Understanding Illness Anxiety Disorder and Somatic Symptom Disorder: When Worry Becomes the Symptom

In today’s fast-paced world, it’s common to worry about our health from time to time. But for some individuals, these worries become all-consuming—even in the absence of serious medical conditions. Two diagnoses that help explain this experience are Illness Anxiety Disorder (IAD) and Somatic Symptom Disorder (SSD). At our practice, we frequently support individuals who find themselves overwhelmed by health-related anxiety or persistent physical symptoms that interfere with daily life.

In this blog, we’ll break down what these disorders are, how they’re understood from a psychodynamic perspective, and how they can be effectively treated.

What Are Illness Anxiety Disorder and Somatic Symptom Disorder?

While both conditions involve excessive concern about health, they differ in presentation.

Illness Anxiety Disorder (IAD)

According to the DSM-5, Illness Anxiety Disorder is characterized by:

• A preoccupation with having or acquiring a serious illness.

• Minimal or no somatic symptoms are present (or if present, only mild in intensity).

• The individual has high health-related anxiety, is easily alarmed about personal health status.

• Excessive health-related behaviors (e.g., repeatedly checking the body for signs of illness) or maladaptive avoidance (e.g., avoiding doctors or hospitals).

• This condition persists for at least 6 months, though the specific illness feared may change over time.

• The preoccupation is not better explained by another mental disorder, such as panic disorder or obsessive-compulsive disorder.

  
  

Somatic Symptom Disorder (SSD)

The DSM-5 criteria for Somatic Symptom Disorder include:

• One or more somatic symptoms that are distressing or result in significant disruption of daily life.

• Excessive thoughts, feelings, or behaviors related to these symptoms or associated health concerns, evidenced by at least one of the following:

  • Disproportionate and persistent thoughts about the seriousness of the symptoms.

  • Persistently high levels of anxiety about health or symptoms.

  • Excessive time and energy devoted to these symptoms.

• Symptoms may be medically explained or unexplained, but the key issue is the disproportionate psychological response.

• The state of being symptomatic is persistent, typically more than 6 months.

  
  

A Psychodynamic Understanding

From a psychodynamic lens, both disorders can be seen as expressions of underlying emotional conflicts that are converted into physical symptoms or health-related preoccupations. Some of the core features may include:

• Unconscious expression of distress: For some, physical symptoms may be a more acceptable way to experience psychological pain, especially if direct expression of emotion was discouraged in early life.

• Defense mechanisms: Somatization can serve as a defense against anxiety, guilt, anger, or unresolved trauma. The body becomes a stage upon which psychological conflicts are enacted.

• Attachment dynamics: Individuals with IAD or SSD may have early relational experiences marked by inconsistent caregiving, where illness or distress became a primary means of securing attention or connection.

• Identity and self-worth: Chronic preoccupation with illness may become entwined with one’s identity. The role of the “sick person” may unconsciously serve as a source of purpose, validation, or protection from other life stressors.

  
  

Treatment Approaches

A combination of psychotherapy, psychoeducation, and—in some cases—medication can help individuals reduce symptom burden and improve functioning.

1. Cognitive Behavioral Therapy (CBT)

• CBT is considered a first-line treatment for both IAD and SSD.

• It helps patients identify and reframe distorted health-related thoughts, reduce safety behaviors, and learn how to tolerate uncertainty about their health.

2. Psychodynamic Psychotherapy

• A valuable approach for those interested in exploring deeper emotional conflicts, unconscious motivations, and relational patterns.

• Can help individuals understand how past experiences influence current bodily concerns and begin to develop new ways of experiencing emotion and vulnerability.

3. Psychoeducation and Supportive Therapy

• Teaching clients about the mind-body connection can demystify their experience and reduce shame or confusion.

• Supportive therapy helps reinforce coping skills, encourage healthy behaviors, and strengthen the therapeutic alliance.

4. Medication

• Antidepressants, especially SSRIs or SNRIs, can be helpful in reducing anxiety and depressive symptoms that often co-occur with these disorders.

• Medication is usually most effective when combined with therapy.

5. Collaborative Medical Care

• It’s important to have a coordinated approach with primary care providers to avoid excessive testing while still validating the patient’s concerns.

• A trusted provider who can balance empathy with appropriate reassurance is essential.

  
  

Final Thoughts

Illness Anxiety Disorder and Somatic Symptom Disorder are not simply “in someone’s head”—they are real, impairing, and deeply distressing conditions. Fortunately, with compassionate care and the right therapeutic approach, individuals can gain insight, reduce anxiety, and reclaim their lives from the grip of health preoccupation.

At our WNY Psychiatry & Counseling Associates, we specialize in holistic, person-centered care that honors the complexity of both mind and body. If you or a loved one is struggling with persistent health worries or unexplained physical symptoms, we’re here to help.