Illness anxiety disorder: You aren’t sick; it’s just your mind

Dec 16, 2018 Dr Zulfikar Bux

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By Dr Zulfikar Bux

Assistant Professor of Emergency Medicine

Illness anxiety disorder is a persistent fear of having a grave medical illness. A person with this disorder pays excessive attention to health. He or she can become easily alarmed by anything that might be interpreted as a sign of illness, including normal sensations, bodily functions and mild symptoms. For them, such experiences may signal an illness with a grim outcome.
For example, a person may fear that the normal sounds of digestion, sweating or a mark on the skin may be indicators of life-threatening disease.
Today we will discuss this condition, because it is increasing in numbers and its sufferers cannot be convinced otherwise.

WHAT IS IT?

It is a mental condition where the affected person usually does not have physical symptoms, or if symptoms are present, they are mild. A person with illness anxiety disorder may be especially concerned about a particular organ system, such as the cardiac or digestive system.
A doctor’s reassurance and even a complete medical evaluation often will not calm the person’s fears. Or, if it does calm them, other worries may emerge later. Patients may admit the possibility that their fears are exaggerated. However, they may not accept being told that there is “nothing wrong.”
In severe forms of this disorder, a person may go from doctor to doctor, looking for one that will confirm a feared illness. The patient and the doctors may become frustrated or angry. The pattern sometimes interferes with the person getting proper care, if he or she develops a medical illness for which there is a known and effective treatment.
Some people with this disorder have had a significant illness in the past, for example, during childhood. Often illness anxiety disorder starts in young adulthood and can last many years. But it can occur at any age. Symptoms may become more intense after a stressful event, such as the death of a loved one.
Although medical illnesses are uncomfortable, they can bring benefits, such as relief from responsibilities along with the attention and care of family members, friends and doctors. Illness anxiety disorder may be motivated by these advantages, although the individual is often not aware of that motivation.
Less often, a person may fake illness to seek some obvious gain, such as getting a drug or a financial benefit, or avoiding some work or legal responsibility. In cases where someone is consciously seeking such advantages, the condition is called malingering. But illness anxiety disorder is not malingering. In illness anxiety disorder, the patient is not pretending. He or she believes there is a real danger of becoming ill and truly feels anxious.

WHAT ARE SYMPTOMS OF ILLNESS ANXIETY DISORDER?

Symptoms of illness anxiety disorder include:

• Preoccupation with having or developing a serious illness
• Absence of physical symptoms or, if present, symptoms are mild
• Behaviour indicating health anxiety, such as checking for signs of illness
• Easy alarm about medical problems; persistent fear despite medical reassurance
• Overuse or underuse medical care.
• Absence of delusions or psychosis
• Very distressed

HOW IS IT DIAGNOSED?

The diagnosis is based on a person’s medical complaints and history, plus a doctor’s physical examination and laboratory tests. The disorder may be accompanied by severe anxiety symptoms or obsessive-compulsive symptoms. Patients often refuse to see a psychiatrist because they feel they are being deemed as “mad”. It is not the case, but psychiatrists are the experts who can best help their worrying mind.

ARE THERE TREATMENT OPTIONS?

Some people with illness anxiety may have their concerns because they are suffering from depression, anxiety or a psychotic disorder. Doctors would usually explore those possibilities, and target them for treatment as needed.
The symptoms of illness anxiety disorder may be relieved by an antidepressant even when no other psychiatric illness is present.
There is evidence that a number of therapies can help people with illness anxiety disorder: cognitive therapy, behaviour therapy, cognitive behaviour therapy and stress management.
Therapists teach distraction and relaxation techniques and help patients focus less on their symptoms and talk instead about how stress, anxiety and depression increase their psychological discomfort.
Therapists explain that many of the actions patients take to try to relieve anxiety usually backfire. Feeling for lumps, reading about illness or otherwise scanning for illness makes symptoms worse not better.
Since the medical complaints may never go away, a doctor may set up a regular schedule of short appointments, during which symptoms can be reviewed. This can help contain anxiety. On the other hand, anxiety may get worse if a doctor attempts to limit contact and treats the patient dismissively.

HOW DOES IT PROGRESS?

Some patients respond well to medication, psychotherapy or both. If the person has anxiety or depression that responds to treatment with medication, the prognosis can be quite good. In mild cases, symptoms can be short-lived. If the symptoms are severe and the person has other mental health disorders, the person may be susceptible to chronic distress and have problems functioning.
If you have been doctor shopping and are not sure what’s going on with you or a relative, ask your doctor about illness anxiety disorder to ensure that it’s not the cause of your worry.

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