Hypochondria and Mental Health: The Link Between Anxiety and Illness

Illness anxiety disorder (IAD), formerly called hypochondria or hypochondriasis, is a type of anxiety disorder that affects millions of people worldwide. It can cause individuals to become overly concerned about their health, often to the point of extreme obsession.

While occasional worries about health care are usual, an illness anxiety disorder can seriously impact a person’s quality of life. Those with Illness anxiety disorder, may constantly seek reassurance from doctors and repeatedly undergo tests and procedures, even when there’s no evidence of illness. 

In this case, somebody with IAD obsessively focuses on their health and body, self-examining and self-diagnosing. This stress can occur even if there is no medical condition present, and if there is, their anxiety is disproportionate to the severity of the illness. IAD causes severe psychological distress and physical disability, thereby disrupting daily functioning.

In this article, we’ll look at the symptoms of illness anxiety disorder, why it occurs, and how it can be treated.

Symptoms

The symptoms of an Illness Anxiety Disorder include: 

1. constant preoccupation with having or developing a severe medical condition; 
2. Interpreting minor symptoms as major illnesses; feeling easily frightened by existing health status; 
3. Finding little reassurance from healthcare professionals or negative test results; 
4. Experiencing excessive distress about potential illnesses that hinder daily functioning; 
5. Repeatedly checking the body for signs of disease; 
6. Persistently seeking medical attention for reassurance or avoiding care due to the fear of diagnosis; 
7. Avoiding people, places, or activities due to health concerns; 
8. Discussing health and possible illnesses frequently and repeatedly searching the internet for information on causes, symptoms, and potential diseases.

Classification of symptoms

The illness anxiety disorder has two types:

Care-seeking and care-avoidant

1. Care-seeking individuals seek regular reassurance from doctors despite expected test results, and discuss their symptoms with others. 

2. Care-avoidant individuals avoid doctor visits and sharing their worries with loved ones out of fear of bad news or not being taken care of.

Causes of Illness Anxiety Disorder

Illness anxiety disorder has been linked to several risk factors:

1. An irrational belief that all bodily sensations will indicate a profound illness.

 2. A personal inclination to worry about health.

3. A family history of anticipatory stress or anxiety disorders, like depression, mood and  anxiety disorders, etc.

4. A history of childhood illness and exposure to serious illness within the family. 

5. persistent stress.

6. childhood abuse and trauma.

7. excessive use of health-related websites.

It is necessary to consider these factors when evaluating patients for an illness anxiety disorder.

Diagnosis 

This disorder’s diagnosis is per DSM-5 criteria  for illness anxiety disorder. If a person has health anxiety (or other illness anxiety disorder symptoms) for six months or longer—even after tests show an absence of disease—a medical practitioner may diagnose the person with IAD.

The affected person undergoes physical examinations for substance use or any physical ailment. Based on the results, the primary care provider refers the patient to a mental health professional (MHP) who may review the affected person’s symptoms, stressful life situations, family history of mental health disorders, etc.

The patient may also be requested to fill out psychological self-assessments. The MHP carries out a differential diagnosis of the patient’s both physical and mental health conditions and devises a treatment plan accordingly.

Statistics

Illness anxiety disorder is a mental health condition that affects 0.75-1% of the general population. 25% of patients previously diagnosed with hypochondriasis meet the criteria for IAD. 

It is common in adolescents with no gender preference and worsens with age. It is prevalent among those who are unemployed and have a lower level of education.

The third and fourth decades of life are more susceptible to this condition.

Treatment

 Psychotherapy

Psychotherapy is a popular treatment for illness anxiety disorder, executed via cognitive-behavioural therapy (CBT).

CBT can help ease the stress levels associated with IAD by teaching the person the necessary skills to help manage the disorder. One can avail of CBT individually or in a group.

Pharmacotherapy

If a patient does not respond to psychotherapy, a doctor may recommend medications. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are commonly used for treating illness anxiety disorder.

