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Health Anxiety

A little bit of concern about your health is normal, and even healthy! If you have health anxiety, worries about your health can take over your life and cause you a lot of distress. It is thought that between 1 and 10 people out of every 100 will experience health anxiety every year [1]. Fortunately, Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) are both effective psychological treatments for health anxiety [2, 3].

What is health anxiety?

If you have health anxiety, you might find yourself:

You can develop health anxiety whether you are healthy, or you have a diagnosed medical condition. You can be diagnosed with health anxiety if your symptoms have persisted for at least six months and have caused you significant distress, or have negatively affected your daily life [1].

What is it like to have health anxiety?

When you have health anxiety, concern about your health seriously affects your life, getting in the way of important relationships or things that you enjoy. Samantha’s story illustrates what health anxiety can feel like.

Samantha’s fear that she would have a stroke

I was in my early twenties and had a job as a kitchen worker when I developed a condition called pulsatile tinnitus, which meant that I could hear blood ‘whooshing’ in a vein in my ear. I used to worry that this sound meant I was about to have a stroke and die. I was really frightened, so I paid a lot of attention to it and tried not to make it worse. I didn’t exercise or do anything to raise my heart rate because it made the sound louder, and I refused to travel more than a few miles from the local hospital, preferring to stay with my boyfriend or parents in case I needed medical help. I did ask doctors about it, but after a lot of tests – and lots of my own research on the Internet – I felt they didn’t understand how serious the risk was. I tried a lot of other therapies like acupuncture and homeopathy, but nothing seemed to help very much.

Do you struggle with health anxiety?

Health anxiety should only be diagnosed by a mental health professional or a doctor. However, answering the screening questions below can give you an idea of whether you might find it helpful to have a professional assessment.

Are you concerned that you might have a serious illness or disease that doctors have not found?
 Never  Occasionally  Much of my time  Most of my time
How much time do you spend worrying about your health?
 Never  Occasionally  Much of my time  Most of my time
How often are you afraid that you have a serious illness?
 Never  Occasionally  Much of my time  Most of my time
How relieved do you feel when a doctor tells you there is nothing wrong?
Initially relieved Initially relieved, but worries return later Initially relieved, but worries always return Not relieved
I have difficulty taking my mind off things about my health.
 Not at all  A little bit  Quite a lot  Very much

 

The questions above can’t provide a definitive diagnosis, but if you ticked the rightmost box to lots of these questions, you might be suffering from health anxiety.

What causes health anxiety?

There is no single cause for health anxiety. When thinking about the causes of problems psychologists often separate vulnerabilities (things that make you more likely to develop a problem) from triggers (things that make a problem begin).

Vulnerabilities to health anxiety

Some people are more vulnerable than others to becoming anxious about their health. Things that can make you more likely to experience health anxiety include:

  • Personality traits.
  • Life experiences.
  • How much you pay attention to your body, and to illness.

There may be genes which make you more likely to develop emotional problems in general, but no specific genes which make you more likely to develop health anxiety.

Triggers for health anxiety

Not everyone who is vulnerable goes on to develop health anxiety. It can develop gradually, but might be triggered by:

What keeps health anxiety going?

Research studies have shown that Cognitive Behavioral Therapy (CBT) is one of the most effective psychological therapies for health anxiety. CBT therapists work a bit like firefighters: while the fire is burning they’re not so interested in what caused it, but are more focused on what is keeping it going, and what they can do to put it out. This is because by working out what keeps a problem going, they can treat the problem by ‘removing the fuel’ and interrupting this maintaining cycle. Some of the things that psychologists think are important in keeping health anxiety going are:

Treatments for health anxiety

Psychological treatments for health anxiety

Psychological treatments for health anxiety which have good research support include Cognitive Behavioral Therapy (CBT) [2] and Acceptance and Commitment Therapy (ACT) [3].

CBT is a popular form of talking therapy. CBT therapists understand that what we think and do affects the way we feel. Unlike some other therapies, it is often quite structured. After talking things through so that they can understand your problem, you can expect your therapist to set goals with you so that you both know what you are working towards. At the start of most sessions you will set an agenda together so that you have agreed what that session will concentrate on. CBT treatment for health anxiety will involve some of the following ‘ingredients’:

  • Thinking about the costs and benefits of change.
  • Understanding more about the normal range of bodily feelings that most people experience.
  • Considering different interpretations for your experiences (sometimes referred to as ‘Theory A’ and ‘Theory B’)
  • Testing your beliefs with behavioral experiments.
  • Working with your thoughts and images.
  • Experimenting with what happens when you reduce how often you check and seek reassurance.
  • Experimenting with what happens when you don’t use safety behaviors.
  • Deliberately exposing yourself to your worries.

Medical treatments for health anxiety

There is a small amount of evidence that medication can be helpful for reducing the symptoms of health anxiety. These include clomipramine, imipramine, fluoxetine, fluvoxamine, paroxetine, and nefazodone [4]. The effectiveness of medical treatments appears to be smaller than for cognitive behavioral therapy [5].

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
  2. Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110-123.
  3. Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2016). Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial. Psychological Medicine, 46(1), 103-115.
  4. Taylor, S., & Asmundson, G. J. (2004). Treating health anxiety: A cognitive-behavioral approach.Guilford Press.
  5. Taylor, S., Asmundson, G. J., & Coons, M. J. (2005). Current directions in the treatment of hypochondriasis. Journal of Cognitive Psychotherapy, 19(3), 285.

About this article

This article was written by Dr Matthew Whalley and Dr Hardeep Kaur, both clinical psychologists. It was last reviewed on 2021/12/08.