Health Anxiety

Health anxiety, sometimes referred to as illness anxiety disorder or hypochondriasis, involves excessive worry about having or developing a serious medical condition. Individuals with health anxiety often misinterpret normal bodily sensations or minor physical symptoms as evidence of severe illness, leading to significant distress and frequent medical consultations. This condition can disrupt daily life, impair relationships, and cause financial strain due to repeated medical investigations. Psychological models emphasize the role of cognitive biases, misinterpretation of symptoms, and reassurance-seeking behaviors in maintaining health anxiety. Evidence-based treatments, such as cognitive behavioral therapy (CBT), have shown efficacy in reducing symptoms and improving quality of life for those affected.

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Information handouts

Links to external resources

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Assessment

  • Health Anxiety Inventory (HAI-18) | Salkovskis, Rimes, Warwick, Clark | 2002
    • Scale
    • Reference Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(05), 843-853.

Guides and workbooks

  • Health Anxiety – A Self-Help Guide | Maunder, Cameron, Young, Leyland | 2015

Information Handouts

  • Health Anxiety (Information Handouts) | Centre For Clinical Interventions

Self-Help Programmes

Worksheets

Recommended Reading

  • Cognitive Behaviour Therapy for Health Anxiety: A Systematic Review and Meta-Analysis | Cooper, Gregory, Walker, Lambe, Salkovskis | 2017
  • Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis) | Salkovskis, Warwick, Deale | 2003
  • Health anxiety: detection and treatment | Tyrer, Tyrer | 2018

What Is Health Anxiety?

Signs and Symptoms of Health Anxiety

According to DSM-5, illness anxiety disorder is characterized by:

  • A preoccupation with having or acquiring a serious illness.

  • Absence of significant somatic symptoms, or when present, they are mild in intensity.

  • High levels of anxiety about health, with individuals being easily alarmed about their health status.

  • Excessive health-related behaviors (e.g., checking the body for signs of illness) or maladaptive avoidance (e.g., avoiding doctor visits or hospitals).

  • Symptoms persisting for at least six months, although the specific illness feared may change over time.

ICD-11 Criteria for Health Anxiety (Hypochondriasis):

Health anxiety in ICD-11 emphasizes:

  • Preoccupation with having a serious illness despite medical reassurance.

  • Persistent fear or conviction of illness even after negative medical tests.

  • Excessive self-monitoring or avoidance of health-related information.

  • Impairment in functioning due to the preoccupation with health concerns.

Incidence and Predictors of Health Anxiety

Health anxiety affects approximately 4–7% of the general population, with prevalence increasing in medical settings (Salkovskis & Warwick, 2001). Predictors include high levels of neuroticism and anxiety sensitivity, a tendency toward catastrophic thinking, and a low tolerance for uncertainty. Personal experiences, such as serious illness in oneself or close family members, exposure to media portrayals of illness, and overprotective parenting, can also contribute to its development (Asmundson et al., 2005). Studies also link health anxiety to specific cognitive vulnerabilities, such as attentional biases toward health-related information and hypervigilance to bodily sensations (Rief & Broadbent, 2007).

Psychological Models and Theories of Health Anxiety

Cognitive Behavioral Model

Salkovskis and Warwick’s (2001) cognitive model of health anxiety explains how excessive fears about health are maintained through misinterpretation of bodily sensations and external health cues. Health anxiety often starts with a trigger, such as a benign symptom or alarming health information, which activates pre-existing fears. Catastrophic interpretations, like perceiving a headache as a brain tumor, amplify distress, while cognitive biases heighten sensitivity to health-related cues and reinforce these fears. Safety-seeking behaviors, such as reassurance-seeking and excessive checking, provide temporary relief but prevent disconfirmation of fears, creating a self-reinforcing cycle. Misinterpretations, cognitive biases, and these behaviors interact to intensify health anxiety. Additionally, individuals with health anxiety often struggle with intolerance of uncertainty, seeking unattainable reassurance about their health. This model has empiricial support (e.g., Marcus et al., 2007) and highlights the interplay of cognitive and behavioral factors in perpetuating health anxiety, providing a foundation for targeted interventions.

