- You may have illness anxiety if you constantly worry about sickness and check yourself for symptoms.
- With somatic symptom disorder, you'll also have persistent physical health issues you can't explain.
- The most helpful treatments address your physical and mental health symptoms at the same time.
Many people use the word hypochondriac when they think someone is excessively concerned with their health or "imagining" an illness — and until 2013, "hypochondria" was an official mental health diagnosis.
But the term "hypochondriac" is pretty stigmatizing. People diagnosed with this condition tended to face intense negative judgment from friends, family, and doctors. Healthcare professionals who suggested the diagnosis also risked driving away offended patients.
That's one reason why experts removed the diagnosis from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and replaced it with two conditions: illness anxiety disorder and somatic symptom disorder.
These two conditions may not draw the same stigma as hypochondria, but they do come with their fair share of controversy — in part because they're difficult to diagnose accurately.
Here's a rundown on what it means to have illness anxiety or somatic symptom disorder and how to get support.
Illness anxiety disorder
Illness anxiety disorder is fairly rare, affecting about 0.1% of the general population. While "anxiety" is in the name, it's not technically an anxiety disorder — though it does involve intense concern you are, or will become, seriously ill.
The DSM-5 lists six main criteria for illness anxiety:
1. Preoccupation: You constantly worry about your health and whether you potentially have a serious disorder or disease.
2. No physical symptoms: You have no major bodily symptoms — only minor, vague ones, like headaches or itchiness.
3. High anxiety: Anxiety about your health becomes distressing enough to interfere with your quality of life. Even small changes, like a new freckle on your skin, may cause feelings of panic.
4. Checking or avoidance: You may spend a lot of time checking your body for signs of disease and dysfunction. Or, you might develop extreme avoidance behaviors, even skipping doctors' appointments because the thought of bad news frightens you.
5. Time: This anxiety about your health has lasted for at least six months. You might develop concerns about multiple illnesses during this period, but your stress levels remain high overall.
6. Exclusion: Your symptoms can't be better explained by another mental health issue. For example, if you compulsively check your body for signs of flaws rather than disease, you may have body dysmorphic disorder.
According to the DSM-5, illness anxiety often develops as a response to extreme stress or trauma.
For example, if a family member passed away from cancer, you may become hyper-focused on your own cancer risk. This anxiety may prompt frequent visits to the doctor if you notice a mole or a raised patch of skin, or when you feel knots in your stomach, according to Kimberly Parker, therapist and social worker at Healthy Mind Counseling & Nutrition.
Someone else might consider this panic over a minor skin issue excessive. They may even use the term "hypochondriac." Of course, they likely don't realize your worries are fueled by a larger emotional trauma or loss.
Somatic symptom disorder
Somatic symptom disorder resembles illness anxiety, but with this condition you'll also have somatic — aka bodily — symptoms like aches or nausea.
Experts don't agree on how common this condition is in the general population, in part because the criteria are very loose. However, one study found that 74% of people who previously had a hypochondria diagnosis met criteria for this new condition.
The DSM-5's three criteria for somatic symptom disorder include:
- Presence of physical symptoms: Symptoms vary, but the point is they cause significant anxiety. That anxiety, if accompanied by severe stress, can manifest as acne, muscle aches, diarrhea, and other physical symptoms. "The physical symptoms are just as real as those caused by organ disease or structural damage. The only difference is that the symptoms are generated by the brain," says Dr. David Clarke, president of the Psychophysiologic Disorders Association.
- Time: With somatic symptom disorder, your physical symptoms stick around for at least 6 months. The symptoms need to be consistently present and disruptive.
- Disproportionate reaction: You constantly monitor your symptoms and can't control your worries about them. For example, say your heart rate is slightly higher than average at 105 BPM. If you know a normal reading is 60-100 BPM, you might begin to worry about serious conditions like heart disease — even though that tiny increase is more than likely a brief hiccup.
A diagnosis of somatic symptom disorder requires that your fears go above and beyond what an everyday person with similar symptoms would experience, according to Sarah-Nicole Bostan, clinical health psychologist and Director of Behavior Change Strategy at Signos.
