Hypochondria (illness anxiety disorder) and somatic symptom disorder

For many who suffer from illness anxiety disorder (often colloquially referred to as ‘hypochondria’) and somatic symptom disorder, everyday life can be fraught with fear, concern and significant distress. While the term “hypochondria” is frequently used as a lighthearted jest or a critique for those grappling with these disorders, the challenges are very real, with profound implications on daily life. It is essential to understand that these conditions are not merely a result of “overthinking” or “seeking attention”. They have genuine psychological roots and can be incredibly debilitating.

UKAT London Clinic understands that compassion and knowledge are pivotal in approaching and supporting individuals with these disorders, both for the sufferers and those around them.

Understanding illness anxiety disorder and somatic symptom disorder

Illness anxiety disorder (IAD) and somatic symptom disorder (SSD) are both classified under the umbrella of somatic symptoms and related disorders. “Somatic” refers to the body, so these disorders involve physical symptoms that may or may not have a clear medical explanation but still result in significant distress. While they share some similarities, each presents distinct challenges and characteristics.

Illness anxiety disorder

Previously referred to as hypochondriasis, illness anxiety disorder is characterised by an intense preoccupation or anxiety about having a serious illness despite having minimal or no symptoms. These individuals are often apprehensive about their health; even the smallest physical sensations can be perceived as signs of a severe illness.

Illness anxiety disorder/hypochondriasis symptoms

Persistent fears or beliefs that one has a serious disease.
High sensitivity and attention to bodily sensations or minor physical abnormalities.
Frequent medical check-ups or, conversely, a fear of medical appointments and tests.
Misinterpretation of normal bodily functions (like a heartbeat) or minor ailments (like a common cold) as something more serious.
Seeking frequent reassurance about health status.
Even when tests come back negative or when reassured by professionals, the anxiety remains or shifts to another health concern.

Somatic symptom disorder (SSD)

In somatic symptom disorder, the individual experiences real physical symptoms, but the focus and anxiety are disproportionately high relative to the actual symptoms. It is not so much the existence but the interpretation and reaction to the symptoms that characterise SSD.

Somatic symptom disorder symptoms

Real physical symptoms that cause significant distress and impairment.
Excessive anxiety related to the physical symptoms.
The symptoms may not have a clear medical explanation, or if there’s a medical condition present, the reaction to it is excessively intense or prolonged.
Symptoms may be pain, fatigue or any other bodily sensation.
While the symptoms can vary in intensity, they are persistently present for at least six months.

Causes and risk factors

While the exact causes of hypochondria and somatic symptom disorder are not completely understood, researchers and clinicians believe they result from a combination of physical, psychological and environmental factors. Exploring these can provide a more comprehensive picture of what might lead someone to develop these disorders.

Factors	Causes
Physical factors	Neurobiological differences: Some research suggests that people with IAD or SSD may have differences in the areas of the brain responsible for processing fear, anxiety and interpreting bodily sensations. Genetic predisposition: There could be a genetic component, as these disorders tend to be more common in people with close relatives with similar conditions or other anxiety disorders.
Psychological factors	Personality traits: Individuals who tend to be negative, pessimistic or have a low tolerance for uncertainty may be at a higher risk. Previous trauma or significant stress: Events such as serious illness, death of a loved one or major life changes can trigger or exacerbate these disorders. Childhood trauma, including abuse, can also significantly predispose someone to SSD or IAD. Learned behaviour: Growing up in a family where health concerns and illnesses are frequently discussed, or family members react strongly to minor health issues might make someone more prone to developing these disorders.
Environmental factors	Past negative medical experiences: Having experienced severe or life-threatening illnesses, especially during childhood, or having undergone extensive medical procedures can contribute to heightened health anxiety later in life. Cultural factors: Cultural background and societal influences can impact how one perceives and responds to physical symptoms. In some cultures, expressing distress through physical symptoms might be more acceptable than discussing emotional or psychological distress. Information overload: With the vast amount of health information available online, it’s easy to fall into the trap of “cyberchondria,” where frequent online searches about health concerns can exacerbate anxiety about potential illnesses.

Factors

Causes

Physical factors

Neurobiological differences: Some research suggests that people with IAD or SSD may have differences in the areas of the brain responsible for processing fear, anxiety and interpreting bodily sensations.

