It’s not uncommon for people to occasionally worry that something is wrong with their health. However, for some, these worries become excessive and unrelenting. When someone has a persistent preoccupation or fear about having an undiagnosed medical illness, despite no or minimal signs or symptoms, it is known as health anxiety or hypochondriasis.
What are the signs and symptoms of health anxiety?
People with health anxiety tend to have extreme health-related worries that are disproportionate to their actual likelihood of being ill. They may experience some of the following signs and symptoms:
- Frequently worrying about having or developing a serious illness, even with no or minimal physical symptoms
- Being preoccupied with normal or common sensations in the body and interpreting them as signs of illness
- Repeatedly checking their body for signs of illness, such as lumps, tingling sensations, rashes, or asymmetry
- Seeking constant reassurance from loved ones or doctors that they do not have a serious illness
- Frequently looking up symptoms online and believing they have those conditions
- Avoiding activities due to exaggerated concerns about their health
- Repeatedly asking doctors to order tests or procedures to check for illnesses
- Obsessively examining their body for defects or asymmetry
People with health anxiety tend to be intensely preoccupied with their health and bodily sensations. They may wrongly attribute normal aches and pains to a catastrophic medical cause. Even when medical tests come back normal, they usually find it difficult to relax and move on.
What causes health anxiety?
There are several potential causes and risk factors for developing health anxiety:
- Genetics: Research suggests health anxiety can run in families, so genetics may play a role.
- Environmental factors: Traumatic medical experiences, having a serious illness as a child, or growing up with family members who had medical conditions can increase risk.
- Personality traits: People who are perfectionistic, prone to worry, or have trouble dealing with uncertainty may be more vulnerable.
- Biological factors: Differences in brain structure and functioning are associated with health anxiety.
- Cognitive biases: Paying selective attention to threatening health information while ignoring reassuring information can perpetuate fears.
Often, health anxiety arises from a complex interaction of multiple factors, including genetics, environment, cognition, and personality traits. Stress or traumatic life events can also trigger or exacerbate health anxiety in predisposed individuals.
When does health anxiety become a disorder?
Health anxiety exists on a spectrum from mild to severe. According to the DSM-5 diagnostic manual, it becomes a mental disorder requiring treatment when:
- The individual has excessive health-related worries most days for at least 6 months.
- The health anxiety causes significant distress or interferes with daily functioning.
- Even after an appropriate medical evaluation finds no evidence of illness, the worries persist.
Many people have some degree of health anxiety, especially in times of stress. But health anxiety becomes problematic when persistent, unrelenting worries about illness cause substantial distress and disruption to daily life over an extended period.
How is health anxiety diagnosed?
To diagnose health anxiety disorder, a mental health professional performs a psychological evaluation asking about symptoms, thoughts, behaviors, and related issues. They may also:
- Ask about any relevant medical history
- Rule out other conditions with similar symptoms
- Assess the nature, severity, and duration of health worries
- Evaluate how the individual’s functioning is impacted
The clinician needs to determine that the person’s health anxiety is disproportionate to their actual medical status and physical symptoms. Often, they have to assess whether health worries are irrational or if further medical investigation is warranted. Questionnaires and scales may help quantify the extent of health anxiety.
What conditions are associated with health anxiety?
Health anxiety often co-occurs with or leads to development of other mental health conditions, including:
- Generalized anxiety disorder (GAD): Chronic uncontrollable worry about a variety of topics, including health.
- Depression: Persistent feelings of sadness, hopelessness, and loss of interest in life.
- Panic disorder: Recurring panic attacks characterized by sudden terror along with physical symptoms like chest pain.
- Obsessive-compulsive disorder (OCD): Intrusive thoughts (obsessions) and repetitive behaviors (compulsions) done to alleviate anxiety.
- Somatic symptom disorder: Experiencing multiple chronic physical symptoms along with excessive thoughts, feelings, and behaviors related to the symptoms.
The anxiety, preoccupation, and stress associated with health anxiety can also worsen physical illnesses or symptoms the individual already has.
How is health anxiety treated?
Cognitive behavioral therapy (CBT) is the most effective and commonly used treatment for health anxiety. Treatment components may include:
- Building a collaborative relationship between the therapist and client.
- Education about health anxiety and how thoughts, feelings, and behaviors interrelate.
- Cognitive restructuring to identify and modify unrealistic health-related thoughts.
- Exposure therapy to gradually face feared medical situations until anxiety decreases.
- Response prevention to reduce compulsive health checking and reassurance seeking.
- Relaxation training to manage anxiety and stress.
- Problem solving to improve daily functioning and quality of life.
Some individuals may also benefit from antidepressant medication or joining a health anxiety support group. Overall, CBT provides clients with new skills and strategies to manage their symptoms, alter dysfunctional thoughts, and stop avoiding health-related situations.
What tips can help cope with health anxiety?
Along with professional treatment, some self-help tips that can aid in managing health anxiety include:
- Avoid excessive online searches for health information, which can feed anxiety.
- Find alternative relaxing activities when you notice health worrying.
- Focus attention outwardly on external events rather than inwardly on bodily sensations.
- Exercise regularly to manage anxiety and improve mood.
- Share feelings with trusted friends and family who can provide reality-testing.
- Write down excessive health worries then try to rationally challenge or postpone them.
- Set reasonable limits on checking your body, seeking reassurance, or having tests done.
- Remind yourself that medical uncertainty is part of life and doesn’t necessarily mean you are ill.
While not a substitute for professional treatment, these tips can help reduce anxiety provoking behaviors and establish more balanced thinking patterns related to health concerns.
What is the outlook for people with health anxiety?
With appropriate treatment and support, many people with health anxiety can substantially improve their symptoms and quality of life. CBT has been found highly effective, with over 75% of people experiencing significant reduction of health anxiety.
Some important indicators of positive prognosis include:
- Willingness to engage in CBT
- Strong therapeutic relationship with one’s clinician
- Social support from loved ones
- Absence of severe mental illness or medical conditions
- Motivation and persistence to apply management techniques
While health anxiety can be chronic if left untreated, most people can achieve greatly reduced symptoms and restored functioning with CBT interventions. Support groups also help many people feel less isolated as they manage their health concerns.
Conclusion
Health anxiety is characterized by obsessive worrying about having a serious medical illness despite no or minimal objective physical symptoms. Also known as hypochondriasis, it causes significant distress and life disruption. While occasional health worries are normal, they become problematic when excessive, disproportionate, uncontrollable, and persistent.
Health anxiety likely arises from a combination of biological, psychological, and social factors. Treatments like CBT, medication, and support groups can help people reduce fears about illness and resume a more balanced lifestyle. With proper intervention and self-care strategies, the prognosis for health anxiety is generally very good.
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Key Points
- Health anxiety involves disproportionate preoccupation with fears of having a serious illness despite little or no physical symptoms.
- It becomes a mental health disorder when persistent worries cause significant distress and interfere with daily functioning.
- Contributing factors can be biological, psychological, social, and involve cognitive biases.
- Health anxiety often co-occurs with conditions like generalized anxiety, depression, and OCD.
- Cognitive behavioral therapy focusing on altering thoughts and behaviors has proven very effective in treating health anxiety.
- With proper treatment and management, many people with health anxiety can resume more balanced, functional lives.