Pediatric somatic symptom disorder includes emotional distress that causes a child to fixate on physical symptoms (i.e., headaches, stomachaches, tiredness), therefore enabling them to think that they have a serious illness.

Pediatric Somatic Symptom Disorder 

Pediatric illness anxiety disorder is characterized by children who worry a lot about being sick, even though they have no symptoms. This fixation causes them to become severely stressed and anxious that it can hinder them from normal activities (i.e., school). Additionally, children will engage in care-seeking, in which they will spend a lot of time in a healthcare setting, or are care-avoidant, in which they don't trust doctors or healthcare providers. 

Pediatric Illness Anxiety Disorder

In the DSM-5, the diagnosis of hypochondriasis (i.e., health anxiety) was replaced by two new diagnostic entities. Both diagnoses share high health anxiety as a common criterion. 
- Somatic Symptom Disorder (SSD)
- Illness Anxiety Disorder (IAD) 

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University of California, San Diego

Health anxiety refers to excessive concerns regarding one's health. While the DSM-5-TR suggests that the condition primarily begins in adulthood, retrospective reports point to a possible origin in childhood with onset as early as preschool age. 

Health Anxiety in Children 

Hypochondriasis, commonly known as hypochondria was considered a disorder where an individual believes that they have illnesses or symptoms of diseases, even when they did not. It caused anxiety and distress for patients, and potentially impeded their day-to-day functioning. However, in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders), hypochondria itself was declassified as a separate disorder and instead was considered a symptom or manifestation that occurred in two different disorders. Certain characteristic features of hypochondriasis were classified under Illness Anxiety Disorder and more severe manifestations under Somatic Symptom Disorder. These disorders are both largely characterized by the preoccupation over certain undiagnosed or unexplained symptoms that persist in the individual. 

Hypochondriasis 

Bailer, J., Kerstner, T., Witthöft, M., Diener, C., Mier, D., & Rist, F. (2016). Health anxiety and hypochondriasis in the light of DSM-5. Anxiety, stress, and coping, 29(2), 219–239. https://doi.org/10.1080/10615806.2015.1036243

Health anxiety and hypochondriasis in the light of DSM-5

Health anxiety symptoms within children include, but are not limited to: 
- Worrying about or preoccupation with fears of harboring a severe physical disease
- Bodily preoccupation
- Persistence of preoccupation despite medical evaluation and reassurance 

Health Anxiety Symptoms in Children 

Research suggests that children's health concerns are positively associated with increased levels of physical health problems. One study found that children with impairing functional somatic symptoms (i.e., muscle/joint pain, headaches, fatigue) were reported to have higher levels of health anxiety symptoms compared with children with non-impairing functional somatic symptoms. 

Association between health anxiety and physical health problems in children 

Research points out that the transmission of health anxiety from parent to child is likely a combination of genetics, environment (i.e., parent psychopathology, parent modeling, and reinforcing behaviors), and the interaction of the two factors. Additionally, it was found that parents who have physical health conditions (i.e., functional bowel symptoms) engage in increased treatment seeking for their children with benign symptoms (i.e, sniffles, colds). 

Transmission of health anxiety from parent to child

Health-related worries and behaviors are common in children and adolescents. In a study evaluating health anxiety in children and adolescents, it was found that 15.7% of 14 to 19 year olds reported "clinically hypochondriacal symptoms," and the parents of 2.7% of 5 to 7 year olds reported "considerable" health anxiety symptoms in their children. 

Prevalence of health anxiety in children and adolescents 

A child's cognitive ability to process and understand complex information is more limited and concrete in comparison with adults. This makes it more difficult for children to understand abstract information, such as a "viral"health-related threat. Cognitions typically center on the risk and likelihood of becoming ill with COVID-19, alongside thoughts of how catastrophic this could be (i.e. ultimately death of self/parent).

Health anxiety in children related to COVID-19 

This article explores how growing up in dysfunctional home environments can lead to mental disorders in children.  

