US Pharm. 2020;45(5):13-14.
Illness anxiety disorder (IAD), formerly known as hypochondriasis, or commonly as hypochondria, is a complex psychiatric disorder categorized as a somatic symptom disorder. People with IAD have a preoccupation with having or acquiring a serious, undiagnosed medical condition though they have few or no symptoms. Those with IAD may visit the doctor and receive testing. Even if no illnesses are found, they are not reassured and continue to worry. Many healthy people and those without major psychiatric disorders have periodic and unfounded worries about their health and becoming ill. However, those with IAD can have symptoms that disrupt normal daily functioning and overall quality of life.
A Preoccupation With Illness
IAD is equally prevalent among men and women. Although there are studies indicating a higher prevalence in women, those numbers may be inaccurate because under normal circumstances, women tend to seek medical attention more frequently than do men. IAD can begin at any age. The most common age of onset is young adulthood. The preoccupation with a specific disease or illness seems to be episodic, with periods of increased anxiety around disease for months or years and equal periods with an absence of symptoms.
The first goal of diagnosis is to identify and treat nonpsychiatric medical conditions that may be present and that account for the physical symptoms. After it is clear that the concern about serious medical illness is excessive, the following criteria are used to identify a person with IAD:
• Preoccupations with having or acquiring a serious illness
• Physical symptoms are not present or are only mild. If another medical condition exists or if there is a high risk of developing a medical condition, the preoccupations are clearly excessive or disproportionate
• A high level of anxiety about health, and easily alarmed about personal health status
• Excessive health-related behaviors (frequent medical test or visits to the doctor) or healthcare avoidance (e.g., avoiding doctor appointments or the hospital)
• This has been occurring for at least 6 months
• The preoccupation isn’t better explained by another psychological disorder (e.g., panic disorder, generalized anxiety disorder)
Exposure to Serious Illness Increases Risk
Some life circumstances can increase the risk that a person will become overly preoccupied with serious illnesses. Some studies suggest that IAD has an increased prevalence in families, especially among identical twins, and parents and children, although a genetic marker has not been identified. Exposure to severe or life-threatening medical conditions oneself or through close friends and family may play a role in the development of IAD.
Individuals with somatic symptom disorders like IAD often have other psychological disorders as well. Most commonly, generalized anxiety, depression, and sometimes obsessive-compulsive disorder are experienced in conjunction with IAD. Successful management begins with a strong team approach between a physician, a psychologist, and the patient. A relationship with a supportive and understanding primary care physician can be reassuring while the patient seeks other treatments.
Randomized trials suggest that cognitive-behavioral therapy (CBT) is effective for the treatment of IAD. Patient adherence to CBT and medication is essential for a positive outcome and relief from symptoms. A healthy diet, physical movement, and plenty of sleep will also help to reduce anxiety and related symptoms. The overall goal of IAD management is to enable the individual to function normally in daily activities like work and child care, to ease mental distress, and to reduce doctor visits.
Medication Is Used to Manage Comorbid Conditions
Prescription medication is sometimes used to complement psychological therapy. There are no drugs specifically approved by the FDA for the treatment of IAD. Pharmacologic treatment is mainly used to manage comorbid conditions of depression and anxiety. Antidepressants, such as selective serotonin reuptake inhibitors, are the class most commonly prescribed. Treatment begins at a low dose, and the dose increases to find the lowest effective dose.
With understanding, support, and adherence to therapy and medication, the prognosis for individuals with IAD is good.
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