Health anxiety

Everyone worries about their health sometimes. Health anxiety is different. The fear of having, or getting, a serious illness takes up so much time that it starts to run your life.³

People with health anxiety are not faking, and they cannot simply switch the fear off.¹ The good news is that it responds well to treatment, especially a talking therapy called cognitive behavioral therapy (CBT).⁵

What is health anxiety?

Health anxiety is the common name. Doctors may call it illness anxiety disorder. It used to be called hypochondria, but that word fell out of use because it sounded like an insult.²

A doctor may diagnose illness anxiety disorder when:²

• You have been worried about having or getting a serious illness for at least six months.
• You have few or no physical symptoms, or only mild ones.
• The fear stays even after an exam and tests find no serious problem, or find only a minor one that does not match the level of worry.
• The worry causes real distress or gets in the way of work, family or daily life.

Some people with health anxiety see doctors very often. Others feel so afraid of bad news that they avoid doctors altogether.² Both patterns come from the same fear.

A related condition. In illness anxiety disorder, the fear of disease is the main problem, and physical symptoms are mild or absent. When a person has strong physical symptoms, such as pain, and is very worried about them, a doctor may diagnose somatic symptom disorder instead.^2,1 Health anxiety is also related to obsessive-compulsive disorder (OCD), because both involve repeated checking.³

How common is it?

Numbers vary a lot depending on how studies define it. A review of 47 groups of people found health anxiety in about 2 to 13 in 100 adults, depending on the study. The full disorder, as it was defined then, was much rarer, at well under 1 in 100 on average.⁴

It is far more common in medical clinics. In a large British study of nearly 29,000 hospital outpatients, about 1 in 5 had a level of health anxiety that needed attention.⁷

It affects men and women about equally.^1,2 It most often begins in early adulthood.²

Signs of health anxiety

You may have health anxiety if you often:^3,2

• Worry about your health most days, or for hours at a time
• Check your body for signs of illness, such as feeling for lumps, taking your pulse or looking at your skin again and again
• Ask for reassurance from family, friends or doctors that you are not sick
• Feel that the doctor or the tests must have missed something
• Search for symptoms online or read a lot about diseases in the news
• Avoid reminders of illness, or avoid exercise because you fear it could harm you
• Take normal body sensations, or signs of anxiety such as a headache or racing heart, as proof of disease

The focus of the fear may shift over time, and symptoms are often vague.¹ For example, one month the worry may be cancer, and the next month a heart problem.

Why checking and reassurance keep the worry going

Health anxiety tends to run in a loop:

1. A trigger. You notice a body sensation, such as a skipped heartbeat, or hear about someone who got sick.
2. A scary thought. "What if this is cancer?" "What if my heart is failing?"
3. Anxiety rises. Your heart speeds up and your muscles tense. These new sensations seem like more proof of illness.
4. A safety behavior. You check your body, search online, ask someone you trust, or book another test.
5. Brief relief. You feel better for a while.
6. The worry comes back, often stronger. Your brain learns that the danger was real and that checking is the only way to feel safe.

Paying close attention to the body makes you notice more sensations. That extra noticing then fuels more worry.¹ Reassurance helps only for a short time.¹ It can even backfire if a person starts to feel the doctor is not taking them seriously.²

Internet searches can add fuel. Online, rare and frightening causes sit right next to common, harmless ones. A search about a headache can lead you to pages about brain tumors, even though headaches are often a sign of stress.³

What causes health anxiety?

There is no single cause. Some things that seem to play a part:

• Misreading normal body signals. Many people with health anxiety take minor sensations, or normal body processes like a heartbeat, as signs of danger.²
• Trouble living with uncertainty. Finding it very hard to accept "probably fine" instead of "definitely fine" is linked with health anxiety in both younger and older adults.¹²
• Fear of anxiety sensations themselves. Being frightened by a racing heart or dizziness is linked with health anxiety, including in older adults.¹²
• Hard life experiences. People who have lived through physical or sexual abuse are more likely to develop it, though many people with health anxiety have no such history.¹
• Other anxiety or mood problems. Health anxiety can come with depression, other anxiety or panic attacks.¹ It can also overlap with generalized anxiety.

Read more in what causes anxiety.

