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Illness Anxiety Disorder

Mary H. Thornquist, Ph.D., O. Joseph Bienvenu, M.D., Ph.D.
Illness Anxiety Disorder is a topic covered in the Johns Hopkins Psychiatry Guide.

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  • Illness anxiety disorder is characterized by excessive anxiety and consuming preoccupation with illness in the absence of physical symptoms or when only mild physical symptoms are present.
  • Illness anxiety disorder is classified under the Somatic Symptom and Related Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)[1].
    • Other diagnoses under this section include somatic symptom disorder, conversion disorder, and factitious disorder.
    • Illness anxiety disorder replaces the DSM-IV-TR[2] diagnosis of hypocondriasis.
    • Although illness anxiety disorder is listed under the Somatic Symptom and Related Disorders section of the DSM-5, it is also conceptualized as an anxiety disorder.
  • When considering this diagnosis, it is important to have a firm understanding of somatization.
    • Somatization is the expression of mental phenomena as physical (somatic) symptoms.
    • There is a continuum of unconscious/non-volitional display of symptoms (patient unaware of the non-physiologic nature of symptoms) to conscious/volitional display (patient aware of the non-physiologic nature of symptoms).
    • Also important is the difference between primary gain (positive internal motivations) vs. secondary gain (positive external motivations).
      • Primary gain example: A patient feels guilty about not being able to perform a task, but if there is a medical condition justifying this inability, the guilt diminishes.
      • Secondary gain example: A patient is allowed to miss work and gets financial compensation as the result of a medical condition.
      • Any given patient with illness anxiety disorder will have primary and/or secondary gains associated.

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Last updated: May 2, 2017


Thornquist, Mary H, and O. Joseph Bienvenu. "Illness Anxiety Disorder." Johns Hopkins Psychiatry Guide, 2017. Johns Hopkins Guide, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787072/all/Illness_Anxiety_Disorder.
Thornquist MH, Bienvenu O. Illness Anxiety Disorder. Johns Hopkins Psychiatry Guide. 2017. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787072/all/Illness_Anxiety_Disorder. Accessed August 21, 2019.
Thornquist, M. H., & Bienvenu, O. (2017). Illness Anxiety Disorder. In Johns Hopkins Psychiatry Guide. Available from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787072/all/Illness_Anxiety_Disorder
Thornquist MH, Bienvenu O. Illness Anxiety Disorder [Internet]. In: Johns Hopkins Psychiatry Guide. ; 2017. [cited 2019 August 21]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787072/all/Illness_Anxiety_Disorder.
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