"I've got that, too!": Do I have hypochondria?

Dear Alice,

I've always been something of a hypochondriac, although my friends and family know nothing about it. As a child, I would regularly convince myself that I had appendicitis. As a teenager, I worried about being pregnant despite never having had vaginal intercourse. As a college student, I worked in a hospice for late-stage AIDS patients. Although I never had contact with blood or semen, I convinced myself that I may have contracted HIV somehow by doing their laundry with some kind of minor cuts on my hands I never noticed, or because a patient drooled on my hands. I've been tested at least three times since then, but I still haven't gotten over it and am nervously preoccupied with the idea that I have infected the whole two people that I've ever slept with. At the moment, I'm also convinced I have cancer. I *know* I'm completely wrong about all of this... I know, I know. And get this: I'm in medical school now. It's only going to get worse. Help me!

Dear Reader,  

Kudos to you for being open about the disconnect you’re experiencing between how you feel and the way your brain interprets it. While having self-awareness may allow you to recognize that your mind isn’t matching up with the experiences that you’ve had, it doesn’t discount the toll these worries exert on your daily life. As of 2013, what was known as hypochondriasis — a mental illness marked by a preoccupation with fear or belief that one has a serious medical illness — has been reclassified into two more specific conditions: somatic symptom disorder and illness anxiety disorder. While these two conditions are similar, they vary slightly in how symptoms present (more on this in a bit), which many health care providers believe can better tailor treatments compared to the original definition. If you feel that you need help, a good place to start is to contact to your health care provider to rule out any underlying health conditions, assess your symptoms, and link you to treatment options that fit your needs.  

Differentiating somatic symptom disorder and illness anxiety disorder was intended to help people get more appropriate care. There’s some debate among health care providers about whether the reclassification is specific enough. Generally speaking, most agree that the updated terminology helps differentiate between unexplained medical conditions and anxiety-driven conditions. The main difference between somatic symptom disorder and illness anxiety disorder is whether any physical symptoms are present. With somatic symptom disorder, people typically have one or more physical symptoms (such as pain, dizziness, fatigue, or weakness) that cause heightened fear and worry. The physical symptoms aren’t related to a specific medical condition, but they’re interpreted as a serious medical illness, leading to excessive concerns when physical sensations present. Individuals with somatic symptom disorder frequently look for irregularities on the body and seek repeated medical care despite feelings that it doesn’t resolve the problem.  

On the other hand, people with illness anxiety disorder tend to not have any physical symptoms, but share the intense anxiety and fear about having a serious medical illness. Typically, minor bodily sensations (such as stomach grumbling, mild rash, and headache) lead to excessive scrutiny of the body for signs of illness and preoccupation that there’s an underlying health condition. For example, people may avoid activities and places that they perceive as a health risk or routinely browse the internet for answers to explain their symptoms. In many cases, these worries are so intense that they make it difficult to engage in daily responsibilities and interactions. At the same time, people with illness anxiety disorder usually either frequently seek medical care for tests and reassurance (known as care-seeking type) or they avoid seeking medical care for fear of a concerning medical diagnosis (care-avoidant type).  

While more research is needed to understand the exact causes of these conditions, medical experts suspect that moments of profound stress, previous trauma (such as abuse), being around people that have health anxiety, generally being a worrier, and overuse of the internet for health information may play a role. The good news is that there are recommended treatments to help work through these thoughts, no matter why they arise. If you’d like to explore these feelings further, it’s recommended that you reach out to a health care professional when the anxiety begins. They may conduct routine medical exams and consultations and refer those with somatic symptom disorder and illness anxiety disorder to a mental health professional. These professionals can recommend different types of therapy, that often involve working to reframe beliefs and feelings to develop more realistic interpretations and expectations of symptoms and general health. In some cases, they may also prescribe medications such as selective serotonin uptake inhibitors (SSRIs), which are used to help with underlying mood or anxiety disorders. In addition to these treatments, they may recommend lifestyle tips to reduce stress such as participating in physical activity, keeping busy with daily activities, using relaxation techniques, and cutting down or stopping alcohol or tobacco use.  

The mind can act as a powerful force on the body. For these reasons, it can be hard to get over worrying thoughts, especially on your own. While the mind-body connection is complex, here’s hoping with time, patience, and support, that you get the relief you seek.  

With encouragement, 

Last updated Jun 11, 2021
Originally published Oct 05, 2006