Kids Who Worry They're Sick When They're Not

We’ve all worried needlessly about our health at some point or another. Perhaps you have niggling thoughts about being diagnosed with cancer every time your mammogram comes due. Or you have a coughing spell and wonder if it’s COVID.

Children and adolescents do the same thing. But if the occasional intrusive thought or worry about their health turns into intense, persistent anxiety, it may be more. What used to be called hypochondria is now two separate but closely related disorders: illness anxiety disorder and somatic symptom disorder.

Children with illness anxiety disorder worry a lot about being sick even though they don’t have any symptoms. Kids with somatic symptom disorder fear that a normal, minor physical symptom, such as a headache or stomachache, is indicative of a serious health problem.

There’s a great deal of overlap between the two disorders, says Sandra L. Whitehouse, PhD, senior director of the Anxiety Disorders Center at the Child Mind Institute. “In both, kids have an intense worry that they have something wrong with them medically when, in fact, they don’t.”

These disorders are different from more fleeting complaints about ailments, such as having a stomachache before a big test or class presentation. With illness anxiety disorder and somatic symptom disorder, the worry is longer-lasting and often results in numerous trips to the doctor and demands for a physical diagnosis.

A child with one of these disorders might also repeatedly seek reassurance from parents or other adults, explains Dr. Whitehouse. “They might go to the school nurse multiple times to have a small abrasion looked at to make sure that it’s not developing an infection, or concealing an underlying fracture.”

Dr.  Whitehouse recalls a teenager she worked with who had somatic symptom disorder. He had developed a small rash. “He thought, ‘That must be Lyme disease, so I have to get it properly evaluated to make sure. And if it’s not Lyme disease, then for certain it’s got to be meningitis,’” Dr. Whitehouse says. He also worried he might have multiple sclerosis.

Both illness anxiety disorder and somatic symptom disorder are anxiety disorders, which are characterized by intense worry that interferes with daily life. They can affect children and adolescents of all ages and largely develop equally in males and females, although somatic symptom disorder tends to affect girls slightly more than boys in adolescence.

Kids with illness anxiety disorder or somatic symptom disorder tend to be “internalizers,” Dr. Whitehouse says, or people who hold in their emotions.

“Someone who is prone to these disorders probably internalizes, and tends to repress and hold their stress in their bodies and try to contain it,” she says. “These are kids who may not have a lot of emotional awareness and so when they’re having emotions, they don’t notice or attend to them or perhaps don’t really want to recognize them.”

Children and adolescents often develop these anxiety disorders as a coping mechanism when they’ve been unable to deal with stress or trauma in other ways.

“There’s often a stressful experience that has led up to these disorders,” Dr Whitehouse says. “There may be a trauma history or a history of not being able to directly express, process, or address emotions. Perhaps the child has observed others in the home who have medical problems who are getting care, and things are getting better.”

For example, Dr. Whitehouse describes a former patient whose mother had substance use disorder and a terminal illness. There was also other instability at home. “This child, growing up, saw that when Mom went to the hospital and saw doctors, she seemed to feel better, there was less tension and conflict between her parents and Dad didn’t seem to be as upset. And so there was this great sense of relief,” she recalls. “Meanwhile, this child wasn’t really allowing herself to experience emotions because she didn’t want to upset the apple cart at home.”

Years later, she adds, when the girl’s father had remarried and there was stress in the new household, she developed fears that she now had similar health concerns as her mother’s. “That’s how she was problem-solving,” she adds. “Not consciously, of course, but at some level she believed that if you see doctors and get whatever is wrong with you diagnosed, things stabilize at home.”

If your child is beginning to show signs of illness anxiety disorder or somatic symptom disorder, you may be able to prevent the disorder from taking hold by encouraging your child to share their feelings.

“I urge parents to carve out a little bit of time each day — even five minutes — to be present, check in with each of their children, and see how their day was,” Dr. Whitehouse says. “And if they mention something happened at school that was really stressful but say, ‘I’m fine,’ there’s an opportunity to pause and say, ‘Wow, I think if that had happened to me, I would’ve been pretty stressed. Tell me more about that.’”

From there, you can help your child explore and identify their emotions. “Validation is important, acknowledging emotions and modeling how you work through those emotions,” Dr. Whitehouse says.

Ideally, kids will learn healthy ways of expressing their emotions rather than having them manifest in unhealthy ways. “You’re giving them a more direct way to get attention for what’s really needed,” she adds.

If your child expresses deep concern or persistent worry over what they perceive to be a health problem, it’s always a good idea to start with their pediatrician or family healthcare provider to rule out any physical diagnoses. While some, particularly older children and adolescents, may push to see multiple physicians if they don’t get the diagnosis they anticipated, Dr. Whitehouse says it’s important to try to stay with a single provider, who can coordinate and communicate between any specialists, and help avoid multiple unnecessary (and costly) evaluations and tests.

Other children and adolescents with these disorders may try to avoid the doctor out of fear that their concerns will be confirmed and a serious illness will be diagnosed — or, conversely, their concerns will be dismissed as imaginary.

It’s important to remember that the symptoms they’re experiencing “are very real to them,” Dr. Whitehouse says. “So having a provider who says, ‘It’s all in your head. This is exaggerating. There’s nothing wrong with you,’ is extremely invalidating.”

In any situation in which feelings of anxiety or worry become so intense that they interfere with school or other activities, or if they last for weeks, it’s a good idea to see a mental health specialist for an evaluation.

As anxiety disorders, illness anxiety disorder and somatic symptom disorder are typically treated with cognitive behavioral therapy (CBT). In CBT, kids learn that their worries are just thoughts and not real things to be afraid of. They also learn how to recognize scary thoughts as they happen and ways to make them less scary.

Exposure therapy may also be used. In this treatment, the therapist will ask the child to take small steps toward tolerating the things that make them fear they are ill. Dr. Whitehouse offers the example of a child who gets worried that something is wrong if they are breathing hard after physical activity. The therapist might start by teaching them some breathing exercises and then offer a challenge, such as doing jumping jacks. Once they are out of breath, you help them notice the anxious thoughts, label these as thinking errors, and reassure themselves they are going to be okay. Then you can do breathing exercises together to show them they can challenge the thinking errors and work through their fear of being out of breath.

Left untreated, illness anxiety disorder and somatic symptom disorder can persist into adulthood. But children and adolescents who receive treatment for these disorders do very well, Dr. Whitehouse says.

“With treatment, the prognosis can be very good,” she says. “You need to resolve the underlying causes, and help a person develop more mindfulness and emotional awareness so that they’re not repressing their emotions. And then from there, via CBT with a skilled clinician, you can have a good resolution.”