To put it simply, if you have a health condition that causes intense pain or majorly impairs your daily life, anxiety about these symptoms likely wouldn't suggest somatic symptom disorder.
Illness anxiety disorder vs. somatic symptom disorder
There's a lot of overlap between these two conditions, but they do have a few key differences:
| Illness anxiety disorder | Somatic symptom disorder |
| Anxiety about potential or future illness | Anxiety about current symptoms |
| No major physical symptoms | Physical symptoms present |
| May visit the doctor very often or avoid the doctor entirely | Tend to visit doctors more often for tests |
Subtypes include: Care-seeking: Frequently visit doctors and seek new tests and treatments Care-avoiding: Avoid medical care due to fear doctors will give them bad news or dismiss their concerns | Subtypes include: Predominant pain: Most somatic symptoms involve pain Persistent: You experience the same physical symptoms for over six months, and they seriously impact your life |
The risk of misdiagnosis
Illness anxiety and somatic symptom disorder can be challenging to diagnose correctly because they have very subjective criteria.
Two clinicians treating the same person could come to opposite conclusions about whether their worries are "appropriate" or "excessive."
Additional controversy around these conditions stems from the fact that healthcare professionals frequently misdiagnose physical health issues — especially chronic illnesses — as mental health conditions.
Women, LGBTQIA+ people, and other people with marginalized identities are even more likely to experience dismissal of their health concerns, aka medical gaslighting.
For example, Black Americans are frequently under-treated for pain due to the false beliefs many healthcare professionals have about race and skin sensitivity. Thus, some doctors may conclude a Black person seeking care has excessive anxiety about their pain and refuse to offer testing or treatment.
COVID-19 plays a role, too
The pandemic has made diagnosis of illness anxiety disorder and somatic symptom disorder even more complicated in several ways.
For one, the pandemic sparked a lot of anxiety worldwide, says Frank Thewes, a licensed clinical social worker at Path Forward Therapy. And because there's such a wide variety of reactions to a potential SARS-COV-2 (COVID-19) infection, clinicians may find it more challenging to determine what counts as "disproportionate" anxiety.
The pandemic has also made getting the right tests to rule out underlying medical issues difficult due to:
- Delays of non-emergency care early in the pandemic
- Widespread staffing shortages at hospitals
- Over-reliance on telehealth when in-person tests are needed
- High healthcare costs
Treatment
Illness anxiety and somatic symptom disorder are mental health conditions that can improve with the right kind of support.
Experts generally recommend a combined approach to treatment, which means you'll receive medical and mental health care at the same time.
Therapy
Mental health care focuses on helping you reduce anxiety, address compulsive behaviors, and get more in tune with your body.
Your therapist may recommend one or a combination of these therapy approaches:
Medical care
A trusted physician, meanwhile, can:
- Monitor ongoing symptoms
- Recommend the most efficient combination of tests to avoid unnecessary expenses
- Help you explore options for symptom relief, like physical therapy or lifestyle changes
- Prescribe antidepressants or anti-anxiety medication, depending on your needs
It's important to find a care team that treats you with respect and empathy.
"A healthcare provider's job is to meet the patient where they are at, not to convince the patient they are 'fine'" Bostan says.
Insider's takeaway
You can't get a hypochondria diagnosis anymore, but you can be diagnosed with illness anxiety disorder or somatic symptom disorder — mental health conditions that involve severe anxiety about your health.
With these conditions, you may obsessively check yourself for signs of disease, or you may become extremely worried about symptoms most people wouldn't notice, such as flushed cheeks or itchy elbows.
Of course, what's considered "excessive" health anxiety is often a matter of opinion. These diagnoses can be controversial, and assessment depends a lot on your individual circumstances.
If you do receive a diagnosis of illness anxiety or somatic symptom disorder, know that treatment can make a difference in your symptoms, whenever you're ready to start.
If you or someone you know is dealing with substance misuse or mental illness, call the Substance Abuse and Mental Health Services Administration's National Helpline (1-800-662-4357) for 24/7, free, confidential treatment referral and information.