Health Anxiety (Hypochondria): Symptoms, Causes, Treatment

It is common to have anxiety about a health concern, illness, or recent diagnosis. But feeling preoccupied with worry that physical symptoms are signs of a serious illness even when there is no evidence to support it is called health anxiety or illness anxiety disorder (previously referred to as hypochondriasis). 

You may have health anxiety if you’re constantly worried about your health or have unrealistic fears about developing diseases and illnesses. Understanding the symptoms, causes, and treatments of health anxiety can help you to get the care you need. 

What is Health Anxiety?

Health anxiety (previously called hypochondriasis and now referred to as illness anxiety disorder, or IAD) is a mental health disorder defined by excessive worry about having or developing a serious undiagnosed medical condition. People with health anxiety experience chronic anxiety about developing a serious health condition even when results from examinations and tests performed by their medical provider are normal.

There are two main types of health anxiety:

1. Care-seeking: People with care-seeking health anxiety frequently use the healthcare system and may change their doctors often in search of multiple tests and treatments.

2. Care-avoidant: People with care-avoidant health anxiety will avoid seeking medical care for fear that it will reveal a life-threatening illness.

It’s important to note that people with health anxiety cannot control their anxiety, worry, and unrealistic fears about their health.

Symptoms

The main symptom of health anxiety is a persistent fear of having or developing a serious or life-threatening illness. Additional symptoms can also include:

• Excessive concern about health-related issues
• Excessive body checking for skin lesions, hair loss, or other physical changes
• Constantly seeking reassurance from family, friends, or healthcare providers

What Causes Health Anxiety?

The exact cause of health anxiety is unknown. But there are several risk factors that can increase the risk of developing the disorder, such as: 

• Being uncomfortable experiencing normal body sensations
• Being raised in a family where health anxieties are frequently discussed
• Having parents who were disproportionately anxious about health concerns
• Experiencing serious illness in childhood
• Having a parent or sibling who suffers from a serious medical condition
• Having an underlying anxiety disorder (including generalized anxiety disorder)
• A personal history of physical or sexual abuse

Diagnosis

Diagnosing health anxiety is a diagnosis of exclusion. This means that your healthcare provider will perform a comprehensive medical examination, which may include laboratory testing, to ensure that the physical symptoms you’re experiencing don’t indicate an illness or disease. If the examination and test results come back normal, your provider may refer you to a mental healthcare professional for evaluation.

The difference between concern for your health and health anxiety

Concern for your health is not the same as health anxiety, especially if you’ve experienced a severe illness in the past. Worrying about upcoming examinations, test results, or new physical symptoms is also not the same as health anxiety. However, it is common to have anxiety about a diagnosed health condition.

People with health anxiety will continue to feel anxious about their health even when examinations and test results come back normal. They may also feel disproportionately anxious about mild or benign symptoms, like their leg falling asleep. According to the DSM-5 diagnostic criteria, people with health anxiety will have severe anxiety about their health that lasts for six months or longer. 

Treatments for Health Anxiety

Treatment for health anxiety is focused on helping people with the condition cope with their unrealistic fears and worry. It’s recommended that people with health anxiety develop a trusting relationship with one primary care provider with whom they feel comfortable talking about their health concerns. 

It’s important that you find a primary care provider who acknowledges your concerns rather than brushing them aside or saying things like “it’s all in your head.” Your provider may also recommend working with a therapist or mental health provider. 

Psychotherapy

Psychotherapy, or talk therapy, is often the first-line treatment for health anxiety. Cognitive behavioral therapy (CBT) can be especially effective in helping you address your negative thoughts and behaviors. Other forms of therapy that can help treat health anxiety include mindfulness-based cognitive therapy (MBCT), and acceptance and commitment therapy (ACT).

Medication

Medication may also be used as part of your treatment plan for health anxiety. Types of prescription medication used to treat health anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs)
• Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Keep in mind that medication is rarely prescribed as a standalone treatment for health anxiety. In most cases, it should be used alongside psychotherapy. If a medication helps to curb your health anxiety, your provider may recommend taking the medication for at least 6-12 months. 

Tips for Managing Health Anxiety

Working with a healthcare provider and psychotherapist will help you to find strategies that work to manage your health anxiety. Some of these strategies may include:

Keep a diary

Keeping a diary of your anxieties, behaviors, and negative thoughts about your health can help you to identify when and how often these feelings and behaviors arise.  

Challenge your unrealistic fears

Challenging your unhelpful and unrealistic fears about health is a common strategy used in CBT. For example, if you often worry that your sore throat is a sign of throat cancer, you can work to challenge that anxiety by telling yourself that a sore throat is more commonly a sign of a more mild condition, like the common cold or allergies. Writing down these thoughts can also help you to challenge them in the future.

Distract yourself

When an anxious feeling or worry thought arises, try to distract yourself with a different activity, like calling or texting a friend or watching your favorite TV show.

Get back to enjoying normal activities

If your health anxiety makes it difficult to enjoy everyday activities, like spending time with friends and family or attending social events, try to gradually reincorporate these activities into your routine.  

Try relaxation techniques 

Research shows that mindfulness-based interventions can be effective at reducing anxiety in many people. Breathing exercises, including deep breathing, meditation, guided imagery, or mindfulness, can help you to practice mindfulness more regularly and lower your overall anxiety. Progressive muscle relaxation may also help to soothe physical tension caused by your anxiety. 

When to See a Medical Health Provider

It’s important to reach out to your medical health provider if you’re experiencing any of the signs of health anxiety, especially having disproportionate levels of anxiety about a possible or undiagnosed health concern. In addition to ruling out any illness or disease, your provider can refer you to other professionals and resources that can help to treat your anxiety. 

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