316 Somatic Symptom and Related Disorders
alarmed about illness, such as by hearing abou t someone else falling ill or reading a health-
related news story. Their concerns about undiagnosed disease do not respond to appro-
priate medical reassurance, negative diagnostic  tests, or benign course. The physician’s at-
tempts at reassurance and symptom palliation generally do not alleviate the individual’s
concerns and may heighten them . Illness concerns assume a prominent place in the indi-
vidual’s life, affecting daily activities, and may even result in inva lidism. Illness becomes
a central feature of the individual’s identity and self-image, a frequent topic of social dis-
course, and a characteristic response to stressful life events. Individuals with the disorder
often examine themselves repeatedly (e.g., ex amining one’s throat in the mirror) (Crite-
rion D). They research their suspected disease excessively (e.g., on the Internet) and re-
peatedly seek reassurance from family, friends, or physicians. This incessant worrying often
becomes frustrating for others and may result in considerable strain within the family. In
some cases, the anxiety leads to maladaptive avoidance of situations (e.g., visiting sick
family members) or activities (e.g., exercise ) that these individuals fear might jeopardize
their health.
Associated Features Supporting Diagnosis
Because they believe they are medically ill, individuals with illness anxiety disorder are
encountered far more frequently in medical than  in mental health settings. The majority of
individuals with illness anxiety disorder have  extensive yet unsatisfactory medical care,
though some may be too anxious to seek medi cal attention. They generally have elevated
rates of medical utilization but do not utilize me ntal health services more than the general