Am I a Hypochondriac? Understanding Health Anxiety

By Ross Nelson, PsyD
Medically reviewed
December 5, 2019

It’s very normal to worry about our health. Scary health issues are often sensationalized in the news, and we all know people who have come down with health conditions we hope never to experience. Furthermore, with the internet, it’s tempting to turn to Dr. Google to look up all our aches and pains and read about terrifying diagnoses we might receive.

Some degree of concern over our health can keep us up-to-date with our doctors, making healthy decisions about diet and lifestyle, and can provide motivation to get to the gym or to a yoga class when all we want to do is sink into the couch with a gallon of ice cream. However, if worrying over your health becomes obsessive, drives you to your doctor’s office requesting tests to rule out diseases you have no symptoms for, or impedes your ability to enjoy your life, you might be suffering from health anxiety, also called illness anxiety disorder, or somatic symptom disorder.

You may have likely heard of the term hypochondriac because the disorder used to be called hypochondriasis. However, that term was removed from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM V) because, “the name was perceived as pejorative and not conducive to an effective therapeutic relationship,” according to the American Psychiatric Association.

It is believed that about 13% of the population lives with health anxiety, which is considered a long-term condition that can get better or worse at various times throughout someone’s life. Other estimates put health anxiety at 4-12% of the population. Health anxiety can be treated through therapy, most notably cognitive behavioral therapy (CBT). Sometimes an anti-anxiety medication is also useful in helping patients to ease and work with their fears.

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What Is Health Anxiety?

According to Current Psychiatry, health anxiety has, “three common presentations: disease conviction, disease fear, and bodily preoccupation.” A clinical level of health anxiety is defined by having excessive and consistent fear of having a serious medical condition despite receiving a clean bill of health and reassurances from health care providers. People with health anxiety also tend to focus on normal bodily sensations and interpret them as dangerous.

For example, someone with health anxiety might have a stomach ache, and rather than understand it as a reaction to something they ate or a slight bug, they fear that they have stomach cancer or appendicitis. People with health anxiety tend to fear severe illnesses like cancer or HIV, rather than more common health ailments like strep throat or a cold. People with health anxiety tend to regularly scan their bodies for any feelings or sensations that could be worrisome. The body is always gurgling, shifting, and producing strange sensations, so for those looking for them, they’re easy to find.

Health anxiety can appear in people who are physically healthy, as well as those with medical problems either in the past or present. Health anxiety is defined as excessive worry over their symptoms and conditions, in ways that are harmful to their well-being, relationships, and ability to function in their lives. Their fear of having a serious illness can cause them to repeatedly visit their doctors for tests and examinations.

However, they are often not reassured by the positive outcomes of these tests, rather they fear that the tests missed something or that their doctors are mistaken. Others with health anxiety may avoid the doctor completely, for fear they will find they have something very wrong.

Causes of Health Anxiety

Health anxiety usually starts in early adulthood. It is often triggered by the illness or death of someone you know, or your own health scare or bad experience with an illness or hospitalization.

Roughly two-thirds of those with health anxiety have a coexisting psychiatric disorder, most commonly an anxiety disorder like panic disorder or obsessive-compulsive disorder (OCD).

Depression also co-exists with health anxiety in about half of documented cases.

Some people who are more prone to develop health anxiety are those with a history of abuse, who had a serious childhood illness, whose parents were very ill, and with a high-stress lifestyle. Many people with health anxiety often have someone in their family who is also very worried about health, so it can sometimes be a learned behavior.

Health Anxiety Symptoms

It can be hard to tell if you or a loved one has a normal level of anxiety about health, or traits and behaviors that could be classified as health anxiety. Knowing what to look for can help you determine if you have more than a normal level of health anxiety. Some characteristic symptoms of health anxiety include:

  • You have no symptoms, but fear that you’re sick. Or, you consider normal functioning of the body to be signs that you have a serious illness.
  • You do not feel comforted or secured when tests show you’re healthy or when a doctor reassures you that you don’t have an illness you fear you do.
  • You spend a lot of time researching health conditions and symptoms online.
  • You worry about getting a serious disease when you hear about it in the news or find out someone you know is sick.
  • Your worries about your health prevent you from enjoying your family, work, and regular activities.
  • You constantly check yourself for any signs of illness.
  • You make frequent visits to your doctor requesting tests or exams for conditions you fear you have. Or, you avoid going to the doctor for fear of serious diagnosis.

Can Health Anxiety Cause Physical Symptoms?

