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TRIBUNE PHOTO: SCOTT KEITH - Dr. Jason Guy Richards, clinical psychologist at the Portland Anxiety Clinic, treats patients with illness anxiety disorder. You might have discovered yourself doing this — perhaps several times a year. You experience a symptom, such as a headache, and you instantly search Internet for the cause.


You’re not alone. Many people use the internet and discover that a simple symptom, in some cases, can be fatal. You make the leap that a headache is caused by a brain tumor or a tummy ache is the result of stomach cancer.

While it’s always best to check out a troublesome symptom with your doctor, the convenience of internet access can simply be too much to resist.

Dr. Jason Guy Richards, a clinical psychologist with the Portland Anxiety Clinic in Downtown Portland, follows patients with this specific problem. You can call it health anxiety or, more commonly, illness anxiety disorder. You might even remember a much older term for this: hypochondriasis.

“Illness anxiety disorder is technically classified as a somatoform disorder (where a patient reports a symptom that can’t be traced to a physical cause),” Richards said. “An example might be having, maybe, chronic indigestion, and instead of thinking that maybe it’s your diet that needs to be changed, you immediately go to, ‘I think I have stomach cancer.’ You spend copious amounts of time, kind of, digging up that information or getting medical tests.”

Richards said illness anxiety disorder can resemble generalized anxiety disorder in that patients present with an intolerance for uncertainty.

“These people tend to react very negatively on an emotional, cognitive or behavioral level to uncertain situations,” Richards said. “With life being so full of uncertainty, there’s ample opportunities for these folks to be anxious.”

Comparing illness anxiety disorder with generalized anxiety disorder, Richards said people with generalized anxiety disorder tend to worry a little bit about everything. “It’s usually, kind of, future oriented (worries about a plane accident, for example),” he said. “The worries just get drummed up and drummed up and they usually diversify. So it’s not one thing, it’s many things.”

With illness anxiety disorder, the anxiety is more specified, such as a feeling that a health symptom automatically means cancer.

Richards notices that the Internet plays a major role in his diagnosis of illness anxiety disorder.

“At least from my treatment experience, I can say, yes indeed, the Internet has increased, if not the prevalence of illness anxiety, it certainly has exacerbated it,” he said, adding the Internet provides ready access to ambiguous information about symptom clusters.

With the Internet, Richards said, “There’s ample opportunity to be uncertain with your own self diagnosis.”

Richards notes that patients with illness anxiety will get medical tests, and many tests come back normal. “It just fuels that uncertainty. Medical intervention, or at least medical testing, never fixes the health anxiety problem,” he said, noting that some patients even go from doctor to doctor in search of a cause for their symptom.

If you suspect you have a problem with illness anxiety disorder, professional help is available.

“We use evidence-based practice only,” Richards said, referring to his practice at the Portland Anxiety Clinic. He recommends a patient with this problem seek a cognitive behavioral therapist. “As far as gold standard, about 80 percent of folks who get that kind of treatment, who have an anxiety disorder, get better. My experience, though, is that it’s closer to 90 percent, at least in our practice.”

He added, “It’s a very tenacious disorder. It doesn’t dislodge easily.”

According to Richards, the crux of the problem with health anxiety is the fear of death. “Realistically, when we start boiling this down, people are afraid of getting cancer or HIV, or whatever it is,” Richards said. “What they’re really saying is, ‘I’m afraid to die’ - we have to become OK with our mortality. We all will have health problems which will eventually lead to our death. It’s natural, it’s normal, it’s a part of life. Worrying about it doesn’t decrease those odds.”

Speaking of his practice, Richards said solutions are available for those who suffer from illness anxiety disorder. “I do it every day.”

Illness Anxiety Disorder

What are symptoms of health anxiety?

Health anxiety is hallmarked by chronic and pathological worry and anxiety focused exclusively on health concerns. Hypochondria and Health Anxiety are the same thing. Hypochondriasis was changed to Health Anxiety and is now called Illness Anxiety Disorder (as of DSM 5).

When is it a good idea to seek professional help if a patient suspects health anxiety?

  1. After repeated medical tests have come back negative
  2. Before running out of medical benefits (happens quite often)
  3. Encouraged to do so by medical professionals, friends or family
  4. After recognizing too much time is spent obsessing over health

What steps a patient can take, or some helpful tips, in dealing with or managing health anxiety?

This is a tough one. Health anxiety has only recently been understood and effectively treated. I would strongly encourage anyone who believes they have health anxiety to seek out a specialist (psychologist, counselor, etc.) in the area of anxiety disorders.

How common is this and what role does the Internet play?

Rates are as high as 3 percent of the general population

The Internet is a gateway to articles, videos and advertisements regarding serious illnesses (cancer, HIV, etc.). These diseases are portrayed as being random, insidious and of higher risk than is realistic (skewed statistically) and they are overly sensationalized.

Informational websites lead to identification of non-specific symptoms as signs of serious illness, contributing to exacerbation of the illness anxiety and elevating the belief that they have something wrong with them.

Information about disease outbreaks, such as pandemics (predicted anyways) also exacerbates illness anxiety.

Self treating health anxiety

The issue with self-treating health anxiety is that the treatment of choice is difficult to do without expert guidance. Exposure based treatment requires the health anxious to trigger, on purpose, their fears, then not engage in the reassurance seeking/checking behaviors. This is simple, but very hard!

— Dr. Jason Guy Richards, Portland Anxiety Clinic


Scott Keith is a freelance writer with the Portland Tribune and the Pamplin Media Group. If you have a health tip, or a story idea, contact Scott at [email protected].com

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