AKT · Psychiatry/Personality & otherlow yield

Illness anxiety disorder

Overview

Preoccupation with HAVING or ACQUIRING a serious illness, with high health anxiety, despite minimal or no somatic symptoms and repeated negative investigations (formerly hypochondriasis). Contrast with somatic symptom disorder, where distressing somatic symptoms ARE present.

Recognise

Preoccupation/fear of having a serious disease for ≥6 months
Few or no actual somatic symptoms (or very mild)
Excessive health behaviours (checking, researching) OR maladaptive avoidance of doctors
Not reassured by normal investigations

Red flags

Do not miss genuine organic disease; assess depression/anxiety and suicide risk

Differentials & how to tell them apart

Somatic symptom disorderprominent DISTRESSING somatic symptoms are present — illness anxiety has few/none

Generalised anxiety disorderworry across many domains, not focused on having a disease

Obsessive-compulsive disordercontamination/illness obsessions with compulsions, broader than health

Depressionhealth worry secondary to low mood

Investigations

Clinical; avoid repeated unnecessary investigations that reinforce the anxiety; screen for depression/anxiety.

Management

1CBT for health anxiety; a consistent single clinician; limit unnecessary tests and reassurance-seeking cycles.Gate: Distinguish from somatic symptom disorder (symptoms PRESENT) — illness anxiety has few/no symptoms but intense fear of disease
2SSRI if comorbid depression/anxiety; scheduled review rather than symptom-driven attendance.

SSRI — if significant anxiety/depression

CBT — first-line psychological therapy

Key points

Illness anxiety = fear of disease with FEW symptoms; somatic symptom disorder = real DISTRESSING symptoms with an excessive response. Both are genuine (not feigned).

Monitor & prognosis

Health-anxiety behaviours; mood; attendance pattern.

Chronic-relapsing; improves with CBT.

Source: DSM-5; NICE (common mental health problems)