Summary for Dysfunctional Family Environments and Child Psychopathology

Reference for Dysfunctional Home environments and Childhood Psychopathology

Chappel, A. (n.d.). Toward a Lifestyle Medicine Approach to Illness Anxiety Disorder (Formerly Hypochondriasis). https://journals.sagepub.com/doi/full/10.1177/1559827618764649?casa_token=fo_C6Nu_1NgAAAAA%3ATsT1fWeBA10OM279_cF24uSXGx1qNM23vrKV-TSpRZUujyN0UOtyNyZP22q_dEv6fz6Pa4SjhOMjQg. 

Toward a Lifestyle Medicine Approach to Illness Anxiety Disorder (Formerly Hypochondriasis)

Harding, K. J., Skritskaya, N., Doherty, E., &amp; Fallon, B. A. (2008). Advances in understanding illness anxiety. Current Psychiatry Reports, 10(4), 311–317. https://doi.org/10.1007/s11920-008-0050-1 

Advances in understanding illness anxiety


Newby, J. M., Hobbs, M. J., Mahoney, A. E. J., Wong, S. (K., &amp; Andrews, G. (2017, July 23). DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis. Journal of Psychosomatic Research. Retrieved August 15, 2022, from https://www.sciencedirect.com/science/article/abs/pii/S0022399917307201?casa_token=BT8X_Jp3rlcAAAAA%3AMdA2qtqdUT4_k5MQoPrMM8x9bzZY-FLQfPBpWQp76OJAoYiHMsokhLuJsP-6aGGaAGIqFidK 

DSM-5 illness anxiety disorder and somatic symptom disorder

Rivera, R. M., &amp; Carballea, D. (2020). Coronavirus: A trigger for OCD and illness anxiety disorder? Psychological Trauma: Theory, Research, Practice, and Policy, 12(S1). https://doi.org/10.1037/tra0000725 

 Coronavirus: A trigger for OCD and illness anxiety disorder

Illness Anxiety Disorder  (IAD) is a disorder, colloquially or previously referred to as hypochondria, where individuals experience stress and anxiousness about having an illness or pre-empting an illness that they have not been diagnosed with.  his can range from stressing about having certain symptoms to being keenly aware of any sensations that can link to the illness (however normal they may be) or investing time and effort trying to understand potential health concerns. Even when people do not have any illness and are told so by medical professionals, if they have IAD they are likely to continue to feel anxious. 

Illness Anxiety Disorder

Somatic Symptom Disorder is a severe form of the phenomenon colloquially referred to as hypochondriasis, where an individual is anxious about and concerned about somatic symptoms. Somatic symptoms are symptoms that are not linked to a medical condition which the patients tend to focus on but can cause stress anxiousness and even physical pain. They tend to seek out healthcare services for these symptoms which can rarely assuage their concerns. 

Somatic Symptom Disorder 

The term cyberchondria is used to explain hypochondria or illness anxiety disorder in our current technological landscape. Illness Anxiety has the potential to be exacerbated with easy access to technology. When people with illness and anxiety are concerned about their symptoms they can easily research the symptoms and potential disorders and are very often overwhelmed by the amount and the nature of the information. This is particularly pronounced during COVID-19 when new information on the disease and symptoms is easily available on the internet. 

Cyberchondria

Ever since COVID-19, people with health anxiety are likely to experience more enhanced symptoms of the disorder. They are likely to experience stress about developing COVID-19 symptoms or interpret their normal sensations as being related to the onset of COVID. This is particularly dangerous with a relatively new infection like COVID since a lot of information and studies are not concrete as they are still being developed. Long-term research on COVID is not easily available so the reliability of the information that the person with health anxiety is consuming comes into question. During the pandemic, there is also an emphasis on certain behaviors like cleaning, sanitizing, and checking biomarkers which may become a part of the daily lives of such individuals. Given that paranoia during the pandemic is normal, it is harder to notice the difference between people who are actually suffering from health anxiety. However, as the pandemic subsides the risk of infection, re-infection and long-term will still persist and that’s where one can trace the level of stress and anxiety to someone  with a chronic disorder.

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