Genetic predisposition: There could be a genetic component, as these disorders tend to be more common in people with close relatives with similar conditions or other anxiety disorders.

Psychological factors

Personality traits: Individuals who tend to be negative, pessimistic or have a low tolerance for uncertainty may be at a higher risk.

Previous trauma or significant stress: Events such as serious illness, death of a loved one or major life changes can trigger or exacerbate these disorders. Childhood trauma, including abuse, can also significantly predispose someone to SSD or IAD.

Learned behaviour: Growing up in a family where health concerns and illnesses are frequently discussed, or family members react strongly to minor health issues might make someone more prone to developing these disorders.

Environmental factors

Past negative medical experiences: Having experienced severe or life-threatening illnesses, especially during childhood, or having undergone extensive medical procedures can contribute to heightened health anxiety later in life.

Cultural factors: Cultural background and societal influences can impact how one perceives and responds to physical symptoms. In some cultures, expressing distress through physical symptoms might be more acceptable than discussing emotional or psychological distress.

Information overload: With the vast amount of health information available online, it’s easy to fall into the trap of “cyberchondria,” where frequent online searches about health concerns can exacerbate anxiety about potential illnesses.

Diagnosing illness anxiety disorder and somatic symptom disorder

Diagnosing IAD and SSD is a nuanced process which requires differentiating between the two disorders and other potential medical conditions. Here is a comprehensive look at the diagnostic criteria and process for both:

Clinical assessment

The first step in diagnosis is always a comprehensive clinic assessment by medical professionals. This often includes:

Medical history review: This helps to determine if any medical conditions could explain the symptoms. It also provides context for patterns in the patient’s concerns about their health.
Physical examination: Before arriving at a diagnosis of IAD or SSD, it is essential to rule out any underlying medical conditions. A physical examination can help to identify or eliminate potential causes.
Interview: A structured or semi-structured interview allows clinicians to understand the depth and nature of a person’s health anxieties and somatic symptoms. This can provide insights into these concerns’ duration, intensity and impact on the individual’s daily life.

DSM-5 criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), is a comprehensive classification of mental health disorders used by healthcare professionals. It gives diagnosis clinicians a distinct set of criteria to identify.

Hypochondriasis criteria

A preoccupation with fears of having or acquiring a serious illness.
Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk of developing a medical condition, the preoccupation is clearly excessive or disproportionate.
A high level of anxiety about health and easily alarmed about personal health status.
The individual performs excessive health-related behaviours or exhibits maladaptive avoidance.
Illness preoccupation has been present for at least six months but the specific illness feared may change over that period of time.
The illness-related preoccupation is not better explained by another mental disorder.

Somatic symptom disorder criteria

One or more somatic symptoms that are distressing or result in significant disruption of daily life.

Excessive thoughts, feelings or behaviours related to somatic symptoms or health concerns, manifested by at least one of the following:

Disproportionate and persistent thoughts about the seriousness of one’s symptoms.

Persistently high level of anxiety about health or symptoms.

Excessive time and energy devoted to symptoms or health concerns.

Although any one somatic symptom might not be continuously present, the state of being symptomatic is persistent (typically more than six months).

Psychological evaluations

Standardised psychological questionnaires or evaluations can also be employed to assess the intensity and nature of health-related fears, beliefs and behaviours.

Differential diagnosis

It’s essential to differentiate IAD and SSD from other conditions with similar symptoms. These include other anxiety disorders, depression and conditions like body dysmorphic disorder. Determining the primary concern (e.g., health anxiety versus appearance concerns in body dysmorphic disorder) can help arrive at the correct diagnosis.

Multidisciplinary approach

Given the intertwining of physical and psychological symptoms, primary care providers usually collaborate with psychiatrists and therapists for a comprehensive understanding and holistic treatment plan.

Effective treatment for IAD and SSD

UKAT London Clinic understands that the complexities and individual variances of IAD and SSD mean no “one-size-fits-all” solution exists. Instead, treatment programmes should be tailored to each individual’s unique needs, understanding that these are real, distressing concerns that profoundly impact daily life.

