Is Hypochondriasis another word for OCD?

It’s normal to experience occasional preoccupations with one’s health and the health of others. We’ve all googled our symptoms only to find out they could mean we are sick in more ways than we wanted to know. Similarly, many of us have grown increasingly concerned with our health over the past few years and have adopted new behaviors, from healthier eating habits to better handwashing techniques, in order to stay well. 

For some, a persistent focus on symptoms, suspected illnesses, and health prevention can become problematic, interfering with their ability to live a happy, productive life. We spoke with Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD, to shed some light on how to know when your health concerns are maladaptive, how this relates to obsessive-compulsive disorder (OCD) and other mental health conditions, and the best available treatments. 

What is Health and Contamination OCD? 

OCD is a mental health condition that affects around 1 in 40 adults. It is characterized by unwanted images, thoughts, beliefs, feelings, or urges that cause distress or anxiety (called obsessions), as well as behaviors or mental actions done in an attempt to relieve this distress or avoid negative outcomes (called compulsions).

Often, individuals with OCD develop obsessions and compulsions that focus on a particular topic. One of the more common themes involves health and contamination concerns. As Dr. McGrath notes, this can take several different forms. Individuals with health and contamination concerns may experience obsessive thoughts and fears about becoming contaminated themselves, contaminating others, or contracting and spreading disease. These may also display a general distrust of doctors or of medical results demonstrating that they have not contracted a serious illness. 

Importantly, as with all forms of OCD, those concerned about health and contamination experience obsessive fears or concerns and engage in compulsions to alleviate stress and avoid adverse outcomes.

Examples of Health and Contamination Obsessions

• What if touching that doorknob gets me sick?
• What if I come into contact with a person who is sick and catch their illness?
• Could that red spot on the floor be contaminated blood?
• How many people have used this utensil before me?
• What if I’m asymptomatic and give someone an illness?
• I’m feeling pretty fatigued. What if I have COVID?

Examples of Health and Contamination Compulsions

• Repetitive hand washing
• Praying, counting, or repeating words silently to avoid catching to transmitting an illness
• Disinfecting or sterilizing things
• Throwing things away
• Frequently changing clothes
• Repeatedly or excessively seeking medical tests
• Staying inside or avoiding social gatherings
• Repeatedly or excessively taking medication

What is Hypochondriasis?

“Hypochondriasis is not used anymore. It’s an old term that is now outdated,” shares Dr. McGrath. The term was removed as part of the updates made to the diagnostic and statistical manual of mental disorders (DSM). The fifth edition no longer includes the condition. Instead, it now recognizes two different disorders: illness anxiety disorder and somatic symptom disorder. These are very similar, with only subtle differences. 

Illness Anxiety Disorder

Illness anxiety disorder is characterized by an excessive worry that one has or is developing a serious medical condition. Notably, the concerns occur in the absence of somatic symptoms and without a focus on them. For example, an individual with illness anxiety disorder may fear they are coming down with a debilitating condition despite not having unusual physical or bodily sensations or symptoms. 

Examples of Reassurance-Seeking Behavior in Illness Anxiety Disorder

Dr. McGrath notes that those dealing with the condition may engage in various behaviors to reassure themselves that they aren’t sick or to avoid thinking about it altogether. Some examples include:

• Examining or checking their body
• Going to the same doctor over and over again to ensure they are okay
• Requesting medical tests to detect the presence of underlying medical conditions
• Frequently searching the internet for causes and symptoms 

Their fears are also generally unresponsive to counterevidence. They will persist despite a doctor’s reassurance or tests showing that nothing is wrong with them.

Somatic Symptom Disorder

Somatic symptom disorder is essentially the same as illness anxiety disorder, except for one key difference. In somatic symptom disorder, health concerns result from somatic or bodily sensations. For example, an individual with somatic symptom disorder may be preoccupied with a fast heartbeat, light-headedness, headaches, fatigue, or stomach pains. 

As with illness anxiety disorder, the resulting worry is excessive and unwarranted, leading to similar checking behaviors. In somatic symptom disorder, individuals may be given medications or treatments to alleviate the symptoms they are concerned about, but this will not typically provide them with any relief. 

