Facing health anxiety: The brave first step toward freedom

"What if this ache in my chest is something serious, what if it’s a heart attack and I’m ignoring it?".

"Why does no one else seem to worry like I do?", "Could the doctor have missed something in my last appointment?", "I keep checking my pulse, but it feels off, too fast, too slow, what does that mean?", "Every new sensation feels like a warning sign. Should I go back to the Doctor, even though they told me I was fine?", "What if they were wrong?", "I’m scared to Google my symptoms because I always end up convinced it’s something fatal, but how else am I supposed to get answers?", "Why can't I trust my body or even believe the reassurance when I hear it?", "What if this time, it really is something?"

If even reading these questions fills you with the fear that somehow you have just caused something bad to happen just by reading these words... then keep reading because this article is for you!

In a world that feels full of uncertainty, we can often wonder what bad thing is going to happen next. If you've ever caught yourself thinking thoughts similar to those listed above, you may be experiencing a very common condition called health anxiety.

Health-related anxiety is something many people experience. It’s actually quite normal to feel concerned about your health every now and then. In small doses, this kind of worry can be beneficial, especially if it encourages you to address symptoms you've been putting off. However, when the fear becomes constant, overwhelming, and exists even in the absence of any real medical problem, it shifts from being helpful to harmful. At that point, the anxiety itself becomes the issue.

What is health anxiety?

People with health anxiety, or the preoccupation with being or becoming ill, used to commonly be referred to as “hypochondriacs”. This diagnosis was removed from the Diagnostic and Statistical Manual of Mental Disorders in 2013 because of the offensive connotations associated with the word.

Medical professionals now use the term illness anxiety disorder (IAD) instead. I’ve witnessed the distressing and debilitating impact this condition has on people’s lives. Sufferers often feel misunderstood and ashamed, and are led to believe that they are “just paranoid” or should simply “get over” their fears, when in reality, they can’t, at least not without support.

Reaching out

Making the first step to reach out to a counsellor can be extremely hard for someone suffering from health anxiety, as it means going against what their intrusive thoughts are telling them, that 'something is wrong medically with them and they should go to the doctor's and not a counsellor's office'.

For me, it signals hope that a person is willing to explore ‘Theory B’. Theory B proposes that all of the intrusive thoughts and images, the compulsive checking of their body, researching symptoms online and the constant reassurance seeking from loved ones may actually be anxiety instead. No health professional would encourage you to ignore a hunch that something is wrong; however, there’s a big difference between a true intuition and brain wiring that has gone awry.

Some common worries I’ve worked with clients on who suffer from health anxiety are;

• Fear of having a serious illness – Despite negative test results or reassurance from doctors, there's a constant worry about having cancer, heart disease, neurological disorders, or other life-threatening conditions.
• Hyper-awareness of bodily sensations – Normal bodily functions like heartbeat, digestion, or muscle twitches may be interpreted as signs of illness.
• Misinterpreting symptoms – A mild headache might be seen as a brain tumour; a cough might be feared as lung disease.
• Frequent checking – Constantly monitoring the body for changes, checking moles, measuring pulse, or examining for lumps.
• Doctor-hopping or avoiding doctors – Some people seek repeated medical opinions, while others avoid doctors altogether out of fear of receiving bad news.
• Obsessive researching – Spending excessive time online looking up symptoms.
• Fear of dying or becoming disabled – Persistent worry that a condition will progress quickly or go unnoticed until it’s too late.
• Concern over missed diagnoses – Believing doctors might have overlooked something critical during an exam or test.
• Anxiety about others' health – Sometimes, the fear extends to loved ones, worrying excessively that they may become seriously ill.
• Avoidance of certain activities – Avoiding exercise, travel, or certain foods due to fear that they could trigger or worsen an illness.

These worries can be distressing and often interfere with daily life, work, and relationships, even though the individual may logically understand that their fears are exaggerated. 

