Health anxiety: symptoms, causes and what helps

The NHS suggests you may have health anxiety if you recognise several of the following patterns. They are less about the symptoms themselves than about what you do in response.

• Constantly worrying about your health.

• Frequently checking your body for signs of illness, such as lumps, tingling or pain.

• Always asking people for reassurance that you are not ill.

• Worrying that a doctor or medical tests may have missed something.

• Obsessively looking at health information on the internet or in the media.

• Avoiding anything to do with serious illness, such as medical programmes.

• Acting as if you were ill, for example avoiding physical activities.

Everyone worries about their health from time to time, particularly when a symptom is new or a relative has been ill. Health anxiety goes further. It is a persistent preoccupation with the idea that you have, or will get, a serious illness, which continues even when examinations and tests are normal and doctors have given reassurance.

Anxiety UK describes it as an anxiety condition often placed within the obsessive compulsive disorder spectrum, in which people fixate on any type of illness, with cancer a common example, and are convinced that harmless physical symptoms indicate serious disease. For example, a tight chest is interpreted as an impending heart attack. The NHS makes the same link with OCD.

The condition is sometimes called hypochondria or illness anxiety disorder. These terms overlap, but the language people prefer varies, and the aim of treatment is the same: to loosen the grip of the worry rather than to prove the person is imagining things. The distress and the physical sensations are real.

The NHS says that if a GP diagnoses health anxiety they may refer you for a talking therapy such as cognitive behavioural therapy (CBT) or offer a medicine for anxiety. You can also refer yourself directly to an NHS talking therapies service without going through a GP.

CBT is a talking therapy in which a therapist helps you change how you think and act. The NHS lists anxiety, including OCD, among problems for which it is a recommended treatment, and says it can be free on the NHS, with self-referral possible for many anxiety problems from age 18 (16 in some areas). For some conditions a GP referral is required. Anxiety UK mentions self-help resources based on CBT that look at the thoughts and behaviours that keep health anxiety going.

In CBT for health anxiety the work typically involves understanding the cycle, testing beliefs about bodily sensations, and gradually dropping checking and reassurance-seeking behaviours. Therapy is collaborative, and a therapist is not trying to persuade you that your symptoms are imaginary.

The NHS offers a short list of practical steps. None needs special equipment, and they work best when practised steadily over weeks rather than tried once.

The NHS observation that anxiety causes physical symptoms is central. A racing heart, tight chest, dizziness, stomach upset or muscle tension are normal parts of the body's alarm response. When these are noticed and read as proof of disease, anxiety rises, producing more sensations and more attention to them.

Checking, searching online and seeking reassurance usually bring brief relief, which teaches the brain that these behaviours are necessary. Over time the relief fades faster and the urge to repeat grows. Anxiety UK lists constant online searches, self-examination, and disbelief of or lack of conviction in a doctor's reassurance as characteristic features, and notes that the preoccupation can affect family life, social life and work.

Avoidance has a similar effect: staying away from hospitals, news or physical activity prevents you learning that you can cope. That is why the self-help steps recommended by the NHS focus on gradually reducing checking and reassurance and returning to normal activities.

Health anxiety does not mean that new symptoms should be ignored. Real illness can occur at any time, and new or changing symptoms should be assessed in the usual way. The NHS advice is to see a GP if your worries are stopping you from living normally or self-help is not working, which makes it possible to separate a medical check from the cycle of repeated reassurance.

If you feel you cannot cope, are thinking of harming yourself or feel hopeless, that is an emergency: call 999 or go to A&E, or contact NHS 111 to be directed to urgent mental health support. For physical emergencies such as crushing chest pain, sudden weakness or severe breathlessness, call 999 regardless of any history of anxiety.

NHS talking therapies are free and can be accessed by self-referral, though waiting times differ between areas. The assessment helps decide whether CBT, guided self-help or another approach is right for you.

Some people choose to see a therapist privately to start sooner or to find someone with experience of health anxiety. The NHS says you can find an accredited CBT therapist on the UK CBT register, and its health anxiety page points to the British Association for Behavioural and Cognitive Psychotherapies register and the British Psychological Society directory. Check accreditation, ask about their experience with health anxiety and what a course of sessions would involve, and ask whether they will liaise with your GP if physical symptoms are being investigated.