Here is an overview of various treatment strategies:

Therapy

Therapy is an essential pillar in treating IAD and SSD, providing individuals with coping tools and strategies. Effective therapeutic modalities include:

Cognitive-behavioural therapy (CBT): CBT is a primary therapeutic approach for both IAD and SSD. It focuses on identifying and challenging irrational beliefs and thoughts about illness, teaching coping strategies and developing healthier behaviours related to health concerns.

Exposure therapy: This form of therapy, often a component of CBT, exposes patients to their health fears in a controlled setting, helping them confront and reduce their anxiety.

Holistic therapies: Mindfulness therapy, meditation, yoga therapy, and other holistic approaches can help reduce the anxiety associated with health concerns and foster an overall healthier, happier outlook.

Medication

Medications can play a role in managing the symptoms and emotional distress associated with IAD/hypochondria and SSD.

Antidepressants: SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) may be prescribed to help alleviate symptoms of anxiety and depression that can accompany these disorders.

Anti-anxiety medications: In some cases, benzodiazepines or buspirone might be used temporarily to manage severe anxiety. However, they are typically not the first line of treatment due to concerns about dependency and potential side effects.

Beta-blockers: These can sometimes be used to treat the physical symptoms of anxiety, such as heart palpitations.

Mental health support

UKAT London Clinic provides all our clients with comprehensive mental health support to give them confidence and reassurance during difficult moments in recovery.

Education

Knowledge is empowerment, and educating individuals about their condition, the nature of health anxiety and the mind-body connection can help alleviate fears and misconceptions.

Stress reduction techniques

Chronic stress can exacerbate symptoms, but techniques such as art, exercise and journaling can be beneficial in managing stress.

Lifestyle considerations

Limiting health-related media: Reducing exposure to medical television programmes, websites or news that can trigger or worsen health anxieties.

Healthy sleep, diet and exercise: Establishing a routine that prioritises physical health can sometimes alleviate some of the concerns related to perceived illnesses.

Collaboration with primary care providers

Regular check-ups with trusted healthcare providers can reassure individuals and ensure any genuine health concerns are addressed.

Integrative and complementary therapies

Approaches such as acupuncture, massage therapy or herbal supplements can also be beneficial.

Begin the journey to well-being today

If you or a loved one are grappling with IAD or SSD, it is crucial to understand that you are not alone. With the right support in place, you can learn to navigate your anxieties and symptoms, leading to a more balanced and fulfilling life. UKAT London Clinic offers compassionate, bespoke treatments by our world-leading experts. Embarking on a journey towards healing begins with one step, and our dedicated team is here to guide and support you every step of the way. Contact UKAT London Clinic today to explore the best treatment options tailored to your unique needs.

Frequently asked questions

How common is somatic symptom disorder?

Somatic symptom disorder is relatively uncommon, with prevalence rates varying across different populations and studies. Estimates suggest that about 5-7% of the general population may experience SSD at some point. However, the prevalence can be higher in medical settings, as individuals with the disorder often seek medical care for their symptoms.

Is somatic symptom disorder a disability?

Somatic symptom disorder can significantly impact an individual’s daily functioning and quality of life. While it may not be classified as a disability in all contexts, the distress and impairment caused by the disorder can be disabling for some individuals.

Is hypochondria an anxiety disorder?

Yes, what was historically referred to as “hypochondria” is now classified under the DSM-5 as “illness anxiety disorder”. It is an anxiety disorder where individuals are excessively worried about having a serious illness despite having few or no symptoms and, after medical exams, showing no sign of a condition.

Works cited

(Click here to see works cited)

D’Souza, Ryan S., and W. M. Hooten. “Somatic Syndrome Disorders – StatPearls.” NCBI, 13 March 2023, https://www.ncbi.nlm.nih.gov/books/NBK532253/. Accessed 13 October 2023.
French, Jennifer H., and Sajid Hameed. “Illness Anxiety Disorder – StatPearls.” NCBI, 16 July 2023, https://www.ncbi.nlm.nih.gov/books/NBK554399/. Accessed 13 October 2023.
PsychDB. “Somatic Symptom Disorder.” PsychDB, 11 July 2023, https://www.psychdb.com/somatic/dsm-5/somatic-symptom. Accessed 13 October 2023.