If a person suffers from a mood or anxiety disorder apart from illness anxiety, they can also use medications to treat the condition. Since some medicines have serious side effects and health risks, one must consult their doctor and review the treatment options thoroughly.

Preventing An Illness Anxiety Disorder

Famous people with an illness, anxiety disorder?

Florence Nightingale, Adolf Hitler, Tennessee Williams, Charles Darwin, and Hans Christian Andersen are some famous personalities who might have suffered illness of anxiety disorder.

Conclusion

An early psychiatric evaluation can enhance the prognosis for those with illness anxiety disorder compared to general medical care alone.

Educating patients can effectively prevent the development or progression of the condition.

By educating patients about the nature of the illness, coping mechanisms, and symptom management strategies, healthcare providers can help patients with illness anxiety disorder achieve favourable outcomes and improved quality of life.

Question 1.

What is the difference between illness anxiety disorder and Munchausen syndrome?

Illness anxiety disorder (IAD) and Munchausen syndrome (MS) are two distinct mental health conditions, although they share some similarities.

Illness anxiety disorder (IAD) is characterized by excessive worry about having a serious illness, despite having no or only mild symptoms. People with Illness anxiety disorder frequently seek medical attention and may engage in excessive health-related behaviours, such as constantly checking their body for signs of illness or avoiding certain activities or foods. However, despite their worries and behaviours, people with Illness anxiety disorder do not intentionally make themselves sick.

On the other hand, Munchausen syndrome is a factitious disorder in which a person intentionally feigns or induces physical or psychological symptoms in themselves to gain attention, sympathy, or medical treatment. People with Munchausen syndrome may make up stories about their symptoms, or even tamper with medical tests or equipment to appear sicker than they actually are.

Some individuals with Munchausen syndrome may spend years travelling from hospital to hospital, faking a wide range of illnesses. When it's discovered they're lying, they may suddenly leave hospital and move to another area.

Someone with Munchausen syndrome can be very manipulative and, in the most serious cases, may undergo painful and sometimes life-threatening surgery, even though they know it's unnecessary.

In summary, while both IAD and MS involve preoccupation with illness, Illness anxiety disorder is characterized by excessive worry and fear about having an illness, while Munchausen syndrome (MS) involves intentionally causing or exaggerating symptoms for personal gain.

Question 2.

Difference between Munchausen syndrome by proxy and Munchausen syndrome

Munchausen syndrome is a mental disorder where an individual pretends to be sick or exaggerates their symptoms for attention and sympathy from others.

Munchausen syndrome by proxy (MSBP) is a form of child abuse where a caregiver, usually a parent, intentionally makes a child or dependent person sick to gain attention and sympathy for themselves. 

The individual with Munchausen syndrome is the one who pretends to be sick, while the individual with MSBP makes another person sick.

Though both disorders involve deliberate deception, they are different in their victims and methods of obtaining attention.

Healthlink BC defines, ‘Munchausen syndrome by proxy (MSBP) as a mental health problem in which a caregiver makes up or causes an illness or injury in a person under his or her care, such as a child, an elderly adult, or a person who has a disability.’

Usually, the caregiver feeds off the sympathy, attention and benefits that are given to them by their community for taking care of a sick or a vulnerable person, mostly their child. This encourages their behaviour, and they continue to make the person believe they are sick, even when they are not. The exploitation could extend to both physical and mental abuse of the victim.

In 2013, American Psychiatrist Association renamed Munchausen Syndrome by Proxy to Factitious Disorder Imposed on Another (FDIA) to more accurately describe a person who is suffering from the condition. However, the disorder is still widely recognised and called by its previous name to date.

Munchausen Syndrome by Proxy on Screen

The Act (2019)

The Act is based on the true story of a mother who makes her daughter believe that she is sick and forces her to go through umpteenth tests and medications. She loved the pity of her neighbours and the financial benefits this brought their way. 

