All About Health Anxiety

Health anxiety, once known as hypochondria, is characterized by irrational worry and fixation about having or developing an illness.

The term, “hypochondria,” itself is outdated. In 2013, it was replaced in the clinical setting by two separate health anxiety diagnoses:

• illness anxiety disorder
• somatic symptom disorder

This change was made with the hope of offering more specific, inclusive diagnostic criteria so more people might receive treatment.

The difference between illness anxiety disorder and somatic symptom disorder

When you live with illness anxiety disorder, your anxiety about being sick or becoming sick persists even without symptoms.

With somatic symptom disorder, you do experience real symptoms. Those symptoms, which are often mild, can cause you to focus on worst-case scenarios.

The exact cause of health anxiety is unknown.

As a mental health condition, health anxiety isn’t within your control. You aren’t “looking for attention,” as stigma suggests.

In fact, many people living with health anxiety are care-avoidant, meaning they don’t seek medical care for what they’re feeling.

Health anxiety may be related to a number of factors, including:

• genetics
• childhood illness
• development
• environment
• psychology
• cultural beliefs

For some, traumatic experiences may influence health anxiety. Having a family member who died unexpectedly of an illness, for example, might contribute to your level of health vigilance.

General misunderstanding of how the body functions may be partially to blame, as well.

Natural sensations that can be interpreted as pain symptoms (like intestinal gas movement) may create a sense of panic if they can’t be recognized for what they are.

Health anxiety and anxiety disorder

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), approximately two-thirds of people living with health anxiety experience a co-occurring mental health condition.

Living with another anxiety disorder can increase your chances of experiencing health anxiety.

While health anxiety often exists alongside other anxiety and depressive disorders — particularly generalized anxiety disorder — having an anxiety disorder doesn’t mean you’ll develop health anxiety.

The symptoms of health anxiety include those of both illness anxiety disorder and somatic symptom disorder.

According to the DSM-5, the majority of people diagnosed with health anxiety would now fall into the category of somatic symptom disorder, with the minority meeting criteria for illness anxiety disorder.

Symptoms contributing to one of these health anxiety diagnoses may include:

• obsessively performing self-health exams
• constant physical assessment
• excessive health habits (e.g., brushing your teeth every hour)
• avoiding situations that may result in injury or sickness exposure
• over-utilizing medical facilities, laboratory services, or over-the-counter therapies
• a steadfast belief that a condition is present, even without evidence
• fixation on researching and reading about health conditions
• excessive conversation about health
• suspicion about accurate test results or a doctor’s honesty
• unexplained mild physical symptoms like stomachaches or headaches
• no physical symptoms
• linking normal body sensations to illness
• general symptoms of anxiety
• symptoms of depression

Illness anxiety disorder criteria

For a diagnosis of illness anxiety disorder, the DSM-5 states the following criteria must be met:

• preoccupation about developing or having a serious illness
• symptoms are not present, or if they are, they’re considered more mild than in somatic symptom disorder
• concern about the illness is clearly disproportionate and excessive in relation to present risk factors
• a high level of anxiety about health
• quick alarm regarding personal health
• presence of excessive health-related behaviors or avoidance behaviors

For illness anxiety disorder, illness preoccupation must be present for at least 6 months with no other mental health conditions possibly causing the health anxiety.

Somatic symptom disorder criteria

For a diagnosis of somatic symptom disorder, the DSM-5 states the following criteria must be met:

• presence of one or more real physical symptoms that cause distress or disruption in daily life
• excessive feelings, thoughts, or behaviors related to physical symptoms that demonstrate one of the following measures:
  • disproportionate, persistent preoccupation with the seriousness of symptoms
  • consistently high level of anxiety regarding health or symptoms
  • significant time spent dedicated to symptoms or health concerns

For a diagnosis of somatic symptom disorder, the state of being symptomatic must be constant, usually for a period of 6 months or longer.

Somatic symptom disorder may be mild, moderate, or severe, and it may sometimes be predominantly focused on feelings of pain.

When you live with health anxiety, your first impulse may be to visit a doctor.

While it’s true a healthcare professional can point you in the right direction, health anxiety isn’t treated through a barrage of laboratory tests, examinations, or trial and error procedures.

In fact, you will likely be guided away from unnecessary processes.

If you have mild symptoms of a health condition, they can treat those accordingly, and can help manage your concerns about a more severe underlying illness.

Ultimately, when you live with health anxiety, successful treatment often means visiting a mental healthcare professional.

Cognitive behavioral therapy (CBT), a form of psychotherapy, is considered the first-line treatment for health anxiety.

With CBT, you’ll explore your beliefs about illness with the goal of modifying unhelpful behaviors and thought processes. Eventually, you can learn new behaviors and coping strategies to help relieve anxiety related to illness.

You may also benefit from other forms of psychotherapy, including:

• mindfulness-based cognitive therapy
• group therapy
• acceptance and commitment therapy

In addition to psychotherapy, you may be prescribed an antidepressant or anti-anxiety medication for additional symptom relief.

Preliminary case-study data suggests there may be benefits to using the Japanese herb, Keishikajutsubuto, for treatment of somatoform disorders, but more research is needed.

Managing health anxiety at home can be a challenge. By nature, health anxiety creates a state of over-awareness regarding health.

It can turn many self-care initiatives into obsessive habits.

To help supplement the treatment you’re receiving from your healthcare teams, you may find the following home care strategies helpful:

• Avoid drugs and alcohol. Certain recreational substances can increase feelings of anxiousness.
• Learn relaxation techniques. Deep breathing exercises, meditation, and other relaxation methods can help calm your thoughts when excessive health worries cause anxiety.
• Involve your loved ones. Ask loved ones to gently remind you to limit online symptom searching, excessive doctor visits, or too-frequent self-exams.

Health anxiety, formerly referred to as hypochondria, is now recognized as two distinct conditions: somatic symptom disorder and illness anxiety disorder.

While these two disorders share many symptoms and treatment options, they aren’t the same.

Somatic symptom disorder means you’re experiencing real symptoms that cause you unwarranted health anxiety and preoccupation.

Illness anxiety order often has no symptoms at all but still creates a fixation on having or developing an illness.

Both of these disorders, once collectively called health anxiety, can be successfully treated through psychotherapy, medication, and management of real physical symptoms.

If you think you may have health anxiety, consider reaching out to a mental health professional. They can guide you on next steps.