The vast array of health-related information available online and the numerous discussions surrounding COVID-19 could increase the likelihood of developing a health anxiety disorder, but it is important to note that a health anxiety diagnosis does not preclude the existence of a real medical condition, says a psychotherapist from global health system Cleveland Clinic.
“In many ways, COVID-19 is the perfect storm for developing a health anxiety disorder. I have seen many patients present with increased health anxiety over the course of the pandemic,” says Natacha Duke, MA, RP. “Similarly, many health-anxious people are turning to the internet to reduce their anxieties, but instead, they’re making the situation much worse.”
Duke adds professional views on health anxiety disorders have evolved over time, particularly over the past decade. “Previously, a diagnosis of a health anxiety disorder was often reserved for those who did not have a medical condition. Now, however, being told you have health anxiety no longer discounts the possibility that you may also have a medical condition.”
Duke explains there are two distinct types of health anxiety disorder recognized in the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), which is widely used by professionals in across the world to diagnose mental health disorders. “The first type is somatic symptom disorder and the second is illness anxiety disorder, both of which were previous lumped together under the term ‘hyperchondriasis’,” she says.
Both conditions involve excessively worrying about one’s health despite reassurance from medical experts, but there is an important difference, Duke says. While someone with somatic symptom disorder experiences physical symptoms, which may or may not be due to a medical condition, someone with illness anxiety disorder would be worried about their health in the absence of physical symptoms.
“There’s usually a part of the individual that knows their worrying is out of proportion and another part that can’t tolerate any uncertainty when it comes to their health,” she notes.
The two health anxiety disorders can occur at all stages of life, but usually begin by 30, and they affect approximately 5% to 7% of adults, Duke says, adding that there is a higher prevalence among women.
Duke says that in addition to the proliferation of health-related information online and the focus on health issues inspired by COVID, a common contributory factor to developing health anxiety is a past negative experience, such as having had a serious illness as a child or witnessing a family member go through a prolonged or serious illness.
Diagnosis, symptoms and treatment
Commenting on how to distinguish between a health anxiety disorder and a general concern for one’s health, Duke says, “We all have different personalities and some of us are always going to be more anxious than others. However, anxiety becomes a problem when it interferes in someone’s functioning.”
Duke adds that in order to be diagnosed, significant symptoms must have been present for six months or longer. In the case of somatic symptom disorder, these symptoms could include one or more persistent physical symptoms that cause distress and interfere with functioning; and excessive anxiety about health and symptoms or excessive time spent thinking of symptoms or seeking medical care.
In the case of illness anxiety disorder there is a lack of physical symptoms or mild symptoms along with signs such as a preoccupation about getting or having an illness; anxiety that’s disproportionate to symptoms or risk of illness; hypervigilance about health and repeated checking for symptoms; and avoidance of medical care due to anxiety or frequently seeking medical care, despite repeated reassurance.
“Often, those who have a health anxiety disorder have disrupted their lives with the time and money spent chasing a health concern,” Duke says. “The main goal of treatment in a health anxiety disorder, therefore, is to increase the individual’s quality of life.”
Duke says that if patients present with health anxiety, she will always insist they seek a medical evaluation first. “If their doctor has ruled out a physical cause and we’re confident that this is illness anxiety, they will likely benefit from treatments such as psychotherapy and mindfulness. However, in cases of somatic symptom disorder, where there are physical symptoms present, it’s important that the treatment plan includes both medical and mental health treatment.”
