Illness Anxiety Disorder

By: Florence Dominique T. Ramirez

 What is Illness Anxiety Disorder?
● It's a new diagnosis in the DSM-5 that applies to those persons who are
preoccupied with being sick or with developing a disease of some kind.
● Physical symptoms are either not experienced at the present time or are
very mild, but severe anxiety is focused on the possibility of having or
developing a serious disease
● The disorder is not about the presence or absence of illness, but the
psychological reaction
● Formerly known as “hypochondriasis” under the DSM-IV-TR
 1. Preoccupation with having or acquiring a serious illness.
2. 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 for
developing a medical condition (e.g., strong family history is present), the
Criteria preoccupation is clearly excessive or disproportionate.

for
3. There is a high level of anxiety about health, and the individual is easily
alarmed about personal health status.

Illness
4. The individual performs excessive health-related behaviors (e.g.,
repeatedly checks his or her body for signs of illness) or exhibits

Anxiety 5.
maladaptive avoidance (e.g., avoids doctor appointments and hospitals).
Illness preoccupation has been present for at least 6 months, but the

Disorder 6.
specific illness that is feared may change over that period of time.
The illness-related preoccupation is not better explained by another
mental disorder, such as somatic symptom disorder, panic disorder,
generalized anxiety disorder, body dysmorphic disorder, obsessive-
compulsive disorder, or delusional disorder, somatic type.
 Illness Anxiety Disorder

● Prevalence: Similar to male and females

● Development and course are unclear.
● Generally thought to be chronic and relapsing condition.
● Age of onset: Early and middle adulthood.
● Comorbidity: Exact comorbidities are unknown. Approximately two-thirds
of individuals with illness anxiety are likely to have at least one other
comorbid major mental disorder
 Biological Perspective
Neurotransmitters
● Somatic symptom disorders run in
families and that there is a - Antidepressants, such as
modest genetic contribution selective serotonin reuptake
● But this contribution may be inhibitors (SSRIs), may help
nonspecific, such as a tendency to treat illness anxiety disorder.
over respond to stress, and thus
may be indistinguishable from the
nonspecific genetic contribution
to anxiety disorders.
Biological Perspective

1. Reduced functional connectivity

between the left extrastriate body area
(EBA) and the paracentral lobule
- Reduced connectivity might reflect a
deficit in multisensory integration
between visual and somatosensory
information
 Biological Perspective

2. Strong functional connectivity

between the right EBA, the right
amygdala, and the right
hippocampus.
- The enhanced FC of these areas
with EBA in individuals with
higher illness anxiety levels could
be related to a deficit in emotion
regulation, with more intense
fear/anxiety signals related to
self-body signals
 Biological Perspective
3. Higher functional
connectivity between
right hippocampus and
nucleus accumbens
bilaterally
- Hyperconnectivity
between these regions,
could be related to a
sharpened awareness
of self-body signals
 Biological Perspective
4. Higher functional connectivity
between left anterior cingulate
cortex (ACC) and orbitofrontal
cortex (OFC)
- The increased connectivity
between ACC and OFC related to
might reflect the same
hyperactivation between these
regions found in inpatients with
anxiety disorders, characterized by
recurrent and intrusive anxiety-
related thoughts

● IAD patients' attention is strongly focalized on the body, and this might lead
patients to misinterpret bodily signs as symptoms, with consequent high
anxiety levels
Integrative model of causes of hypochondriasis. (Based on Warwick, H. M., & Salkovskis, P. M. [1990].
Hypochondriasis. Behavior Research Therapy, 28, 105–117.)
 Cognitive Perspective

● This disorder is basically a disorder of cognition or perception with strong

emotional contributions
● Individuals who have illness anxiety disorder show enhanced perceptual
sensitivity to illness cues which leads to them misinterpreting these cues
as indicative of a serious illness or disease.
● They have a restrictive concept of health as being symptom-free
 Psychological Factors
Learned Behavior
● It is possible that some individuals who
develop somatic symptom disorder or
illness anxiety disorder have learned
from family members to focus their
anxiety on specific physical conditions
and illness.
Other factors
1. This disorder seem to develop in the
context of a stressful life event.
2. People who develop this disorder tend
to have had a disproportionate
incidence of disease in their family
when they were children.
3. Personal rewards.
 Psychodynamic Perspective
● Aggressive and hostile wishes toward others are transferred into minor
physical complaints or the fear of physical illness.
● The fear of illness is also viewed as a defense against guilt, a sense of innate
badness, an expression of low self-esteem, and a sign of excessive self-
concern.
● The feared illness may also be seen as punishment for past either real or
imaginary wrongdoing.
● The nature of the person’s relationships to significant others in his or her past
life may also be significant.
● Unconscious conflict
References:
Barlow, D. H., & Durand, V. M. (2012). Abnormal psychology: An integrative approach. Cengage Learning.

