What Is Health Anxiety?

Health anxiety is persistent, excessive worry about having or getting a serious illness, even when exams and tests are normal. The clinical name is illness anxiety disorder. The Merck Manual defines it as "preoccupation with and fear of having or acquiring a serious disorder" and notes that the diagnosis applies when the preoccupation has lasted 6 months or more.

A short course of therapy can help, and the best evidence comes from ordinary hospital clinics. In a trial published in The Lancet, researchers screened 28,991 patients at hospital cardiology, endocrine, gastroenterology, neurology and respiratory clinics and enrolled 444 with excessive health anxiety. Those who received 5 to 10 sessions of adapted cognitive behavioral therapy improved more than those given standard care, and the benefit was still present 2 years later. This post covers the symptoms, how health anxiety differs from ordinary worry, how it is diagnosed, and what treatment looks like.

This article is for general education and is not medical advice. Talk with your prescriber before starting, stopping or changing any medication.

What Is Health Anxiety?

Health anxiety is a pattern in which fear of illness takes up a large share of a person's attention and does not settle with reassurance. Everyone worries about a strange symptom now and then. With health anxiety, the worry returns after a normal test, shifts to a new illness, or grows until it crowds out work, sleep and relationships.

The fear is real even when the disease is not. MedlinePlus describes illness anxiety disorder as a preoccupation that physical symptoms are signs of a serious illness, and it notes that people often believe any symptom or sensation points to something serious.

The Merck Manual groups the condition under somatic symptom and related disorders. Its worry and checking can resemble anxiety disorders and OCD, which is why an evaluation looks at the whole picture.

What Are the Symptoms of Health Anxiety?

The Merck Manual summarizes the diagnostic features this way:

• Preoccupation with having or getting a serious illness.

• No physical symptoms, or only mild ones.

• A high level of anxiety about health and being easily alarmed by personal health matters.

• Either repeated checking of the body for signs of illness, or avoiding doctor appointments and hospitals.

• Preoccupation lasting 6 months or more, although the feared illness may change during that time.

• Symptoms that are not better explained by depression or another psychiatric disorder.

In daily life, checking can take many forms, such as examining the same mole every morning, taking your pulse repeatedly, or searching symptoms online for hours. Reassurance seeking is common too. MedlinePlus notes that people with the disorder seek reassurance from family, friends or health care providers on a regular basis.

Anxiety itself produces physical sensations, including a fast heartbeat, muscle tension and an upset stomach. Those sensations can then be read as proof of illness, which feeds the cycle. The post on how anxiety affects physical health explains that connection.

Is Health Anxiety the Same as Hypochondria?

It is the same idea under a newer name. The Merck Manual explains that illness anxiety disorder was previously called hypochondriasis or hypochondria, and that those terms were abandoned because of their pejorative connotation.

The change matters for more than politeness. Calling someone a hypochondriac suggests the problem is imaginary. The current term treats it as an anxiety problem with recognized criteria and treatment.

There are also two recognized types. According to the Merck Manual, some patients visit clinicians frequently, which is the care-seeking type. Others rarely seek medical care, which is the care-avoidant type. Someone who is too frightened of bad news to schedule a checkup can have health anxiety just as much as someone who visits urgent care every month.

Who Gets Health Anxiety?

The Merck Manual reports that illness anxiety disorder commonly begins in early adulthood and appears to occur equally among men and women.

It also shows up alongside real medical conditions. The Lancet trial recruited its participants from specialty clinics, where people were already being seen for heart, hormone, digestive, nerve and lung problems. Having a diagnosis does not rule out health anxiety, and health anxiety does not rule out a diagnosis. The post on how chronic illness affects mental health covers that overlap.

How Is Health Anxiety Diagnosed?

Diagnosis starts with making sure medical causes have been reasonably checked. A provider reviews your symptoms, your medical history and any testing already done. New, severe or changing symptoms need a medical evaluation first. Call 911 for chest pain, trouble breathing or signs of a stroke.

A mental health evaluation then looks at how long the worry has lasted, how much time it takes, what you do in response, and how it affects your life. The provider also checks for conditions that can look similar or occur together, including generalized anxiety disorder, panic disorder, depression and OCD. The difference is often in the focus. In generalized anxiety, the worry moves across money, family, work and health. In health anxiety, it stays on illness.

How Is Health Anxiety Treated?

Two treatments have support: cognitive behavioral therapy and antidepressant medication. The Merck Manual states that selective serotonin reuptake inhibitors may be helpful, as may cognitive behavioral therapy.

The Lancet trial led by Tyrer is a large test of therapy. Patients assigned to adapted cognitive behavioral therapy had 5 to 10 sessions with hospital-based therapists. At 1 year, their scores on the Health Anxiety Inventory had improved by 2.98 points more than the scores of patients receiving standard care. The authors reported that the benefit was sustained over 2 years, with no significant effect on total health care costs. The post on how cognitive behavioral therapy reduces anxiety describes how that kind of therapy works.

Medication is a separate decision. Antidepressants take time to work, and whether one makes sense depends on how severe the symptoms are and what else is going on. Ask your prescriber what improvement to expect and how long a fair trial takes.

The relationship with your clinician counts as well. The Merck Manual notes that patients can benefit from a trusting relationship with a caring, reassuring clinician. Seeing one provider consistently is different from seeking a new opinion each time the fear returns.

What Helps Between Appointments?

Daily habits do not replace treatment. The anxiety page from T and C Psychiatric Services lists several practical strategies for managing anxiety in everyday life: practice deep breathing, keep a daily routine, limit caffeine and alcohol, and get regular physical activity.

It can also help to notice your own checking and reassurance habits and bring that list to an appointment. A therapist can use it to build a plan. Obsessive checking of other kinds is discussed in the post on what OCD looks like beyond the stereotypes.

FAQ

What is the medical term for health anxiety?

Illness anxiety disorder. Older sources call it hypochondriasis or hypochondria.

How long does health anxiety have to last to be a disorder?

The Merck Manual describes preoccupation with illness lasting 6 months or more as part of the diagnostic criteria. The specific illness a person fears can change during that time.

Can health anxiety cause real physical symptoms?

Anxiety can cause real sensations such as a fast heartbeat, muscle tension and stomach upset. They are not imagined, and they can make the fear of illness feel more convincing.

Does avoiding the doctor mean I do not have health anxiety?

No. There is a care-avoidant type in which a person rarely seeks medical care because of fear.

Is health anxiety a form of OCD?

They are separate diagnoses. Both can involve unwanted worry and repeated checking, so an evaluation is the way to tell them apart.

Can medication help health anxiety?

The Merck Manual states that selective serotonin reuptake inhibitors may be helpful. Whether medication is right for you is a decision to make with your prescriber.

Help for Anxiety in Greensburg, PA

T and C Psychiatric Services LLC in Greensburg, PA offers evaluations and assessments, medication management and ongoing monitoring for anxiety. Its board-certified nurse practitioners can also connect you with trusted local therapists. Visits are available in person and through online and remote services.

If you or someone you know is in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline, text HOME to 741741 to reach the Crisis Text Line, or call 911 for an immediate emergency.

Visit T and C Psychiatric Services or call 724-951-2413 today. Contact us for more information.