7 Ways to Help Someone with Illness Anxiety Disorder

By Phil Lane, LCSW

In the past, clients who presented to counseling with anxiety related to the possibility of acquiring a serious illness may have been labeled as “hypochondriacs” or “neurotics.” Far from reflecting neurosis, illness anxiety is simply an intense focus on physical health and well-being. For counselors, understanding this distinction and using mindful language are crucial for helping clients heal. Here are seven ways counselors can provide compassion and practical coping skills to help clients manage their fears, restore a sense of safety and regain control over their lives.

1. Change the Language

A decade has passed since the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) changed the description of someone who is anxious about their physical health from “hypochondriasis” to illness anxiety disorder, which falls in the category of somatic symptom and related disorders. Labels such as “hypochondriac” or “neurotic” can be stigmatizing. By removing the negative label, clinicians can create an immediate and necessary sense of humanness, rather than of pathology. While illness anxiety contains an irrational cognitive component (as does any form of anxiety), it does not mean a client is neurotic, manipulative or histrionic. Rather, it is a narrow focus of anxiety towards one’s physical well-being and health status. All people experience anxiety, and illness anxiety disorder is simply a subset of generalized anxiety. Understanding this helps the client and clinician work together toward healing.

2. Understand the Common Responses to Illness Anxiety

The DSM-5 describes two typical responses to illness anxiety: “care-seeking” and “care-avoidant.” The client who responds in a care-seeking manner will pursue multiple diagnostic and treatment options, often undergoing many tests, scans and medical appointments. This overuse of care can result in financial strain and increased anxiety. One client shared that he spent more than $20,000 on out-of-network providers, urgent care, emergency room visits and holistic care, all in response to his fear of a catastrophic illness or physical problem.

The client who responds in a care-avoidant manner will often become isolative and avoid all medical care out of fear a major illness will be discovered. The emotional cost of such behavior is high, as this client may feel completely alone and without support. The avoidance of care can also, ironically, result in medical problems going undetected. Clinicians can help clients strike a healthy balance of seeking treatment when appropriate, while not overusing medical care.

3. Understand the Brain-Body Connection

Counselors may pride themselves on understanding the emotions and the psyche, but understanding how the mental and emotional intersect with the physical is vital. Many anxious feelings “house” themselves in the body, such as through heart palpitations, muscle tension, bladder and bowel constriction and loosening, respiratory tension and headaches. Understanding the connection between the emotional state and the physical state can provide a more complete picture of how these two systems affect and interact with one another.

4. Understand the Social Climate

The COVID-19 pandemic might be considered a global trauma. Across the world, people felt they were in danger of acquiring a serious illness. Being an informed clinician means understanding how larger social events influence clients’ emotional functioning. The pandemic brought to light the prevalence of illness anxiety and enabled mental health professionals to better understand how physical health relates to one’s emotional state.

5. Educate Clients

Because anxiety thrives on the unknown, educating clients can help them feel more autonomy. Teaching clients what anxiety is, why it occurs, how it manifests and how humans respond to fear can give clients a sense of understanding, which can promote healing. Once clients understand anxiety conceptually, they can begin learning and implementing coping skills.

6. Teach Practical Coping Skills

Clients benefit from practical skills they can use to reduce the intensity of anxious thoughts and feelings. Cognitive behavioral therapy is often a first-line treatment for illness anxiety disorder because it teaches clients to begin questioning anxious assumptions. Thought-challenging can help clients put less stock in anxious conclusions. Other modalities such as dialectical behavioral therapy and mindfulness-based cognitive therapy can help clients learn new and more effective ways to cope with uncomfortable thoughts.

Clinicians can educate and train clients to understand these concepts and implement them into their daily lives to challenge and change maladaptive cognitive patterns. While mental health professionals commonly use such modalities in the treatment of illness anxiety disorder, clinicians should tailor therapy to a client’s unique needs and design a flexible, adaptable treatment plan.

7. Restore a Sense of Safety

In Trauma and Recovery, Judith Herman, MD, explains that the final stage in trauma recovery is the restoration of a sense of safety and a return to everyday life. This is what clinicians must work to provide for illness-anxious clients. This sense of safety begins with building rapport and compassionate understanding of the client’s experiences and health status.

I worked with a 20-year-old client who came to therapy after taking a break from college due to intense anxiety related to his physical health. After many months of therapy, including fits and starts, strides forward and steps backward, he was able to return to school, pick up his life as it had been prior to illness anxiety and reengage with ordinary life as a high-functioning young person with a bright, exciting future. This is the return Herman speaks of, and it is the goal of counseling for clients with illness anxiety.

Note: Opinions expressed and statements made in this blog do not necessarily represent the policies or opinions of ACA and its editors.