Health Anxiety | Signs, Causes and How Therapy Can Help
Health anxiety is when worrying about being ill, or about becoming ill, takes up so much of your attention that it begins to shape your life. The bodily sensations you notice are real, and so is the fear. There is a form of cognitive behavioural therapy developed specifically for health anxiety, with good evidence behind it.
Featured in
What is health anxiety?
Almost everyone worries about their health sometimes. A lump, an unfamiliar ache, a headache that lasts longer than usual. Most of the time the worry rises, you get it checked or it passes, and life carries on.
Health anxiety is different in two ways: proportion and persistence. The fear is bigger than the evidence supports, and it does not settle when it should.
Most people describe a recognisable cycle. You notice a sensation. You interpret it as a sign of something serious. You do something to reduce the fear, such as checking your body, searching online, or asking someone close to you whether they think it is normal. The fear drops for a while, and then it returns, often stronger, and often attached to a new sensation.
The relief is the problem. Reassurance works briefly and then wears off, which teaches you to seek it again. Over time you need more of it, more often, for less relief.
You may have heard this called hypochondria, or heard someone described as a hypochondriac. Those terms have largely fallen out of clinical use because they carry a suggestion that the person is exaggerating or making it up. That is not what is happening.
Reliable figures on how common health anxiety is are hard to come by. Estimates in the research range from well under 1% to around 4.5% of the general population, and higher again among people attending medical clinics. What is clearer is that it is frequently missed, and that people often live with it for years before anyone names it.
Is health anxiety a recognised condition?
Yes, though it appears under different names depending on which classification system you look at, and the two major systems disagree about what kind of condition it is.
ICD-11, used across the NHS, keeps the older term hypochondriasis but has moved it into the group of obsessive-compulsive and related disorders. The reasoning is that the pattern looks like OCD in important ways: repetitive intrusive thoughts about illness, and repeated behaviours such as body checking that are driven by the preoccupation. These conditions also tend to run together in families and to respond to similar treatments.
DSM-5-TR, used more in research, takes a different view. It divides these presentations into illness anxiety disorder, where the worry is about illness without significant physical symptoms, and somatic symptom disorder, where physical symptoms are present and the distress attaches to them.
The NHS follows the first of these, describing health anxiety as related to obsessive compulsive disorder.
What none of this means is that health anxiety is a lesser or vaguer problem than a condition with a tidier label. It means the classification systems are still working out where it sits.
One practical consequence is worth knowing. NICE, which publishes the national guidance that shapes NHS treatment in England and Wales, has never issued a guideline for health anxiety specifically. This has been raised in the medical literature as a gap. It does not mean treatment is guesswork, and the treatment section below explains what the evidence actually rests on.
Signs of health anxiety
Health anxiety tends to show up in what you do as much as in what you feel.
Things you may find yourself doing
checking your body repeatedly for lumps, marks or changes
searching online for symptoms, sometimes for hours
asking family, friends or doctors for reassurance, then needing to ask again
booking appointments and tests, or avoiding them entirely because of what they might find
monitoring your pulse, breathing or temperature
Things you may find yourself thinking
that an ordinary sensation is a sign of something serious
that a normal test result was wrong, or missed something
that you would rather know than not know, while also dreading finding out
that other people do not take your concerns seriously
How it may feel physically
Anxiety produces genuine physical effects, including a racing heart, tension, dizziness, nausea and disturbed sleep. These are often the very sensations that then get interpreted as evidence of illness.
What you may be avoiding
Medical programmes and health news, conversations about illness, hospitals, exercise that raises your heart rate, or people who have been unwell.
Not everyone experiences all of these, and the specific illness that worries you may change over time.
Can health anxiety cause physical symptoms?
Yes, and this is one of the most important things to understand about it.
The symptoms are not fake, and you are not imagining them. Anxiety triggers a genuine physiological response. Your heart beats faster, your muscles tense, your breathing changes, your digestion is affected. That produces palpitations, chest tightness, headaches, dizziness, stomach upset and fatigue, all of which are real bodily events.
Two further things then amplify them. Attention makes sensations louder: focus on your swallowing for a minute, and it starts to feel effortful. And checking can create what it looks for, since repeatedly pressing an area or examining your throat leaves it sore.
So the loop is genuinely closed. Anxiety produces sensations, the sensations are read as illness, and that reading produces more anxiety.
One caution matters here. Understanding this does not mean assuming that every symptom is anxiety. If something is new, persistent or changing, get it checked once, properly, by a GP. Health anxiety and physical illness can and do coexist, and part of good treatment is being able to respond sensibly to real symptoms rather than either catastrophising or dismissing them.
What causes health anxiety?
There is no single cause, and it can develop at any point in life.
Factors that come up repeatedly in NHS clinical services include watching a family member experience serious illness, particularly during childhood or adolescence, having a parent who was themselves very worried about health, having been seriously ill yourself, and exposure to distressing health information online or in the media.
That last one has grown. The pattern of searching symptoms online and finding the most alarming explanation is now common enough that researchers have given it a name, cyberchondria, and there is evidence that health anxiety in medical clinics has increased over recent decades.
