What to Know About Illness Anxiety Disorder

Recently, a new patient of mine sent me the following email: “I have a fear of having or developing an illness, not necessarily dying, but the fear that maybe someday I will be diagnosed with a disabling illness. I spend a lot of time on WebMD researching illnesses that I'm convinced I have.”

This sounds like it could be Illness Anxiety Disorder.

Illness Anxiety Disorder (IAD) may not be a familiar term, but here’s a word which may be: hypochondriac. Hypochondriasis used to be a medical diagnosis but has been split into two new diagnoses: Somatic Symptom Disorder and Illness Anxiety Disorder. We will focus on the latter, as it relates to my patient’s question.

What is Illness Anxiety Disorder?

According to the DSM-5 (the bible of psychological diagnoses), Illness Anxiety Disorder is defined by the following symptoms:

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• Preoccupation with having or developing a debilitating or life-threatening illness.
• The patient doesn't actually have any physical symptoms, or if they do, they're mild. If a medical condition is present or the patient is high-risk for developing a medical condition, their anxiety about it reaches extreme proportions.
• Typically, people with IAD are either care-seeking (that is, frequently performing health checks and going to the doctor), or care-avoidant (they avoid doctor's appointments entirely, for fear of what they might learn).

Nine Signs and Symptoms of Illness Anxiety Disorder

1. All-or-nothing thinking: Seeing things in black-and-white categories, ignoring the shades of gray. For example: “I’m either healthy or I'm dying of an illness,” or, “If the test isn’t 100 percent accurate, how can I trust it at all?!”
2. Negative filter: You pick out a single negative detail and ignore everything else. For example, if your doctor said, “Your headache is probably due to an increase in stress,” you might start dwelling on the word “probably” and begin thinking about more deadly causes of headaches and ignore the doctor’s main message that there’s no cause for concern.
3. Rejecting positive information: For example, if your doctor said, “We’ve run the standard battery of tests and there are no indications of you having a tumor,” you might insist that the test might be wrong. Similarly, you might discount non-lethal explanations of bodily complaints, such as assuming that your stomach pains are due to ulcerative colitis rather than just some bad fish.
4. Jumping to conclusions: Just because you have a sore throat does not mean you have COVID-19. Your headache is not necessarily a brain tumor.
5. Fortune telling: Assuming that your pessimistic expectations are true. For example, proclaiming that you know you would die from the flu if you got it.
6. Catastrophizing: Viewing minor ailments as having terrible consequences. For instance, assuming that random aches and pains are always a sign of an underlying terminal illness.
7. Overgeneralization: Taking one example as proof for a general rule (for example, “I feel tired today. I must have mono.”)
8. Emotional reasoning: Treating your feelings as facts. For example, “There must be something physically wrong with me because otherwise, I wouldn’t feel so anxious.”
9. Intolerance of uncertainty: Refusing to accept that uncertainty is a part of everyday life. For example, “Doctors must rule out all possible diseases” and “I must be completely sure that I’m healthy before I leave the doctor’s office.”

Keep in mind that there is a relationship between your thinking, emotions, behaviors, and physiological responses. Therefore, if you think in these ways, you will only increase your worry and your physical discomfort.

Physical vs. Psychological Symptoms

Individuals with IAD may label subtle bodily changes as pathological. What does that mean? Here is a common example: A person may have stomach pains and be convinced that they have appendicitis as a result. The stress of this thought leads to heart palpitations and nausea and increases their panic. They go to the hospital and are turned away and told that they are having an anxiety reaction. They go home and schedule appointments with several other specialists.

From this example, we can see how a subtle physical change (stomach ache), combined with maladaptive thinking, can lead to increased anxiety and the arrival of other symptoms (heart palpitations and nausea).

If you have this disorder, it may be difficult to move forward without support. Psychotherapy is the primary form of treatment for IAD. Meanwhile, here are a few tips to help ease your illness anxiety:

1. Externalize your anxiety: Instead of telling yourself "I'm going to get very sick and die," it might be helpful to instead say, "My illness anxiety is being loud today.
2. Accept uncertainty: The goal is not to eliminate all anxiety, but to cope effectively with the anxiety that exists. There will always be a .00001 percent chance that you do have a brain tumor, but spending 99 percent of your life engaging with that worry means that you aren’t embracing the good parts of your daily experiences.
3. Decrease compulsive behaviors: Limit the amount of time you spend on medical forums, examining your body, going to the doctor each time you have a minor ailment, and continually looking to family or friends for reassurance.
4. Examine cognitive distortions: Don’t accept your inner monologue as fact. Whenever negative self-talk arises, make a list of the evidence for and against the diagnosis. You will find that, in most cases, there is no substance to the worry. It’s like clickbait in your brain.

Naturally, some level of concern about your health and well-being is normal. But if it's getting to a point in which the worry is worse than the physical symptoms, then it might be time to see a qualified mental health professional.

To find a therapist near you, visit the Psychology Today Therapy Directory.