Health anxiety

What is health anxiety?

Being concerned about your general health and well-being is normal. In fact, worrying about our health can sometimes even be helpful. It can lead to us living a healthier lifestyle, such as trying to give up smoking or eating a healthier, balanced diet.

In this video, clinical psychologist Dr Sophie Gwinnett explains more about health anxiety.

For the purpose of diagnosis, health anxiety can be split into two different disorders:

• Somatic symptom disorder (SSD)
• Illness anxiety disorder (IAD) - formally known as Hypochondriasis

The difference between these conditions is subtle and, sometimes, both may be present. For this reason, health anxiety is a common term used to discuss a range of symptoms.

Somatic symptom disorder

If someone experiences somatic symptom disorder, they may mistake normal bodily functions as a symptom of illness. This is not to say that their symptoms are not real. For example, commonly experienced symptoms may include tiredness or pain - but the person’s reaction to the symptoms is extreme.

Illness anxiety disorder

If someone experiences an illness anxiety disorder, they may be overly preoccupied with a specific disease or illness. They may have no physical symptoms whatsoever. Instead, they may confuse normal bodily processes such as sweating or bloating, as a sign of the onset of the illness they are most fearful of.

For a person experiencing health anxiety, the fear is real and can consume their thoughts and feelings constantly. Intrusive thoughts can be unpleasant, regardless of their nature. But, if they lead you to believe that you are seriously unwell or are at risk of dying, this can be particularly distressing. Health anxiety can have a severe impact on a person’s quality of life.

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What are the symptoms of health anxiety?

Everyone is different. You may be generally worried about your health and look out for a wide range of symptoms, or you may be concerned about one illness in particular.

Signs and symptoms of health anxiety

Common signs of health anxiety can include:

• constant or ongoing fear that you are sick, despite having no symptoms
• frequently checking for signs of illness (e.g. searching for lumps or tingling)
• reassurances or negative test results from a doctor don’t relieve your nerves
• continually seeking reassurance from others that you aren’t ill
• if you read about a disease, you worry that you have it
• your worries about your health are interfering with your life, family, work, or hobbies and activities
• avoidance of medical tv programmes or anything to do with serious illness
• you change your habits to act as though you are ill (such as avoiding physical activity or resting more)

There’s a world of difference between everyday worries about health and health anxiety. This condition can be as paralysing and terrifying as any other form of anxiety - sufferers are often in a constant state of fear, checking themselves for symptoms hundreds of times a day and too scared to lead life as they would like to.

- A counsellor discusses the fear experienced by those with health anxiety.

Can health anxiety give you physical symptoms?

The important thing to remember is that health anxiety is not all in a person’s mind. Anxiety can cause physical symptoms, such as headaches, dizziness, fatigue and nausea. Of the more extreme symptoms, health anxiety can also trigger panic attacks. So, if, for example, a person is afraid of having a heart attack, the symptoms experienced can be truly terrifying.

Anxiety or OCD?

Although it is an anxiety-based condition, health anxiety is often linked with obsessive-compulsive disorder (OCD), on account of the compulsive behaviours that accompany symptoms. Seeking reassurance from doctors or the internet may, in some cases, provide relief. But, just like with OCD, such compulsions only offer relief temporarily - before the fear of illness returns once again.

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What causes health anxiety?

There can be many reasons why someone starts to worry too much about their health. Perhaps you’ve had a bad experience with your health in the past or as a child, or maybe you have a loved one who worries about their health excessively. Just like many other mental health problems, there can be a wide variety of causes or triggers. These can include:

• stressful life events or situations
• health scares that turned out to be not serious or ‘false alarms’
• being abused as a child
• experiencing serious childhood illness or parental illness

But, unlike some other mental health problems, health anxiety isn’t always an internalised problem - it doesn’t always mean that people are worried about their own health. Some people become preoccupied with the health of others. This can be the case, particularly for parents, who worry about the health of their children.