Diagnostic and statistical manual of mental disorders: DSM-5. (2013). American Psychiatric Publishing.

Grossi, D., Longarzo, M., Quarantelli, M., Salvatore, E., Cavaliere, C., De Luca, P., Trojano, L., & Aiello, M. (2017). Altered
functional connectivity of interoception in illness anxiety disorder. Cortex, 86, 22-32.
https://doi.org/10.1016/j.cortex.2016.10.018

Harvard Health Publishing. (2020, June 17). Illness anxiety disorder. Harvard Health.
https://www.health.harvard.edu/a_to_z/illness-anxiety-disorder-a-to-z

Hooley, J. M., Butcher, J. N., Nock, M. K., & Mineka, S. (2013). Abnormal Psychology (17th ed.).

Kring, A. M., Johnson, S., & Davison, G. C. (2013). Abnormal psychology DSM-5 update (12th ed.). Wiley Global Education.

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. Wolters Kluwer
Health.
Somatic Symptom
Disorder
Somatic Symptom Disorder
• Formerly called “Somatoform Disorder”

• Defined by having excessive concerns on physical symptoms or

health that has no medical cause.

• The main diagnosis for this disorder is the presence of positive

signs and symptoms rather than the absence of a medical
explanation for somatic symptom.

• Individuals with somatic symptom disorder undergo surgeries

that are unnecessary to find cure for their medical symptoms.
BIOLOGICAL PERSPECTIVE
Brain Regions
(activated by unpleasant body sensations)

1. Anterior Cingulate Cortex

2. Anterior Insula
3. Somatosensory Cortex
 Anterior Cingulate
Cortex
• In charge of regulating blood
pressure and heart rate.
• Decision making, emotional
regulation, preparation for
tasks, and executive
functions.
Anterior Insula
• Associated with
cardiovascular functions,
respiration, pain, touch,
disgust, general emotional
processing, cognitive control,
and empathy.
Anterior Cingulate Cortex Anterior Insula

Both the Anterior Cingulate Cortex and Anterior

Insula has increase activity that causes the pain
and uncomfortable sensations.
 Somatosensory Cortex

• Involved in processing bodily

sensations.

• Processes sensory input from the

skin, muscles, and joints.

• Detects and interprets information

on touch, temperature, pain, and
pressure.
Summary

● Hyperactive Brain Regions are the reason to the

susceptibility of noticing somatic symptoms and
pain since these brain regions are involved in
evaluating the unpleasantness of body sensations.

● Pain and somatic symptoms can be increased by

depression, anxiety, and stress hormones
ETIOLOGY
• Somatic Symptom Disorder is not heritable
• There is no concordance among twins for somatic symptom
disorders (Torgersen, 1986) or functional neurological disorder
(Slater, 1961).
• Men and women are equally affected by this disorder.
• Onset of symptoms commonly appears in persons 20 to 30
years old.
PSYCHOLOGICAL
PERSPECTIVE
PSYCHODYNAMIC PERSPECTIVE

• Overuse of Defense Mechanism

(Repression, Displacement, and Undoing)

• Wishes of aggressiveness and hostility towards others are

transferred into physical complaints.

• Defense against guilt, innate badness, expression of low self-esteem,

and a sign of excessive self-concern.
BEHAVIORAL PERSPECTIVE

• Social learning model

The symptoms of this disorder is viewed as a

way for a person to escape an insolvable
problem through the “sick role”.
COGNITIVE PERSPECTIVE
• Faulty Cognitive Scheme

People with this disorder focuses on the body

sensations, misinterprets it, and gets alarmed
by it.

• Magnification of somatic sensations

People with this disorder has low tolerance of

physical discomfort.
COGNITIVE BEHAVIORAL
PERSPECTIVE
1. Attention to Body Sensations

2. Attributions

Interpreting the physical

symptoms/sensations in the most horrible
way.
REFERENCES
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013.

Kring, A., & Johnson, S. (2011). Abnormal Psychology (12th ed.). River Street,
Hoboken: John Wiley & Sons, Inc.