Because health anxiety can activate the “fight or flight” system of the body, having excessive worries about your health can cause some physical symptoms. Common symptoms of anxiety that health anxiety can bring on include:

When people with health anxiety experience the symptoms above, they may interpret them to mean they have a serious illness, when in fact what is causing their symptoms is an onslaught of adrenaline caused by fearing for their health.

How Is Health Anxiety Diagnosed?

If you have many worries about your health, of course it’s important to consult with your doctor to rule out any physical health conditions. If your doctor rules out any of the health conditions you’re worried about, she may diagnose you with health anxiety, or illness anxiety disorder. In order to receive this diagnosis, according to the Mayo Clinic, you must satisfy many of the following:

  • Persistent worry about having or developing a serious illness, or having major health concerns for six consecutive months.
  • Worry about disease in the absence of physical symptoms, or very minimal symptoms.
  • Interpreting normal bodily sensations to mean you have a serious health condition.
  • Avoiding people or places you think might get you sick.
  • Avoiding doctor’s appointments so as not to receive feared diagnosis of serious illness.
  • Worrying about your health to the point that it disrupts your job, relationships, and enjoyment of your life.
  • Not feeling reassured by doctors when they tell you you’re healthy, or results that come back negative for a feared health condition.
  • Repeatedly checking your body for disease.
  • Repeatedly researching disease symptoms online.
  • Intense worry about an existing medical condition or a medical condition that runs in your family.

It’s common for people with health anxiety to have other mental health conditions as well, like:

  • Depression
  • Generalized anxiety disorder
  • Panic disorder
  • Phobias
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder

Health anxiety does not correlate with having any particular physical disease.

Treatment Options

Current Psychiatry states that, “a doctor-patient relationship based on mutual trust and respect is vital” when treating a patient with health anxiety. If a patient feels comfortable with and truly trusts their doctor, they are more likely to accept reassurance and a clean bill of health when it comes from them. Once a trusted doctor has ruled out serious ailments with tests and examinations, treatment includes:

  • Cognitive Behavioral Therapy (CBT): CBT is the most effective treatment for anxiety disorders, including health anxiety. In CBT, patients learn to recognize and disbelieve their excessive fears about their health. CBT can also help patients cope with anxiety symptoms that health anxiety can trigger. CBT is effective for those with health anxiety with co-occurring depression, although less so than for those with co-occurring anxiety.
  • Medication: Psychiatric medications, like anti-depressants and anti-anxiety medications, often selective serotonin reuptake inhibitors (SSRIs), can be used in conjunction with therapy to treat health anxiety.

What You Can Do at Home

In addition to communicating and working with your doctor, a mental health professional, and possibly a psychiatrist, there are some stress management and relaxation techniques that may be helpful for easing health anxiety that you can practice at home. These include:

  • Keeping a CBT journal about recurring health related fears and beliefs and writing exercise aimed at dismantling unhelpful beliefs with more healthy thoughts and behaviors.
  • Limiting the amount of time spent on online searches for health conditions and symptoms.
  • Focusing on hobbies and relationships that bring you joy and distract you from focusing on health concerns.
  • Self-talk that normal bodily sensations are not signs of something harmful, but just the body working as it should.
  • Keeping regular appointments with mental health providers and taking psychiatric medication if prescribed.
  • With your doctor, setting and sticking to a limit on doctor visits, tests, and referrals to specialists you request.

When to See a Doctor

If you have concerns about your health, it’s always a good idea to speak to your doctor. They can give you the proper tests to make sure you are healthy and well. It is possible to have both health anxiety and a medical condition, so just because you may have health anxiety, it is important to check on new symptoms that worry you. If your symptoms are found not to be related to a medical problem, it can be a good idea to get a referral to a mental health professional they know and trust, and to discuss how to proceed with scheduling visits for future health concerns.

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How K Health Can Help

Anxiety and depression are among the most under-reported and under-treated diseases in America. Nearly 20% of adults in the US suffer from mental health illness and fewer than half receive treatment. Our mission is to increase access to treatment for those suffering in silence.

You can start controlling your anxiety and depression and get access to the treatment you need with K Health. Starting at $23/month get prescriptions for mental health medications plus unlimited doctor visits through the K Health app. Start your free assessment to see if you’re eligible.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

Ross Nelson, PsyD

Dr. Ross Nelson is a licensed clinical psychologist and entrepreneur in Palo Alto, CA. He received his doctorate from the California School of Professional Psychology, and has professional expertise in cognitive behavioral therapy. He has worked in outpatient services at Kaiser Permanente, and as a psychologist for the startup, Crossover Health. Today, Dr. Nelson runs a private practice and is also the founder of Welleo Health. He is passionate about evidence-based therapy and addressing the global mental health crisis.

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