Patricia Arquette is a powerhouse performer who plays the role of the mother suffering from the said condition with all her might. Her performance also earned her the Outstanding Supporting Actress Emmy. Joey King’s portrayal of the daughter is no short of a marvel itself.

Sharp Objects (2018)

Sharp Objects is another well-crafted miniseries by HBO led by Amy Adams and Patricia Clarkson. Amy Adams plays the role of a reporter who visits her hometown to cover a murder. This is when she comes face-to-face with what is going on in her own home.

Her mother had been keeping her younger sister ill, so she would need her mother more to protect her. This also gives rise to the complicated saviour complex. We also learn that their other sister too had been her victim, Munchausen syndrome by proxy or factitious illness imposed on another which led to her early death.

Phantom Thread (2017)

This Oscar runner is rather complicated and does not portray the disorder outright in-your-face, mainly because it does not fall under the usual perpetrator (the mother) and victim (the child) relationship. Daniel Day-Lewis is a fashion designer who falls in love with a waitress, Vicky Krieps, who later turns his muse. Phantom Thread is a slow burn but absolutely satisfying.

What started as a fascinating tale of love soon turns abusive. When Vicky accidentally poisons her husband’s tea with mushrooms, she discovers what it does to him. There was no going back from there! She takes its aid as retribution for his abusive behaviour. You root for her, even though what she is participating in is a completely aware act of Munchausen Syndrome by Proxy. 

It (2017)

In It, the syndrome is the central theme of one of the kids’ lives. Eddie’s mother convinces him that he is gravely sick, which makes him obsessed with taking his medication. He becomes more anxious and scared due to his mother’s constant worry about his health. It turns out that the pills he was taking were just placebos.

The Politician (2019)

In the more recent shows, The Politician also dabbled in the MSBP subplot. Zoey Deutch’s Infinity Jackson is a victim of her grandmother’s disorder. Her grandmother, Dusty, played by Jessica Lange, fakes Infinity’s cancer to get things like free food at Olive Garden and an all-expense-paid trip to Disneyland besides the usual elements of love and appreciation under the guise of attention and sympathy.

(Reference) https://medium.com/@TheWriteCafe/5-recent-tv-shows-movies-on-munchausen-syndrome-by-proxy-cc689a41ac30

Question 3.

What is the difference between illness anxiety disorder and somatic symptom disorder?

While both illness anxiety disorder (IAD) and somatic symptom disorder (SSD) involve excessive worry about physical symptoms or illness, there are some differences between the two conditions.

Illness anxiety disorder (IAD), also known as hypochondriasis, is characterized by persistent fears and worries about having a serious illness, despite little or no evidence of a medical condition. People with IAD may constantly check their bodies for signs of illness, research diseases online, and visit doctors frequently, even though medical tests come back negative.

On the other hand, somatic symptom disorder (SSD) is marked by distressing physical symptoms that may or may not have a clear medical explanation. People with SSD may experience pain, fatigue, abdominal discomfort, headaches, or other physical sensations that significantly impact their daily lives. They may also become overly preoccupied with their symptoms, despite reassurance from medical professionals that nothing is seriously wrong.

In short, while both conditions involve anxiety around health and physical symptoms, illness anxiety disorder (IAD) is more focused on the fear of having an illness, while somatic symptom disorder (SSD) suggest an illness or injury, but cannot be explained medically and is focused on the distress caused by the apparent physical symptom. Both conditions can be debilitating and may require professional treatment.

Question 4.

What triggers illness anxiety?

Illness anxiety, also known as health anxiety or hypochondria, is triggered by a variety of factors.

Here are a few possible triggers:

1. Trauma or past illness - people who have had a traumatic experience with illness or have had a serious illness in the past may be more likely to develop illness anxiety.

2. Family history - some studies suggest that there may be a genetic component to illness anxiety, meaning that people with a family history of anxiety or hypochondria may be more prone to developing it themselves.

3. Stress - Major stress is a common trigger for a variety of mental health conditions, including illness anxiety.  People who are under a lot of stress may be more likely to worry about their health and develop anxiety about it.  Also, a threat of a serious illness can trigger illness anxiety.