Are Illness Anxiety Disorder or Somatic Symptom Disorder Forms of OCD?

Illness anxiety disorder and somatic symptom disorder share some traits  with OCD that might lead some to suspect that they are types or expressions of OCD. 

Do They Involve Obsessions and Compulsions?

Obsessions and compulsions define OCD. At a superficial level, it can look like illness anxiety disorder and somatic symptom disorder involve both. As Dr. McGrath shares, this appearance can be misleading. 

With OCD, “you’ll see very ritualistic kinds of behaviors. They may have to do something exactly the same way or check it a certain number of times or something like that,” shares Dr. McGrath. “In illness anxiety disorder, they might just run to the bathroom and check quickly to see if that spot of concern has got any bigger. They’re not taking any kind of ritualized approach to doing something about it. They’re just assessing to see what’s there has changed. […] I might not even call them obsessions.” 

In other words, they don’t have the distinctive rigid and ritualized character of obsessions and compulsions in OCD. Because of this, the thoughts and behaviors performed by those with illness anxiety or somatic symptom disorder aren’t clear examples of obsessions and compulsions, which could mean that, when experienced on their own, they aren’t forms of OCD.

OCD Rarely Involves Just One Specific Theme

Though OCD can center around a particular topic, it often focuses on more than one. “The likelihood is that somebody with OCD is going to have some other types of obsessions outside of just health concerns, as well,” shares Dr. McGrath. “So potentially, if it’s only around health, illness anxiety disorder or somatic symptom disorder might be a better diagnosis [than OCD].” 

These claims are well-backed by the empirical literature. One study examining the percentage of individuals with OCD who show symptoms in more than one domain or “theme” found that 81 percent of respondents experienced symptoms in multiple areas. That was based only on the narrow list of subtypes in the study—in a more comprehensive analysis, the number would likely be higher. 

The upshot is that if the fears that characterize illness anxiety and somatic symptom disorder are the sole focus of one’s fear, anxiety, and reassurance-seeking activities, one of these diagnoses is more likely to be accurate.

Can I have a Health Concern Disorder With Other Themes of OCD?

As noted above, OCD often involves several areas of focus or central concerns, so it’s certainly possible to have health contamination OCD along with other subtypes. For example, you might also have relationship OCD, characterized by ongoing intrusive thoughts and compulsive behaviors around relationship uncertainty.

The same goes for the concerns that characterize illness anxiety and somatic symptom disorder. Again, when other themes are present, these disorders may be diagnosed as part of an OCD diagnosis, with health-related concerns, obsessions, and compulsions contributing to one specific theme. 

How are Illness Anxiety Disorder, Somatic Symptom Disorder, and OCD Treated?

The solution is always the same, regardless of which of the three labels we chose. “Three names, one treatment.” shares Dr. McGrath. As with all types of OCD, exposure-response therapy (ERP) is the answer. For these conditions, it’s used to address health-related concerns and fears directly. Dr. McGrath elaborates:

Here’s what we do for people: help them sit with uncertainty and discomfort about why they might have a symptom, what the symptom means, where it came from, and what they should do about it. We help them learn that they can feel confident in medical tests and doctors’ recommendations, even if they feel anxious or uncertain. 

Over time, by resisting the urge to repeatedly turn to compulsions for quick relief from anxiety, people can learn to sit with uncertainty, allowing their overwhelming urges and obsessions to subside. 

Treatment for all of these conditions may also be aided with the same medications. Generally, physicians prescribe selective serotonin reuptake inhibitors (SSRIs) like fluoxetine or sertraline. This is because serotonin is a neurotransmitter heavily involved in anxiety disorders and OCD. Newer research suggests that other chemical messengers, such as glutamate, may also be involved, and novel medications are being developed based on this insight. 

Can I recover From Health Concern themes of OCD and Similar Anxiety Disorders?

No matter which of the three conditions you’re diagnosed with, recovery is possible. ERP alone or in combination with medication is a highly successful intervention. Studies have shown that over 80% of people with OCD achieve a reduction in symptoms through ERP therapy. And even those who cannot eliminate their symptoms entirely can learn to manage them long-term and enjoy significant improvement in their quality of life.