Health anxiety: understanding it

Noticing a change in your body, wondering about it, and getting it checked is a healthy thing to do. Most people feel some relief once a doctor has looked at it or the symptom fades.

Health worry may have become a problem when it…

• Causes a lot of distress, or gets in the way of daily life
• Is out of proportion to the real chance of a serious illness
• Keeps coming back even after normal tests or a doctor’s reassurance
• Leads to lots of checking, reassurance-seeking or avoiding

The NHS describes health anxiety as related to obsessive compulsive disorder (OCD), because both involve unwanted worries and urges to check or seek reassurance.

Common fears include cancer, heart attack, multiple sclerosis, dementia or a thyroid problem. For some people the worry is vaguer: a nagging sense that something is “not quite right”.

• Doubting that a doctor or test has caught everything
• Finding it hard to concentrate on anything else
• Mentally scanning your body for signs
• Seeing ordinary sensations as signs of serious illness

Each time you worry about your health, your body’s fight-or-flight alarm switches on. That can bring a racing heart, chest tightness, dizziness, tingling, nausea, sweating, tension and poor sleep.

These sensations are real, and they can be mistaken for signs of illness. That gives the worry even more to focus on.

• Acting as if you are ill, like avoiding exercise
• Asking others again and again whether you are okay
• Avoiding anything about illness, like medical TV shows
• Checking your body for lumps, tingling or pain
• Searching symptoms online for long stretches

Paying close attention to a symptom can make it feel more intense. Checking behaviours, like pressing on a sore spot, can even bring on or worsen symptoms.

Medical tests rule particular problems in or out. Doctors don’t have a test for everything, so no one can ever have a 100% guarantee of perfect health.

Chasing complete certainty keeps the cycle spinning. Learning to live with a normal amount of uncertainty is a big part of getting better.

Avoiding doctors, hospitals, exercise or even thoughts about illness can lower anxiety in the moment. Over time, it keeps fears unchallenged, chips away at confidence and can shrink your life.

People with this pattern spend a lot of time in healthcare settings, see several specialists and often ask for tests. Relief after a normal result tends to be short.

Repeated tests and appointments can also cost money, time off work and travel.

People with this pattern avoid healthcare, often from distrust or a belief that clinicians will dismiss them. Avoiding care can make the fear grow.

Common things people put off include check-ups, phoning for test results and telling a doctor about a worrying symptom.

The issue in health anxiety is how you are coping with your symptoms or condition. If the response is constant worry, checking, reassurance-seeking or avoiding, health anxiety may still be worth working on.

Some people with illness anxiety also have a real diagnosed illness, and may feel it is more serious than it is.

In illness anxiety, the main problem is fear of having or getting a serious illness, often with few or mild symptoms. When distressing physical symptoms themselves take over, doctors may call it somatic symptom disorder.

• Abuse, neglect or other trauma
• Being seriously ill as a child
• Serious illness in the family while growing up

Many people with health anxiety have none of these experiences, so they are possible influences, not explanations.

A family history of health anxiety, other anxiety, or depression may raise the risk.

Extreme stress is a known risk factor. Health worry also often starts or flares after a trigger, such as a friend or relative becoming ill.

It typically first appears in early adulthood, and symptoms can ease for a while and then return.

Family and friends may join in the worrying, or become frustrated when reassurance never seems to be enough. You might feel let down when they don’t understand.

Worrying, checking and searching can make it hard to concentrate. Appointments and online searching can eat into work or study time.

Some people stop doing things they enjoy, like exercise or seeing friends. Fewer good moments can lead to low mood.

Treating health anxiety with CBT has also been shown to ease general anxiety and depression.

Repeated trips to the doctor without clear results can leave both you and your provider dissatisfied. Some people feel disbelieved or labelled.

People with health anxiety cannot simply switch off their fears, and they do not create symptoms on purpose. The fear can feel completely real to them.

Reassurance brings only short-lived relief, and the worry soon returns. Because no test can rule out everything, there is always another question.

Checking your body and seeking medical advice is healthy. The goal is a helpful middle ground, not swinging from checking all the time to never checking.

Health anxiety can be long-lasting, but there are steps you can take to keep it in check. CBT has strong evidence, with benefits lasting a year or more.

Being honest with your provider about how much health anxiety affects your life helps them support you well.

The NHS suggests doing something absorbing, like going for a walk or calling a friend, when the urge to check comes. Getting back to sport and socialising you’ve avoided helps too.

Loved ones can help most by listening and showing they understand, while gently not answering the same health question again and again.