Intolerance of Uncertainty

Health anxiety is linked to a low tolerance for uncertainty about health status. Carleton and colleagues (2012) emphasize that IU is a transdiagnostic factor contributing to various anxiety disorders, including health anxiety. Their research shows that individuals with high IU are particularly vulnerable to interpreting ambiguous bodily sensations as threatening, exacerbating health-related fears, and driving reassurance-seeking and checking behaviors.

Evidence-Based Psychological Approaches to Health Anxiety

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is widely regarded as the gold-standard treatment for health anxiety due to its robust evidence base. CBT addresses the key mechanisms underlying health anxiety by challenging catastrophic beliefs about health, addressing safety-seeking behaviors such as reassurance-seeking or body-checking, and fostering greater tolerance for uncertainty. Research has consistently demonstrated its efficacy in reducing health anxiety symptoms. For example, Salkovskis et al. (2003) found that CBT not only alleviated distress but also significantly reduced maladaptive behaviors compared to standard care. A recent meta-analysis by Visser et al. (2020) confirmed that CBT leads to durable improvements in symptom severity, avoidance behaviors, and quality of life. CBT also includes behavioral experiments and graded exposure, helping patients test their fears about illness and learn to disengage from preoccupying health-related thoughts.

Acceptance and Commitment Therapy (ACT):

ACT helps individuals accept health-related thoughts and feelings without judgment while focusing on living a value-driven life. This approach is particularly useful for individuals struggling with uncertainty and emotional distress about health. Some evidence suggests that group treatment with Acceptance and Commitment Therapy (ACT-G) is effective in reducing health anxiety (Eilenberg, 2016)

Resources for Working with Health Anxiety

Psychology Tools offers a wide range of resources for working therapeutically with health anxiety, including:

  • Cognitive behavioral models and formulations of health anxiety.

  • Handouts explaining the nature and maintenance of health anxiety.

  • Worksheets for challenging catastrophic health-related thoughts.

  • Exercises for reducing reassurance-seeking and checking behaviors.

  • Mindfulness practices for improving distress tolerance.

References and Further Reading

  • Asmundson, G. J., & Taylor, S. (2005). It’s not all in your head: How worrying about your health could be making you sick—and what you can do about it. Guilford Press.

  • Barsky, A. J., & Klerman, G. L. (1983). Overview: Hypochondriasis, bodily complaints, and somatic styles. American Journal of Psychiatry, 140(3), 273–283.

  • Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. G. (2012). Fearing the unknown: A short review of intolerance of uncertainty. Journal of Anxiety Disorders, 26(3), 389–397.

  • Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2015). Acceptance and commitment group therapy (ACT-G) for health anxiety: A randomized controlled trial. Psychological Medicine, 46(1), 103–115.

  • Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27, 127-139.

  • Matheson, E., & Petrie, K. J. (2013). Health anxiety in the digital age: The impact of cyberchondria on mental health. Frontiers in Public Health, 1(69).

  • Noyes, R., Stuart, S. P., Longley, S. L., et al. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43(4), 282–289.

  • Rief, W., & Broadbent, E. (2007). Explaining medically unexplained symptoms—Models and mechanisms. Clinical Psychology Review, 27(7), 821–841.

  • Salkovskis, P. M. (1989). Somatic problems: Can anxiety be reliably and specifically differentiated from depression? Advances in Behaviour Research and Therapy, 11(2), 65–80.

  • Salkovskis, P. M., & Warwick, H. M. (2001). Making sense of hypochondriasis: A cognitive model of health anxiety. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 171–197). Guilford Press.

  • Salkovskis, P. M., Warwick, H. M., & Deale, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). The British Journal of Psychiatry, 183(1), 37–44.

  • Taylor, S. (1999). Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. Erlbaum.

  • Visser, K., Bouman, T. K., & Meijer, R. R. (2020). The effectiveness of cognitive-behavioral therapy for health anxiety: A meta-analysis. Behavior Therapy, 51(4), 555–571.

  • Warwick, H. M., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117.

  • Watt, M. C., Stewart, S. H., & Cox, B. J. (1998). A panic-specific model of anxiety sensitivity: Theoretical rationale and empirical evidence. Cognitive Therapy and Research, 22(6), 635–655.

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