A Guide for Parents Distinguishing Non-Impairing Health Anxiety from Illness Anxiety Disorder

Ben T. Ladd, BA, Lifespan; and Carly M. Goldstein, PhD, Brown Medical School 

 

Since 2020, children have been exposed to media about the rapid spread of a virus that can lead to unpredictable health issues. In the context of a global health crisis, it is more important now than ever to be mindful of your child’s mental health and to understand and be aware of early indicators of an anxiety disorder. It's important for parents to recognize the differences between two common forms of anxiety: Illness Anxiety Disorder (IAD) and non-impairing health anxiety.

IAD historically was referred to as Hypochondriasis. Now known as IAD, it is a condition in which individuals harbor ongoing worries about becoming seriously ill, exhibit a hypersensitivity to even minor discomforts, and frequently become anxious and worried about their well-being to a disproportionate and sometimes counterproductive extent. Non-impairing health anxiety, on the other hand, presents as reasonable concern for one’s health and safety given the threat posed by COVID-19. 

Given the very real potential for health complications because of COVID-19 infection, it can be difficult to know when your family members are being paralyzed by health anxiety symptoms or appropriately cautious. Some concern is warranted and normal, while fixation on health concerns can become debilitating. The breakdown below can help you identify the differences between IAD and health anxiety.

Illness Anxiety Disorder vs. Non-Impairing Health Anxiety

Illness Anxiety Disorder	Non-Impairing Health Anxiety
Disproportionate concern with physical symptoms or medical conditions (for example: interpreting a stomach rumble as a sign of a serious condition)	Proportionate concern and reactions to common bodily sensations (for example: resting while sick) or present medical conditions
Regular avoidance of people or places due to the fear of becoming sick	Reasonable avoidance of people or places due to the fear of becoming sick (for example: avoiding crowded and enclosed spaces during times of heightened COVID transmission or in cases of significant risk of severe illness)
Regularly engaging in health-related questioning (for example: searching the internet for symptoms or checking their bodies for signs of an illness)	Health-related behaviors are proportionate to the level of threat (for example: checking body for ticks after running in a field)
Preoccupation with health anxiety is present for at least six months (regardless of if their specific concern changes)	Health anxiety is fleeting and does not persist for longer than six months

 

What is Illness Anxiety Disorder?

Though IAD typically presents in early to middle adulthood, research has indicated that many of IAD’s essential features in adults were present since early childhood. Moreover, IAD is related to an array of other mental health issues.

Parents who have children with greater health anxiety spend more money on healthcare on average than those who do not, even when controlling for the child’s physical health. This is because children with IAD sometimes attend unneeded medical appointments, resulting in unnecessary expenses for their family. Seeking unnecessary medical help is an example of a common safety-seeking behavior, and it only strengthens the child’s anxiety in the long-term.

Parents who are considering whether their own child has IAD should watch for:

1. Mentioning one or more health concerns to one’s parents every day. 
2. Becoming anxious when hearing about an illness or disease through the media.
3. Constantly checking their own body for signs of being sick.
4. Spending a significant amount of time learning or reading about illnesses.

Individuals engage in safety behaviors to prevent feared outcomes from becoming true as well as to ease their distress regarding situations that one is anxious about. For example, a child might repeatedly ask a parent to confirm whether a normal bodily sensation, like a stomach rumbling, is normal or a sign of illness, with the parent reassuring them and googling the symptoms each time. Instead of protecting your child, engaging in safety behaviors can significantly increase health anxiety compared to individuals who do not engage in them.

How to Help Children with Illness Anxiety Disorder

Parents can try these suggestions to foster their kids’ healthy relationships to their health and bodily experiences, and to intervene when a child’s well-being is negatively affected by health-related anxiety. 

1. Engage in healthy behaviors that are within your control, such as exercising regularly and eating healthfully. Children who are generally healthier rate lower in health anxiety than those who are less healthy. 
2. Talk to a school counselor, pediatrician, or mental health professional if you observe signs of IAD in your child. 
3. Be mindful of the messaging your child is exposed to through the media and discuss productive and dysfunctional examples of responding to illness that they see.
4. Consider the way that health-related topics are discussed around your child, and how the language used may worsen or foster health anxiety in children. 
5. Upon noticing a behavior that reflects unproductive health anxiety, respond in a way that empowers the child to manage their anxiety instead of eliminating it through reassurance. There are a variety of relaxation techniques that children can employ to manage their anxiety, and a qualified mental health professional can assist with developing this behavioral coping repertoire. It is important that children understand that anxiety is a normal emotion, and parents should empower their child with strategies and coping skills for managing anxiety.

Using these methods, parents can achieve a flexible balance between fostering their child’s sense of agency over their health and developing a tolerance to health-related anxiety.

 

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