Illness anxiety disorder (health anxiety): symptoms and treatment

Almost everyone worries about their health from time to time. Oxford Health NHS Foundation Trust notes this usually resolves quickly after seeking appropriate advice. Health anxiety is different: it is characterised by constant worry, difficulty setting aside thoughts or doubts about illness, a strong belief that developing serious illness is likely, and a belief that the consequences would be severe and unmanageable.

A City and Hackney NHS talking therapies page makes the useful point that some health anxiety is normal and helpful, because it prompts us to seek medical attention when needed or to exercise, eat well and take medication. It becomes a problem when it is out of proportion and persistent, or interferes with day-to-day functioning.

You may see several names. Health anxiety is the term the NHS uses. Oxford Health says the problem was formerly called hypochondriasis. Illness anxiety disorder is a diagnostic label for a closely related pattern in which physical symptoms are absent or mild and the worry is the main problem. Anxiety UK describes health anxiety as often housed within the OCD spectrum, which fits the NHS statement that it is related to OCD.

The NHS lists several behaviours that suggest health anxiety. They tend to fall into three groups: checking, seeking reassurance and avoidance. Each gives short-term relief but strengthens the worry in the long run, which is why the pattern is hard to break without help.

• Constantly worrying about your health

• Frequently checking your body for 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 TV programmes

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

Oxford Health describes a cycle in which focusing on worries and physical sensations produces more worry and keeps attention fixed on ill health. Searching online, repeatedly examining a mole or pulse and seeking opinions from several clinicians all bring brief calm, but the doubt returns, often with a new search or a new sensation to investigate.

The same service notes that some people have had their concerns dismissed, or have had a real problem missed or misdiagnosed, which can fuel mistrust of reassurance. It also says that people are sometimes so anxious that they avoid routine screening or specialist appointments, which is the opposite side of the same problem and worth mentioning to a clinician.

The City and Hackney service says there is no single cause. Research indicates that factors that might matter include watching a family member or loved one go through serious illness, particularly in childhood or adolescence, having a parent who was very worried about health, reading distressing stories about illness online or in the media, and having experienced a serious illness yourself now or in the past.

The NHS suggests keeping a diary of how often you check your body, ask for reassurance or look at health information, then gradually trying to reduce those behaviours over a week. It also suggests a two-column thought record: write your health worry in the first column and a more balanced alternative in the second, for example noting that headaches can often be a sign of stress.

Other steps from the NHS are to distract yourself with something else when the urge to check arises, such as a walk or a call to a friend, to gradually return to activities you have been avoiding such as sport or socialising, and to try breathing exercises or relaxation. These are starting points, not a replacement for treatment if the worry is severe.

The NHS says that if a GP diagnoses health anxiety, they may refer you for talking therapy such as cognitive behavioural therapy (CBT) or offer a medicine for anxiety. It adds that you can refer yourself to an NHS talking therapies service without a GP referral. Oxford Health describes CBT as the evidence-based treatment and says that while brief, focused CBT may help, a longer or more intensive course might be required.

Oxford Health sets out what therapy involves: building a collaborative relationship with the therapist, developing a shared understanding of what maintains the strong conviction that serious illness is present, exploring changes to reassurance-seeking and symptom checking, and planning activities to restart a less restricted life. City and Hackney talking therapies says CBT can help you put worries into perspective so the anxiety interferes less with daily life.

Having health anxiety does not mean that your symptoms are imaginary or that you can never become ill. The NHS recognises that anxiety can produce real sensations such as headaches or a racing heart. A sensible approach is to have new or changing symptoms assessed once, agree a plan with your GP about what is reasonable to investigate, and avoid repeated rounds of tests without a clear reason.

Do not ignore symptoms that need urgent attention. Chest pain, sudden breathlessness, new weakness or confusion should be treated as emergencies via 999 or NHS 111, whether or not you have health anxiety. Anxiety UK advises that people seek guidance from their GP, who can make a formal diagnosis, rather than relying on self-diagnosis checklists.

The NHS advises seeing a GP if worries about your health are preventing you leading a normal life or if self-help is not working. Anxiety UK describes a checklist over the previous six months, including a preoccupation with having serious illness that lasts at least six months, distress, an impact on family, social life and work, constant online searching or self-examination, and disbelief in a doctor's reassurance. Answering yes to most of these suggests health anxiety is likely, although only a clinician can diagnose it.

If you feel unable to keep yourself safe, City and Hackney talking therapies advises calling 111 and choosing the mental health option, or going to your local A&E. Both NHS and private routes offer the same therapy approach; what matters most is a trained therapist with experience of health anxiety.