Illness Anxiety Disorder Diagnosis and Treatment

Diagnostic Criteria

The American Academy of Child and Adolescent Psychiatry recommends ruling out actual medical conditions that can cause or mimic anxiety symptoms, including thyroid disorders, cardiac conditions, endocrine disorders, respiratory conditions, neurological disorders, and substance-related causes, before diagnosing illness anxiety disorder 2, 3, 1
Significant functional impairment in social, occupational, or other important areas is a key diagnostic feature of illness anxiety disorder, according to Praxis Medical Insights 1

The American Academy of Child and Adolescent Psychiatry suggests that laboratory testing, such as glucose and thyroid function tests, should be ordered when clinical signs suggest a medical condition 2, 5
Thyroid disorders, such as hyperthyroidism, should be considered in the differential diagnosis of illness anxiety disorder, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 4

The American Academy of Child and Adolescent Psychiatry recommends screening for comorbidities, including depression, other anxiety disorders, obsessive-compulsive disorder, and substance use disorders, in patients with illness anxiety disorder 2, 5, 1
Standardized screening tools, such as the GAD-7 and the Level 1 Cross-Cutting Symptom Measures, can be used to quantify anxiety severity and screen for comorbidities, according to Praxis Medical Insights 5, 4

Cognitive Behavioral Therapy (CBT) is the first-line psychotherapy for illness anxiety disorder, with demonstrated large effect sizes for anxiety disorders, as recommended by Praxis Medical Insights 4
Selective serotonin reuptake inhibitors (SSRIs), such as sertraline, are first-line pharmacotherapy for illness anxiety disorder, with small to medium effect sizes compared to placebo, according to Praxis Medical Insights 4

For mild symptoms, the American Academy of Child and Adolescent Psychiatry recommends initiating CBT alone and providing psychoeducation about the disorder, with monitoring of response over 4-6 weeks 4
For moderate-severe symptoms, Praxis Medical Insights suggests combining SSRI with CBT, which is superior to either treatment alone, and starting sertraline or another SSRI at standard dosing 4

Pharmacotherapy should be continued for 12 months after achieving remission before considering tapering to prevent relapse, as recommended by Praxis Medical Insights 4

Immediate psychiatric referral is required for suicidal ideation or self-harm, psychosis or severe agitation, symptoms not responding to initial treatment, and severe functional impairment, according to Praxis Medical Insights 4, 1