Psychosomatic symptoms

Clients in my therapy room are not only battling with the mental and behavioural symptoms of health anxiety, but many sufferers also experience real physical pain, which we call ‘psychosomatic symptoms’.

These are physical symptoms that are caused or worsened by mental factors, such as stress, anxiety, or depression. In the case of health anxiety, a person can experience real, distressing bodily sensations, even in the absence of a medical condition, because their mind is hyper-focused on the possibility of illness.

These symptoms are not "imagined" or "faked"; they are very real to the person experiencing them. Some of these symptoms can be chest pain or tightness, headaches or migraines, nausea, bloating, diarrhoea, constipation, muscle tension or pain, dizziness, heart palpitations, tingling or numbness, fatigue, shortness of breath and changes to bladder function, to name a few.

These symptoms can reinforce the person’s belief that they are seriously ill, which creates a vicious cycle: anxiety causes symptoms, the symptoms increase anxiety, and the cycle continues. Recognising the psychosomatic nature of these symptoms is often a key part of the work I do with clients.

Magical thinking

Have you ever caught yourself thinking, "If I have that thought or say it out loud, I might actually make it happen?" If we are already feeling stressed or a little anxious, our scary thoughts and what if's can feel even more threatening.

If we are walking around wondering what bad thing might happen next, we can start making little silent deals in our minds. "If I don't think it, if I don't say it, maybe I can stop it from happening." It makes sense that our brains are trying to create ways to make us feel safe, sometimes that may be following certain made-up rules such as; 'Don't say the thought out loud", "Touch the door handle three times", "Say a prayer each night.", "Don't talk about this fear, or I will curse myself." We call this 'magical thinking', it can feel like it's protecting you from harm when it is actually feeding your anxiety.

Magical thinking is the belief that your thoughts, words or actions have the power to cause or prevent things from happening, even when there's no real connection. We can all fall into the trap of performing certain superstitious behaviours, such as knocking on wood and avoiding walking underneath a ladder, to name a few. However, with health anxiety, these behaviours turn into compulsions and are no longer optional; we feel they are necessary to survive the day.

These bargains we make in our minds, the compulsive behaviours or thoughts that follow our fears, can actually make our anxiety worse, keeping us stuck in fear. By following our magical thinking, we reinforce this sense that we have a magical power and sense of responsibility, which keeps us in this loop. With the right treatment and support, we can stop living in constant fear.

What does treatment involve?

In treatment, therapists can use a variety of approaches to help. I use a combination of cognitive behavioural therapy (CBT), exposure and response prevention (ERP) therapy and acceptance and commitment therapy (ACT) to help clients with health anxiety understand and work through what is really going on for them. We look at the link between how you think, how you feel, and what you do in what are known as “vicious cycles.”

Typically, if you have more anxious thoughts, you tend to feel more anxiety, which leads to engaging in unhelpful behaviours like those listed above.

Again, these behaviours make sense if you are particularly worried about health-related things; however, what we know is that the behaviours can actually keep you more worried about health because you tend to be more focused on your body, which in turn may lead to more anxious thoughts and feelings. Also, the behaviours can make you struggle even further with the uncertainty of what is or isn’t wrong.

Difficulty tolerating uncertainty plays a major role in ongoing worry, and habits like constant checking or seeking reassurance can actually weaken your ability to manage the unknown. Counselling helps you recognise that many of your fears are either unlikely or unfounded, and more importantly, that you're more capable of handling difficult situations than you may have believed. It enables clients to stop living in survival mode and start living!

In summary, counselling focuses not just on managing symptoms, but on understanding and addressing the root causes of your anxiety. It empowers people with tools and strategies to lead more fulfilling lives, despite the challenges that health anxiety poses. You do not have to suffer in silence with health anxiety; there is a road to recovery out there, and it requires a leap of faith from the sufferer to access therapy.

If any of this sounds familiar to you and there is a small part of you that wonders if 'Theory B' could be at play, reach out to a professional, seek support, you deserve to enjoy your daily life, not be living in fear.