What to Do When Your Patient Has Illness Anxiety Disorder

You needn’t be a digital native to appreciate the wonders of the internet. You’ve undoubtedly had plenty of patients who Googled their symptoms before an appointment. But the ubiquity of health advice (much of which may be outdated, misleading, or just plain wrong) can be especially worrisome for people with an illness anxiety disorder (IAD).

When Your Patient Has IAD

“Illness anxiety disorder is a mental health condition where individuals become excessively worried about having or developing a severe illness despite minimal or no physical symptoms and reassurance from medical professionals,” said Pamela Tambini, MD, a double board–certified physician in internal medicine and addiction medicine and medical director at Southeast Detox in Rome, Georgia.

“People with IAD often misinterpret normal bodily sensations — like a slight ache or a stomach rumble — as signs of a life-threatening condition. While the worry may be both genuine and distressing, it’s not based on objective medical evidence yet can disrupt the person’s mental health, relationships, work, and daily life.”

Common IAD Symptoms Your Patients Can Display

• Constant worry about health, even when medical evaluations show no serious illness
• Frequent self-checking, such as examining moles, monitoring heart rate, or looking for lumps
• Seeking reassurance from doctors, family, or the internet (often repeatedly)
• Avoiding medical care out of fear of receiving bad news
• Distress caused by health-related news or stories that trigger fears of illness
• Difficulty focusing on daily tasks due to preoccupation with health concerns

Symptoms can range from mild to severe and may persist for months or even years if untreated, Tambini told Medscape Medical News.

You may also notice that a patient’s chart reflects a lot of care-seeking without corresponding diagnoses. IAD is a diagnosis of exclusion, and doctors must ensure that there isn’t an underlying cause for the patient’s symptoms before diagnosing IAD, said Jeffrey A. Linder, MD, MPH, chief of general internal medicine at Northwestern Medicine in Chicago.

“You have to differentiate it from other medical conditions like inflammatory conditions that cause very general symptoms or psychiatric conditions like anxiety and depression,” said Linder. (Note, too, that IAD often overlaps with other mental health conditions such as generalized anxiety disorder or depression.) 

Studies show that IAD affects about 1%-5% of the population, though those numbers may be higher in medical settings where patients frequently seek reassurance about their health. Tambini has treated many patients with health anxiety, including those who are managing chronic conditions and those who have experienced serious health scares in the past. “IAD can affect anyone, but I’ve noticed it’s particularly common in young to middle-aged adults, possibly because they’re more likely to search online for symptoms and misinterpret harmless sensations as serious illnesses,” she added.

Treating a Patient With IAD

Treating IAD often involves a twofold approach — addressing the root causes of anxiety and helping patients build healthier thought patterns and behaviors. Building a strong doctor-patient relationship can build trust and reduce the need for frequent or unscheduled visits. When patients know they’ll be able to talk about their concerns, their anxiety often decreases. “Validation is key,” said Tambini. “Patients need to feel their fears are acknowledged, even when their symptoms don’t point to a serious condition.”

Educating and reassuring patients about symptoms and test results can help alleviate fears.

For example, Tambini had a patient who was hyper-focused on a mole being skin cancer, despite several dermatologists confirming it was benign. “I validated the patient’s concern by explaining doctors’ specific criteria to evaluate moles, such as symmetry and border changes. I then advised against frequent self-checking, as it was feeding their anxiety, and reassured them that annual skin checks with a dermatologist were sufficient,” said Tambini. “Over time, this approach helped the patient trust their evaluations and shift their focus away from the mole.”

Cognitive-behavioral therapy (CBT) is an effective treatment of IAD that helps identify and challenge unhelpful thoughts, such as, “This headache must be a brain tumor,” and develop healthier coping strategies. Encouraging patients to avoid “health-checking” behaviors (like repeatedly scouring the internet for information about symptoms) can also help reduce anxiety. Patients may also benefit from stress management strategies like mindfulness, meditation, and breathing exercises.

A Fine Line When It Comes to Testing

Doctors should avoid over-testing, said Linder, and be aware of the potential of medical overuse. “As doctors, we can never offer someone the guarantee [that they’re perfectly healthy] that they’re looking for,” said Linder. Be cognizant of the inconvenience, expense, and additional anxiety as well as danger, that providing unnecessary medical care and testing can lead to for patients with IAD. For example, patients who request frequent CT scans are exposing themselves to radiation that can increase their cancer risk. “Patients may not appreciate the dangers of medical investigation,” said Linder. However, as a physician, you must be willing to draw the (reasonable) diagnostic line.

Keeping Your Patients Engaged

It can be frustrating to treat people with IAD, especially if they reject the idea that their symptoms or worries are unfounded. But don’t give up on these patients. “There can be some patients who reject the idea that there’s not something organically wrong with them, and they are going to be dissatisfied and get upset,” said Linder. “Try to keep those patients engaged. Give them the sense that you’re taking them seriously. Some are open to the idea that they might have IAD; some may be open to the idea that there is a connection between their brain and their body.”

You can then overtly broach the topic of IAD with your patient and suggest that they might benefit from psychological, psychiatric, or CBT. “That can help the person reframe what they’re experiencing,” Linder said. “Instead of thinking, ‘my body is broken,’ thinking about their symptoms in a different way has shown to have some benefit for IAD.”

“I worked with a patient who was convinced their recurring headaches were due to a brain tumor,” said Tambini. “After appropriate evaluations ruled out serious causes, I reassured them of their health and referred them to a therapist specializing in CBT. Over time, their worry lessened, and they began focusing on activities they enjoyed instead of constantly monitoring their body.”

As a doctor, “avoid the temptation to be dismissive when something doesn’t fit your biological model of symptoms,” said Linder. Focusing on the doctor-patient relationship and listening closely to your patients’ concerns can help you work with them to identify appropriate treatment strategies that will help them address their IAD.

IAD is an often misunderstood condition, but it’s treatable, added Tambini. “With a combination of supportive medical care, therapy, and sometimes medication, patients can learn to manage their [health] worries and live fulfilling lives” — even becoming ideal patients.

Kelly K. James is a freelancer, content manager, and author of The Book That (Almost) Got Me Fired: How I (Barely) Survived a Year in Corporate America. She covers health/wellness, business/career, and psychology topics from her home in the Chicago suburbs.