Illness Anxiety Disorder & Somatic Symptom Disorder*

  • Redefined in DSM-V, as previously termed Hypochondriasis. 
  • Illness Anxiety Disorder (IAD) is differentiated from Somatic Symptom Disorder (SSD) in that IAD emphasizes a cycle of worry and reassurance seeking regarding health, rather than complaining of somatic symptoms.
  • Differential diagnosis includes medical diagnoses and mental health diagnoses.
  • Children with the diagnosis of IAD will likely continue into adolescence.
IAD is characterized by:
  • Fear that typical bodily sensations (e.g., sounds of digestion, sweating, or a skin mark) are signs of life-threatening disease
  • Heightened awareness of bodily sensations that trigger anxiety about a potential undiagnosed illness
  • Fixation on a particular body system
  • Spending significant amounts of time researching their health concerns;  reassurance from medical providers often provides minimal comfort
  • Agreement that fears are exaggerated, with difficulty accepting no organic etiology; frequently "doctor shop," moving from one provider to the next in the search of a provider who can confirm the suspected illness
DSM-V Criteria:
  • A. Excessive worry about having or developing a debilitating or life-threatening illness.
    B. Somatic symptoms are absent. If somatic symptoms are present, they are only mildly distressing to the patient. If a medical condition is present or a high-risk for developing a medical condition is present (due to family history), the anxiety regarding the medical condition (or potential impending medical condition) is excessive.
    C. Excessive concern and anxiety regarding health-related issues. 
    D. The individual exhibits disproportionate and redundant health-related behaviors, such as
    repeatedly checking his or her body for indications of disease.
    E. Symptoms have been present for at least 6 months
    F. The illness-related preoccupation is not better explained by another psychiatric condition
  • Specifiers:
    -Care-seeking type: Medical care, including physician visits or undergoing tests and procedures, is over-utilized.
    -Care-avoidant type: Medical care is rarely used or avoided.
  • Patients may fluctuate between the two specifiers.​
Treatment:
Treatment is usually similar to treatment for anxiety: cognitive behavior therapy (CBT) and medications such as SSRIs.

Assessment & Screening

There are no validated screening tools for IAD, but anxiety screening tools and obsessive-compulsive screening tools should be used to aid diagnosis. 
  • The Childhood Illness Attitude Scales (CIAS) is a research measure created by Wright & Asmundsen (2003) to measure symptoms of health anxiety in school-aged children; this scale is not widely used.

​Position Papers, Practice Parameters & Treatment Guidelines

  • None specific to Illness Anxiety Disorder

Articles

  • Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment (Scarella, Boland & Barsky, 2019)
  • Pediatric Somatic Symptom Disorders (Malas, Ortiz-Aguayo, Giles & Ibeziako, 2017)

Resources for Families

  • Quick Facts on Illness Anxiety Disorder
*Content originally curated by Sarah Bascand, RN, MSN.