Ruiz, P., Sadock, B., Sadock, V. (2015). Kaplan & Sadock’s Synopsis of Psychiatry (11th
ed.). Market Street, Philadelphia: Lippincott Williams & Wilkins
She had not been 1 month earlier, 8 months before.
able to see for the she was unable to she has been
past week. While speak for 2 weeks. voiceless for 6
she was in the It happened when weeks.
hospital, she was she had
smiling and felt difficulties with Laryngoscopy revealed
nothing unusual. studies and a few nothing abnormal.
hours after she
Ophthalmologic and found out her
neurological exams father had an
were done and illness.
revealed no specific
problems.
Sharrah Kate M. Peñaflorida, RPm
Biological Psychoanalytic Learning
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Biological Psychoanalytic Learning
Sharrah Kate M. Peñaflorida, RPm
Garnett was 5 years old. Ever since he was a baby, his mom would put salt into his
feeding tube to make him sick. His mom would tell the doctors that he couldn't
swallow food so he would need feeding tube inserted.

Garnett's death at 5 years old was said to be caused by what his mom feeds him to
make him sick.

Prosecutors alleged that his mom made him sick because she wanted social media
attention, that she even posted Garnett's dying photos on Facebook.

She was diagnosed with Munchausen's syndrome by proxy or factitious disorder

imposed on another.
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CASE OF JULIAN
FENSTER
 At age 24, Julian Fenster lives with his mother and a
teenage sister. Years ago, he studied at a college several
hundred miles away, but he decided to move back home after
only a semester. He claims that he didn’t want to live that far
from his doctors. As he said, “When you’re trying to prevent
heart disease, you can’t be too careful.”
Julian’s father died when he was a young teenager. His
father’s death, according to Julian, was self-inflicted. His father
had rheumatic fever as a child, which gave him an enlarged
heart. Despite his condition, Julian’s father was not careful with
his health. He never exercised, ate whatever he wanted, and was
a chain smoker, smoking at least two packs of cigarettes a day.
Julian is the complete opposite of his father. He was careful
about what he puts into his body. He had spent hours
researching on the internet for information on health and diet,
and he had even attended a lecture by Dean Ornish. Currently,
he is following a plant-based diet, and he is especially keen on
tofu and broccoli.
 He was listening to the radio when he heard a
report about young people with heart disease. It had
startled him so much that he had dropped the dish he
was putting into the cupboard. Without a second glance,
he hurriedly caught the next bus to the ER. This is now his
third visit to the ER in the past month. Besides odd
palpitations and maybe “hot flushes” on an especially
humid day, Julian had never complained about any
symptom. He explained to the nurse attending him that
he doesn’t feel bad, just scared. Julian agreed that he
needed a different approach to his health care needs and
thought he might be willing to give cognitive-behavioral
therapy a try.
✓ Preoccupation with 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 for developing a medical condition (e.g.,
strong family history is present), the preoccupation is clearly
excessive or disproportionate.
✓ There is a high level of anxiety about health, and the Cr
individual is easily alarmed about personal health status.
✓ The individual performs excessive health-related behaviors
(e.g., repeatedly checks his or her body for signs of illness) or
exhibits maladaptive avoidance (e.g., avoids doctor
appointments and hospitals).
✓ Illness preoccupation has been present for at least 6
D
months, but the specific illness that is feared may change over
that period of time.
✓ The illness-related preoccupation is not better explained by
another mental disorder, such as somatic symptom disorder,
panic disorder, generalized anxiety disorder, body
dysmorphic disorder, obsessive-compulsive disorder, or
delusional disorder, somatic type.
BIOLOGICAL PERSPECTIVE

▪ Hypersensitivity to specific physical

conditions
▪ Julian’s experiences of having odd
palpitations and “hot flushes”
PSYCHODYNAMIC PERSPECTIVE
▪ Wishes of hostility toward others are transferred
to fear of physical illness.
▪ Julian’s fear of physical illness originated from
the time he lost his father due to a heart
disease. He was angry at his father for not
taking care of his health despite his condition.
▪ Symbol of an unconscious conflict
▪ When Julian’s father died, that experience
became the stimulus in his fear of acquiring
an illness.
 BEHAVIORAL PERSPECTIVE
▪ Julian has taken a “better safe than sorry”
approach towards his health.
▪ Moved back home to be close to his
doctors
▪ Researched on the internet about
health and diet
▪ Visited the ER 3 times in 1 month.
▪ Social learning model
▪ Illness is used as an excuse to escape
duties or obligations.
COGNITIVE PERSPECTIVE

▪ Dysfunctional beliefs
▪ When Julian heard the report on the
radio regarding young people with
heart disease, he believed that he
may also have a heart disease.
▪ Julian’s experiences of having odd
palpitations and “hot flushes”