Illness anxiety disorder is a preoccupation with having or getting a serious illness, in someone whose physical symptoms are absent or mild. It has existed under that name only since 2013, when hypochondriasis was removed and its territory split in two.
Which half you fall in turns on a question most people would never think to ask themselves, and it changes what treatment is aimed at.
The question that divides the two diagnoses
The dividing question is whether you actually have significant physical symptoms. Both diagnoses describe people whose lives have narrowed around illness, and they part company on whether there is a symptom in the room. [apa-2022-dsm5tr-iad]
Somatic symptom disorder applies where distressing physical symptoms are genuinely present, alongside thoughts, feelings or behaviours about them that are out of proportion. Our guide to somatic symptom disorder covers that side in detail.
Illness anxiety disorder applies where the symptoms are absent or mild, the preoccupation has run for at least six months, and the fear is of being or becoming ill.
The manual’s own estimate is that most people who would previously have been diagnosed with hypochondriasis now fall under somatic symptom disorder. [apa-2022-dsm5tr-iad] Illness anxiety disorder is the smaller category on purpose, because most people worried about their health do have some sensation they are worried about.
A schematic contrast of the two diagnoses as described in this article and in the manual cited. Not measured data.
The second bar is the whole distinction. Everything else the two conditions largely share.
The form nobody notices
Illness anxiety disorder comes in two opposite types, and one of them looks like the absence of a problem. The manual names them care-seeking and care-avoidant, and the second is not a milder version of the first. [apa-2022-dsm5tr-iad]
Care-seeking is the familiar picture: repeated appointments, repeated tests, repeated searching, brief relief and then the doubt returning. Our guide to reassurance seeking covers why the relief is always temporary.
Care-avoidant is the mirror image. The person has not booked an appointment in years, will not discuss health, changes the subject, and would rather not know. From outside it reads as being relaxed about health, or as being bad at admin.
That second form matters more than its share of the diagnosis suggests, because it is the one that delays real diagnoses. Somebody avoiding a doctor out of fear of what will be found is at genuine medical risk, and nobody in their life is treating their behaviour as anxiety.
Which pattern is this?
Tick anything true. This is a reflection prompt rather than a test, and it produces no diagnosis. Physical symptoms still need a doctor.
0 of 8 ticked
The second item is what points at this diagnosis rather than the other one. Items five and six describe the care-avoidant form, which carries a real medical risk on top of the distress and is the one least likely to be recognised. This is treatable, and the treatment has unusually long follow-up behind it.
Checking a symptom and looking something up is what most people do. It becomes worth acting on at the six-month mark, and when the worry has started changing your behaviour rather than just occupying your attention.
Nothing here matched. If the difficulty is distressing physical symptoms that are genuinely there rather than fear of future illness, our guide to somatic symptom disorder covers that instead.
No screener on this site measures health anxiety specifically. The free anxiety screener uses the GAD-7, which measures general anxiety over the past two weeks. It is a reasonable starting point rather than a match, and it is worth saying so. Two minutes, nothing sent anywhere.
What treatment involves, and what it is not
Treatment targets the response to the fear rather than trying to argue you out of the fear. A UK trial randomised medical outpatients with high health anxiety to five to ten sessions of cognitive behavioural therapy or to standard care, and the therapy group improved more on health anxiety with the difference still present five years later. [tyrer-2014-champ]
Five-year follow-up is unusual, and it is the detail worth carrying into an appointment: this is not a treatment whose effect fades the month after it stops.
What the work involves in practice is dropping the checking, the searching and the reassurance-seeking, and finding out what happens to the anxiety when it is not being fed. That is uncomfortable and it is the mechanism. Our guide to CBT for health anxiety sets out what the sessions actually look like.
A diagnosis here does not mean your symptoms are imaginary or that you will not get ill. Neither of these conditions protects anybody from disease, and neither is a reason for a clinician to stop investigating something new. That is worth stating because the fear of being written off is often what stops people raising it.
When to seek help
See a doctor if you have been preoccupied with illness for six months or more, if reassurance stops working almost immediately, if you are searching or checking your body regularly, or if the worry has changed how you live.
Book an appointment too if you recognise the avoidant side of this: years without a check-up, or a symptom you have not mentioned to anybody because you would rather not find out. That is the version with a medical risk attached, not just a psychological one.
Some talking therapy services take a referral you make yourself, so it is worth asking rather than waiting for one, and it is worth saying that the anxiety is specifically about health, since that points at a different piece of work than general anxiety does.
Go urgently if you have thoughts of harming yourself.
How MyFreud can help
The pattern here is hard to see from inside, because each search and each appointment feels individually reasonable. MyFreud gives you daily mood tracking that takes seconds, which turns a run of separately justified worries into something with a shape you can show a clinician.
Download MyFreud and start today: App Store or Google Play.