Hypochondria – Health Anxiety

health anxiety
Dr Elaine Ryan
Written by Dr Elaine Ryan Psychologist and Founder of MoodSmith® Elaine obtained her Dr in Psychology from the University of Surrey and has worked in psychology for 20 years. Dr Ryan specialises in Intrusive Thoughts, OCD and anxiety-related conditions.

Hypochondria, also known as Health Anxiety, needs to be taken seriously. This page provides:

  • A comprehensive guide to health anxiety.
  • Explaining what it is, what causes it.
  • Signs and symptoms.

Note: The term hypochondria or hypochondriac is no longer used to diagnose. The manual, which clinicians use to diagnose conditions, The Diagnostic and Statistical Manual of Mental Disorder (shortened to DSM) removed hypochondriasis in the most recent 5th edition1 (DSM5) and replaced it with Illness Anxiety Disorder.
Throughout this article, I shall use the more popular label of Health Anxiety, but please note that the correct diagnosis will now be Illness Anxiety Disorder.

What is health anxiety?

Health Anxiety is a type of anxiety disorder where you live in fear that you have a serious illness, even though you have been told that you do not have the disease you fear. You may not feel well; you have physical symptoms in your body and believe you have a severe illness.

 

What causes it?

To end up with health anxiety, it has to start with the initial thought or fear that something is wrong with you. If that thought goes unnoticed, nothing will happen.

 

However, if the thought reoccurs or you attend a doctor to be told nothing is wrong, doubt is a factor in what causes that initial thought to turn into health anxiety.

 

The feeling of doubt is behind many of the ‘what if’ style questions you have. For example, what if the doctors missed something, what if the tests were wrong, what if I have cancer or a tumour?

 

These questions and the nagging doubt lead you to seek reassurance that nothing is wrong or to seek confirmation of your fears.

 

This repeated cycle of thought, fear and doubt, seeking reassurance, can turn initial thought into health anxiety.

 

 

Is health anxiety making you ill?

The symptoms you feel in your body are real.

 

Health worries create real physical symptoms in your body.

 

The more you worry about your health, the more anxious you feel. Anxiety creates real physical symptoms in your body. Some of these symptoms include.

  • headaches
  • tight muscles and tension
  • stomach problems
  • blurred vision,
  • sweating, trembling
 

However, you may misinterpret what is happening in your body.

Suppose your thought processes are concerned with severe illness. In that case, it will not make sense for your brain to think that symptoms you feel in your body may result from anxiety caused by worries relating to your health.

 

A vicious circle begins.

  • Initial worry that something may be wrong with you
  • Over time, these worries create anxiety.
  • The anxiety results in physical symptoms in your body.
  • The physical symptoms then become a source of concern, making you more convinced that something serious is wrong with you.
 

How do I know if I have health anxiety?

There are signs and symptoms of the conditions that you can see below.

Signs and symptoms

Although classed as an anxiety disorder, illness anxiety disorder shares many characteristics of OCD in terms of obsessions and compulsions, and I want to highlight this below.

Obsessions And Compulsions In Health Anxiety.

With an illness anxiety disorder, many people obsess about their health. An obsession refers to the thoughts and fears regarding your health, and compulsions are what you do to make yourself feel better and calm the anxiety created by the unwanted thoughts.


I shall explain this more fully using a worked example of Jane. She believes her doctors have missed a cancer diagnosis.

Health Anxiety And The Fear That You Have Cancer

Jane read something in the paper about cancer; then she sees signs advising people to get health checks everywhere;

 

She keeps getting aches and pains and thinking something dire is wrong with her. This makes her afraid, and she can’t stop thinking, “What if I have cancer?”

So she goes to the doctor and is told her tests are normal but still feels not right. She goes back to the doctor, looking for reassurance that she does not have cancer.

 

The aches and pains are still there; the fear is still there, the worries about her health are still there–the reassurance is not enough. She worries that they have missed something, she goes back to the doctors, continuing the cycle.

The constant fears and thoughts are like obsessions in OCD, and the repeated trips to her doctors are like compulsions in that she does this each time she is afraid of cancer.

 

When something makes you worried or anxious about your health, you try to make yourself feel better.

 

The problem is that the things you do to make yourself feel better may worsen your health anxiety and keep it going.

 

The things you do to feel better could be

  • looking for reassurance–googling, going to the doctor, asking if you are OK, even trying to think it through in your head to reassure yourself that everything is OK, is reassurance
  • Avoiding things that make you feel nervous, anxious–or that you believe may ‘trigger’ your health fears.
 

If you are doing things that are not helpful, you could strengthen Health Anxiety in your brain. You can see what I mean in the following video taken from my online self-help course for Health Anxiety.

Do I need to see a doctor?

If you think you have health anxiety, I recommend meeting with your doctor to rule out physical conditions. Your doctor can refer you to a mental health professional like myself to diagnose.

How is it diagnosed?

Your mental health professional will assess you. They will diagnose illness anxiety disorder if you meet specified criteria for it, as set out in DSM5.

How to get over health anxiety.

There are several options open to you and recommended models of therapy that will help.


I recommend a stepped care approach, which means you start at the lowest level of intervention and, if unsuccessful, move up to the next step.

Start with self-help.

Self-help may be as simple as a book on health anxiety. If you would like my help, I have an online self-help course that you are welcome to look at.

Suppose self-help was not enough for you to overcome illness anxiety disorder. In that case, your next step is individual sessions with a therapist.

Things to try now. The next time you get a thought in your head relating to your health, watch what you do next. For example, do you search on the internet and take your pulse?
You want to teach yourself to react to the thoughts differently, and you can start this by labelling the thoughts. Tell yourself, ‘there’s a thought about my health’ or ‘there’s one of the anxious thoughts and try not to analyse it any further.
Interrupt the things you do to get reassurance. For example, delay going onto google to check your symptoms. Decide to do something else instead and remind yourself it is just a thought.
If that is too difficult, try limiting the time you spend seeking reassurance. To continue with the example of checking your symptoms on Google, decide you can read one article and then do something else instead.
All attempts to interrupt the automatic cycle are your first steps towards overcoming illness anxiety disorder.

Meeting with a therapist.

If you want to get over Health Anxiety, the recommended treatment is Cognitive Behavioural Therapy, CBT. I would also recommend that you find someone who can offer you Acceptance And Commitment Therapy and Mindfulness, as I believe you then have all the tools you need to understand Health Anxiety and get your life back to normal.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

ONLINE SELF-HELP

If you would like my help, please see my online courses.

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