4. Media exposure - with the internet and social media, it's easier than ever to read about health scares and outbreaks.  For some people, exposure to this kind of media can trigger anxiety and worry about their own health.

5. Personality factors - some people may be more prone to anxiety in general, which can manifest as illness anxiety.  Additionally, people who are perfectionist or have high levels of anxiety about other aspects of their lives may be more likely to worry about their health as well.

Question 5.

What is the difference between illness anxiety disorder and conversion disorder?

Illness anxiety disorder (IAD) and conversion disorder (CD) are two types of somatic symptom disorders that can be difficult to distinguish from one another. However, there are some key differences between the two.

Illness anxiety disorder (IAD), also known as hypochondriasis, is characterized by excessive worry and fear about having a serious illness, despite little to no evidence of an actual medical condition. Individuals with IAD may constantly check their bodies for signs of illness, seek medical tests and procedures they don’t need, and may experience significant distress or impairment in daily functioning as a result.

Conversion disorder (CD), or functional neurologic symptom disorder, on the other hand, involves physical symptoms that seem to have no organic basis or medical explanation. These symptoms can range from seizures or paralysis to difficulty speaking or swallowing, and they may be triggered by emotional stress.

Conversion disorder begins with some stressor, trauma, or psychological distress and individuals with CD are often unaware of the psychological factors underlying their symptoms and may believe they have a genuine medical condition.

Overall, the main difference between Illness anxiety disorder (IAD) and conversion disorder (CD) is that IAD is characterized by excessive fear of illness, while CD involves actual physical symptoms that can’t be explained by medical tests or procedures. It’s important to note that both disorders can be distressing and disruptive to an individual’s life, and treatment may involve a combination of psychological and medical interventions.

Question 6.

Does illness, anxiety disorder go away?

With proper treatment and support, illness anxiety disorder can be effectively managed and symptoms can be significantly reduced or even eliminated.

Therapies such as cognitive-behavioural therapy (CBT) and exposure therapy can help individuals with illness anxiety disorder learn to cope with strategies to reduce their anxiety. 

Medications may also be prescribed to help manage symptoms.

However, it is important to note that some people may experience ongoing symptoms despite treatment. It is also possible for symptoms to reoccur during times of stress or anxiety. This is why ongoing support and monitoring is important to manage symptoms and maintain overall mental health.

Question 7.

 Illness anxiety disorder and COVID-19 pandemic.

The COVID-19 pandemic has certainly heightened anxiety about illness for many people, including those with hypochondria. For individuals with IAD, the COVID-19 pandemic has likely increased their symptoms, causing them to obsess over the possibility of contracting the virus.

It’s important for such individuals to stay informed and take necessary precautions, but not to engage in compulsive behaviours like constant checking of news or frequent cleaning that may only escalate anxiety. 

It’s also beneficial to seek professional help if you suspect you may have an illness anxiety disorder or if your symptoms have been exacerbated by the pandemic. Therapy and medication can help alleviate symptoms and provide coping strategies for managing anxiety and fears associated with the virus.

Question 8.

Is there a link between Illness anxiety disorder and Obsessive-compulsive disorder.

Illness anxiety disorder and Obsessive-compulsive disorder (OCD) have been found to be linked through a shared feature of excessive worry and anxiety. Individuals with an Obsessive-compulsive disorder often experience obsessive thoughts related to health concerns, leading to compulsions or repetitive behaviours aimed at alleviating these fears.

On the other hand, those with illness anxiety disorder have an excessive preoccupation with the possibility of having a serious illness, leading to persistent worry and anxiety even in the absence of any physical symptoms.

In some cases, individuals with Obsessive-compulsive disorder may also develop an illness anxiety disorder as a secondary concern, adding to their already existing obsessions and compulsions.

Treatment for both disorders may involve therapy, medication, or a combination of both, aimed at reducing anxiety and helping individuals cope with their fears in a healthier way.