Health anxiety in later life

Older adults often have more real health problems and medical visits, so it can be hard to tell sensible concern from too much worry. One study found older adults reported less health anxiety on average than younger adults.¹² Even so, it can be a heavy burden.

A few things are worth knowing:

• New symptoms deserve a check. Tell your doctor about anything new, severe or lasting.
• Watch the pattern. A worry that settles after a visit is normal. One that returns within days, or jumps to a new disease, may be health anxiety.
• Memory worries. Forgetting a name can set off fear of dementia. If memory problems affect daily life, see a doctor. See the first doctor visit about memory.
• Fear of falling is a related worry. See fear of falling.
• Treatment works in medical settings. In the British study above, patients up to age 75 from heart, lung, stomach, hormone and brain clinics had about six one-hour CBT sessions on average. Their health anxiety improved more than with usual care, and the gains lasted five years.⁶ People from heart clinics improved the most.⁷

See also anxiety in later life.

Treatment: what helps

How CBT for health anxiety works

CBT is a short, structured talking therapy. It looks at the links between thoughts, feelings, body sensations and actions. For health anxiety, a CBT therapist may help you:^1,3

• Map your own loop. You learn what sets off your worry and what you do in response.
• Test your thoughts. You weigh the evidence for and against a scary thought. Our thought check tool uses the same idea.
• Cut back on checking and reassurance. You slowly reduce body checks, searches and "Am I OK?" questions, and learn that the anxiety fades on its own.
• Face what you avoid and stay active. You return step by step to things like exercise or health news, and keep living your life even when worries show up.

In the trials, treatment usually took about 12 weeks.^8,9 Face-to-face CBT helps about 2 in 3 people with health anxiety.⁸ In the British clinic study, nurses and other trained staff gave the therapy, not only psychologists.⁷ Video and online options may suit people who find travel hard. See anxiety treatment and what Medicare covers for mental health.

Medicines

Antidepressants may ease worry and body symptoms, especially when talk therapy alone has not helped enough.¹ A common type called SSRIs (selective serotonin reuptake inhibitors) may be effective.²

In the U.S. trial, the numbers after 24 weeks looked like this:¹⁰

Using both together added only a small extra benefit, and about half of people did not improve enough.¹⁰ Talk with your doctor or pharmacist before starting, stopping or changing any medicine. Read more on medicines for anxiety.

Things you can try yourself

These steps come from CBT. They work best with a therapist, but many people can start on their own.³

1. Keep a simple log for a week. Write down each time you check your body, look up a symptom or ask for reassurance. Just counting can show you how big the habit has become.
2. Cut back a little each day. If you check ten times a day, aim for eight, then six.
3. Write two columns. Put the scary thought on the left and a calmer, more likely explanation on the right. "My chest feels tight" can sit next to "I have been tense all day."
4. Delay the urge. When you want to check, do something else first, like a walk or a phone call. The urge often passes.
5. Go back to what you have avoided. Start small, such as a short walk if you stopped exercising.
6. Calm your body. Try slow breathing, grounding or muscle relaxation.

More ideas are on our self-help for anxiety page and in a written calm plan.

Helping a family member with health anxiety

It is natural to comfort someone who is scared. But answering the same health question again and again can keep the loop going, because the relief does not last.^1,2

• Respond to the feeling: "I can see how scared you are."
• Agree together, ideally with their therapist, on a gentle plan to cut back on reassurance.
• Encourage regular visits with one trusted doctor.²
• Support them in getting CBT. See starting a conversation about mental health.
• Still encourage a doctor visit when a symptom is new or severe.

When to get help

Make an appointment with your doctor or a mental health professional if:^3,1

• Health worries take up a lot of your day or stop you from living a normal life
• You keep seeking tests but never feel reassured for long, or you avoid doctors out of fear
• You also feel low or have panic attacks, or self-help has not been enough

Without treatment, health anxiety often lasts a long time. It can improve, especially when related anxiety or depression is treated too.^1,2

Is it really "all in my head"?

No. The sensations you notice are real. Anxiety itself can cause a fast heartbeat or headaches.³ The problem is how the brain reads those signals, and the loop of worry and checking that follows.¹

What if the doctor misses something real?

People with health anxiety can still get sick, so new or changing symptoms should be checked. One doctor who knows you well, with planned follow-up visits, can help you trust that someone is keeping watch.²

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.