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How can I stop my health anxiety?

There are a number of different options you can try to decrease or stop your health anxiety. How effective each one is can vary from person to person. Trying different methods until you find one that is right for you is key.

Many treatments for health anxiety are similar to those for OCD. One of the most effective forms of treatment is thought to be talking therapy, specifically cognitive behavioural therapy (CBT). However, some people may find that they need additional support, in the form of medication or complementary therapies, such as hypnotherapy.

Self-help for health anxiety can also be a helpful tool to help you get started. The NHS recommends a number of different self-help tools to help you better understand the extent to which health anxiety is affecting you and to try and take back control. These include:

• Keeping a diary. Track how often you seek reassurance, look up health information or check yourself for injuries. Gradually try to reduce how often you do these things over the course of a week.  
• Challenging unhelpful thoughts. Writing down your thoughts can help you to spot unhelpful thoughts or thought processes. Try writing your health worries on one side of the page, then on the other side, write out a more balanced explanation. For example: ‘I’m worried I’m having headaches and it might be something serious’ vs ‘Headaches are often a sign of stress’.
• Undertake normal activities. If you have been avoiding things like exercising, going out with friends, or doing household chores due to health worries, try to gradually start doing these again. This can also help to provide a distraction when you feel the urge to look up health information or check yourself for potential ailments. Other simple activities, like going for a walk or catching up with a friend, can also help. 
• Try relaxation exercises. Simple breathing exercises and mindfulness techniques can provide a positive way of managing feelings of stress, anxiety, and overwhelm. Psychotherapist, Anne-Marie Alger, shares five breathing exercises to reduce anxiety.

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Who do I talk to about health anxiety? 

If you are worried health anxiety is affecting your ability to do normal daily activities or is stopping you from doing things you used to do and self-help isn’t working, speaking with your GP can be a great next step. If you are diagnosed with health anxiety, you might be referred for a kind of talking therapy like CBT or offered medicine to help you manage your anxiety.

You can also self-refer for NHS psychological therapies without a GP referral, though the waiting lists and what type of therapy is offered can vary greatly depending on where you live. Working with a private counsellor can be a fast way to access the type of therapy that best suits your needs. 

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Does counselling help with health anxiety?

Many people find that working with a professional, experienced counsellor or psychotherapist can be helpful. Together, you can explore what you are feeling, the reasons behind why you are feeling this way, and how it is affecting your life.

A therapist may be able to suggest coping mechanisms, provide an external sounding board to help you better understand unhelpful or distressing thought processes and behaviours, and help you to find a more balanced or rational point of view. 

Which therapy is best for health anxiety? 

While cognitive behavioural therapy (CBT) is thought to be an effective way of treating health anxiety, there is no single ‘best’ method. Finding a therapist you feel comfortable working with can be a positive step towards discovering the best way for you to manage your symptoms, challenge unhelpful thoughts, and discover more positive ways to handle anxiety. 

How does CBT work for health anxiety?

Cognitive behavioural therapy can be really helpful in enabling us to take notice of our thoughts about a particular situation and recognise how those thoughts make us feel.

CBT aims to help you overcome fears by correcting irrational thoughts and changing problematic behaviours. By acquiring a certain mindset, you can learn to approach anxious situations differently and learn to tolerate discomfort and uncertainty.

For instance, a therapist can help you to understand why your fear of illness makes you feel anxious and notice when and why your behaviour changes, in order to break this negative cycle. This can help you to notice that it’s not the presence of a symptom of ill health that is causing your anxiety, but the meaning you apply to the symptom.

The good news is that health anxiety can be treated and cognitive behavioural psychotherapy is the most recommended form of therapy in these instances. CBT can indeed help you in acknowledging and changing the cognitive misinterpretations that maintain the problem and in finding new coping mechanisms to better deal with anxiety.

Further help 

• Anxiety UK: Health Anxiety