava kava (Piper methysticum) standardized extract, 100 to 250 mg, 1 to 3 times a day as needed for stress and anxiety. The Food and Drug Administration has issued a warning concerning kava kava's effect on the liver. In rare cases, severe liver damage has been reported. If you take kava, do not use it for more than a few days, and tell your doctor before taking it.
  • Bacopa (Bacopa monnieri) standardized extract, 50 to 100 mg, 3 times a day, for stress and anxiety. Some researchers are concerned that Bacopa may increase secretions in the gastrointestinal tract, urinary tract, and lungs, and therefore, may not be appropriate for people with certain medical conditions. Bacopa may increase the chances of a blockage in the intestines. Speak with your physician.

Homeopathy:

Few studies have examined the effectiveness of specific homeopathic remedies. Some health care professionals, however, believe that homeopathy promotes a sense of well-being and may relieve feelings of anxiety and depression often associated with hypochondriasis.

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

  • Aconitum -- for a sense of panic and fear. This remedy is most appropriate for people who believe they are so sick they are going to die.
  • Arsenicum album -- for anxiety and fear of dying. This remedy is most appropriate for people who call the doctor often and are difficult to reassure, or children who may be worried about everything and tend to act sicker than they actually are.
  • Lycopodium -- for general fear and anxiety about health. This remedy is most appropriate for stressed people who complain of stomach problems.
  • Phosphorus -- for general anxiety about health. This remedy is most appropriate for people who fear that something bad will happen (a sense of impending doom), and may latch onto the fears of others, but tend to be easily reassured.

Acupuncture:

Several studies indicate that acupuncture may be useful in treating hypochondriasis. Acupuncturists believe the procedure balances the flow of energy (qi) in the body. This balancing effect may be particularly helpful for people who have distorted perceptions of normal body sensations. Acupuncture may be useful for:

  • Relieving ongoing fear and apprehension
  • Reducing symptoms of emotional stress
  • Lessening stress and pain
  • Regulating sleep patterns
  • Improving energy

Massage:

Some health care providers believe that regular visits to a massage therapist (which include techniques to relieve stress) may help reduce symptoms of hypochondriasis. It is possible, however, that for some people, having regular massages could draw attention to their physical complaints, and increase their symptoms.

8 Lifestyle and Coping

Lifestyle modifications are necessary in order to cope with illness anxiety disorder.

Cognitive behavioral therapy and stress management are the cornerstones of treatment for hypochondriasis. Acupuncture has also been shown to help.

Similarly, participating in mindfulness techniques, such as meditation, may help patients manage symptoms. Beyond that, few studies investigated complementary and alternative therapies for hypochondriasis. Regular appointments with a CAM health care provider may help relieve health-related fears because of the regularity of the visits, the reassurance from a professional, and the focus on wellness and healthy behaviors. Work with someone who is licensed and reputable to develop a solid program of self-care and health promotion.

However, people with hypochondriasis who also have anxiety or depression may benefit from avoiding alcohol and caffeine.

Following these nutritional tips may also help reduce risks and symptoms:

  • Eliminate all suspected food allergens, including dairy (milk, cheese, eggs, and ice cream), wheat (gluten), soy, corn, preservatives, and chemical food additives. Your health care provider may want to test you for food allergies.
  • Eat foods high in B-vitamins and iron, such as whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell pepper).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat small, frequent meals throughout the day. This helps stabilize blood sugar (which can improve mood) and improve digestion (which may reduce awareness of normal body sensations as food passes through the intestines).
  • Use healthy oils for cooking, such as olive oil or coconut oil.
  • Reduce significantly or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts. These fats are also found in French fries, onion rings, processed foods, and margarine.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 to 8 glasses of filtered water daily.
  • Exercise moderately, for 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • A daily multivitamin, containing the antioxidant vitamins A, C, E, D, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc, and selenium.
  • Omega-3 fatty acids, such as fish oil, 1 to 2 capsules or 1 to 2 tablespoonfuls oil daily, to help reduce inflammation and improve immunity. Omega-3 fatty acids can have a blood-thinning effect and may increase the effect of blood-thinning medications, such as warfarin (Coumadin) and aspirin.
  • 5-hydroxytryptophan (5-HTP), 50 mg, 2 to 3 times daily, for mood stabilization. Do not use when taking antidepressants or any psychoactive medications unless under the supervision of a doctor. Dangerous side effects can occur.
  • L-Theanine, 200 mg, 1 to 3 times daily, for nervous system support. If you are already taking medications for anxiety or depression, check with your doctor before taking L-Theanine.
  • Melatonin, 1 to 6 mg, 1 hour before bedtime, for sleep and immune protection. Ask your health care provider about potential prescription interactions.

9 Risks and Complications

There are several complications associated with illness anxiety disorder.

IAD itself is not life-threatening. However people with IAD (especially accompanied by clinical depression) can develop thoughts of suicide. Such thoughts or feelings should not be ignored.

Most people are reluctant to talk about being depressed and especially about having suicidal thoughts. Hiding or ignoring such thoughts – and not getting help – can have tragic results.

Other complications may include:

  • Overuse of medical and laboratory services
  • Costly medical bills
  • Complications from testing procedures
  • Disability and unemployment
  • Marital or family problems
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