More is known about what keeps health anxiety going than about what starts it, and this is more useful anyway. Checking, reassurance-seeking, searching and avoidance all reduce anxiety briefly and strengthen it over time. Those maintaining behaviours are what treatment works on directly.
If you are unsure and would like to speak to one of our specialists, please don’t hesitate to reach out to our team today.
How is health anxiety treated?
There is no NICE guideline for health anxiety, so treatment is not shaped by a national protocol in the way it is for generalised anxiety disorder or OCD. What exists instead is a body of trial evidence for a version of CBT built specifically for health anxiety, and it is reasonably strong.
-
The model most commonly used in the UK was developed by Salkovskis and Warwick. Rather than trying to establish whether you are ill, it works on how illness-related thoughts are being interpreted and on the behaviours keeping the cycle going. In practice that usually means building a shared understanding of your particular pattern, reducing checking and reassurance-seeking in a planned way, testing predictions rather than arguing with them, and rebuilding activities that health worry has narrowed.
The largest UK trial, CHAMP, followed 444 patients recruited from cardiology, endocrinology, gastroenterology, neurology and respiratory clinics across five general hospitals in England. Participants received between four and ten one-hour sessions of CBT for health anxiety. The benefit was sustained over five years, and generalised anxiety and depressive symptoms improved more than with standard care.
An earlier Cochrane review also found CBT among the psychotherapies effective for hypochondriasis, though it noted that the trials available at that point were small.
-
A GP may offer medication for anxiety, usually an SSRI, either instead of or alongside therapy. Medication is prescribed by a GP or psychiatrist rather than a psychologist.
-
The NHS suggests keeping a note of how often you check your body, seek reassurance or look up health information, then reducing that gradually over a week rather than stopping abruptly. It also suggests writing health worries alongside more balanced alternatives, finding something absorbing to do when the urge to check arrives, and gradually restarting the activities you have been avoiding.
These are worth trying. If the pattern is long-standing, structured treatment tends to be what shifts it.
Support for health anxiety at Regal Private Therapy Practice
Our Clinical Psychologists offer individual CBT for health anxiety to adults, working with the specific cycle that keeps it going rather than trying to argue you out of your worries.
That means understanding what your checking and reassurance-seeking are doing for you before changing anything, then reducing them at a pace you can manage, and testing what actually happens when you do. It also means being straightforward about the fact that treatment is not about becoming unconcerned with your health. It is about being able to notice a sensation without it taking over your week.
We know that arranging therapy can feel difficult when part of what you are worried about is being told something you do not want to hear. The first conversation is a free 15-minute consultation with a Clinical Psychologist, not an assessment, and you are welcome to email rather than call.
Read more about therapy for adults and about cognitive behavioural therapy.
If you are looking for support for a child or teenager whose worries centre on illness, see therapy for children and adolescents.
If you need urgent support
If you are struggling to cope or worried about your safety, help is available now. Call 111 and select the mental health option, or contact your GP. Samaritans are available 24 hours a day on 116 123. If you are worried about a child or young person, the YoungMinds Parents Helpline offers free advice. In an emergency, call 999 or go to your nearest A&E.
Frequently asked questions about health anxiety
-
They are closely related. ICD-11 places hypochondriasis, the clinical term for health anxiety, within the group of obsessive-compulsive and related disorders, because both involve repetitive intrusive thoughts and repeated behaviours such as checking. The NHS describes health anxiety as related to OCD. They remain separate diagnoses.
-
They describe the same thing. Hypochondria and hypochondriac are older terms that have largely fallen out of clinical use, because they suggest someone is exaggerating or inventing symptoms. Health anxiety is the term now generally preferred in UK services, and hypochondriasis remains the formal diagnostic name in ICD-11.
-
It can improve substantially. In the largest UK trial of CBT for health anxiety, improvements were still present five years after treatment. Recovery is usually gradual rather than sudden, and it tends to look like health worries becoming manageable and occasional rather than disappearing entirely.
-
In the main UK trial, treatment ran to between four and ten one-hour sessions. In practice the length depends on how long the pattern has been established and whether anything else is going on alongside it. Your psychologist should discuss an expected range with you at assessment.
-
Stopping abruptly rarely works and often increases anxiety. The NHS suggests noting how often you search, then reducing gradually over a week or so. In treatment this is done deliberately, alongside understanding what the searching is doing for you, which tends to be more sustainable than willpower alone.
-
NICE does not recommend mindfulness-based interventions for social anxiety disorder, including mindfulness-based cognitive therapy and mindfulness-based stress reduction. NICE examined further evidence during surveillance in 2017 and left the recommendation in place. Mindfulness may still be useful for general wellbeing.
Contact Our Team Today
References
NHS. Health anxiety. https://www.nhs.uk/mental-health/conditions/health-anxiety/
First MB, Reed GM, Saxena S et al. (2021). An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry.
Tyrer P, Salkovskis P, Tyrer H et al. (2017). Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years. Health Technology Assessment 21(50).
Tyrer P, Cooper S, Salkovskis P et al. (2014). Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. The Lancet 383(9913).
Thomson A, Page L (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, CD006520.