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Volume 11 Issues 11 November, 2021
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There are many diagnosable psychiatric disorders. The persons struggling with those disorders don’t consult a psychiatrist. Illness anxiety disorder (IAD) is one of them.
Who are the persons with IAD?
- They worry excessively about a medical condition or a physiological sensation like dizziness.
- The usual reassurance does not help them.
- They examine themselves repeatedly.
- They search the internet voraciously.
- They do doctor shopping.
- All these are not explained by other mental health disorders.
- They keep doing these things for more than six months.
- They were diagnosed as hypochondrias previously. Now 75% are diagnosed with Somatic Symptom Disorder (SSD), and 25% fall under Illness Anxiety Disorder (IAD). In SSD, the person experiences distressing symptoms like pain, dizziness, chest discomfort, breathing problem, etc. In IAD, the person has excessive worry, nervousness, concern etc.
- They form 3-8% in primary care.
- They are usually between 25-35 years of age. Rare in children.
- IAD affects both males and females equally.
Why do we need to diagnose IAD?
- Because of the discomfort due to invasive tests and repetitive tests
- They become more vulnerable to depressive and anxiety disorders
- They may become dependent on prescription medication or suffer from their side effects
- They may not attend work or lose a job due to doctor and investigation appointments
- Due to financial stress, they may get into real problems
How to treat them?
By medicines or therapy or both
1. Medicines
- No particular drug has been approved for IAD.
- Drugs used in OCD helps. SSRI like Fluoxetine or SNRI like Venlafaxine make them more happy and relaxed.
- Betablocker like Propranolol helps only in reducing palpitations, Benzodiazepine like Alprazolam may cause dependence, Antipsychotics like Pimozide or Risperidone may cause troublesome side effects
2. Therapy
- Find out the triggers – the person learns that the source of their distress is mental, not physical
- Increase their coping mechanisms
- Advise active and healthy lifestyles, diet, exercise, sleep etc
- Advise them to have fun to break the cycle of worry
- Teach them to inform new doctors that she/he has IAD to avoid further investigations
How to manage them?
- Accept IAD is also a disorder needing treatment
- Get baseline health check and investigation to reassure the person’s health status
- Later, don’t allow doctor shopping and specialist referral except to psychiatrist or clinical psychologist
- Discuss with the person about the need for further investigation or repeat investigations
- Give regular fixed consultation time weekly or monthly and advise the person to delay going for investigations and specialist consultation
- Liaise with the therapist or other specialist about the changes in the symptoms – mainly the side effects
- If possible, let the consultations be in the presence of their family member. He/she will continue the therapy at home and help the patient in finding the triggers
