Health anxiety

Also called Hypochondria, Illness anxiety

Not imagining symptoms, and not attention-seeking. Reassurance is the thing that feels most helpful and makes it worse.

What it is

Persistent, distressing preoccupation with having or developing a serious illness, out of proportion to any medical finding.

The symptoms are real. Anxiety produces a fast heart, breathlessness, chest tightness, dizziness, tingling, muscle tension and gut upset, and those genuinely feel like the illnesses people fear. Being told there is nothing wrong lands as being told they are making it up.

The mechanism is a loop. Noticing a sensation, interpreting it catastrophically, checking or seeking reassurance, feeling briefly better, and then needing to check again sooner. Every reassurance strengthens the loop, which is why a normal test result buys hours rather than months, and why more tests make people worse rather than better.

That has a direct practical consequence: repeated investigation is not neutral. It reinforces the belief that something is being missed, and it exposes people to incidental findings that generate more fear.

It responds well to cognitive behavioural therapy, better than most anxiety conditions do, and most people never get offered it.

Two cautions. People with health anxiety do get ill, and a change in the pattern of symptoms deserves the same assessment anybody else would get. And the reverse mistake is common in people with ME/CFS, long COVID and POTS, whose physical conditions have historically been misattributed to anxiety.

Signs you might notice

Frequent worry about serious illness despite normal tests and examinations.

Repeatedly checking the body, searching symptoms online, or seeking reassurance from family and clinicians.

Or the opposite: avoiding doctors, tests and health information entirely because of fear.

Brief relief after reassurance, followed by the worry returning.

Interpreting ordinary sensations, a headache, a twitch, a lump, as evidence of something serious.

Distress that interferes with work, relationships and sleep.

Distinguish from obsessive compulsive disorder, where checking is one of several themes, and from panic disorder, where the fear is of the attack itself.

How it can affect day-to-day life

People with health anxiety are frequently disliked by services, described as heartsink or frequent attenders, and that judgement is both unfair and counterproductive. This is a treatable condition with a known mechanism.

Online symptom searching has made it substantially worse. Almost every symptom has a rare and frightening explanation somewhere on the internet, and the search always finds it.

Bereavement or a serious illness in somebody close is a common trigger, and so is having had a real diagnosis missed in the past. That last one deserves respect rather than correction.

Families get exhausted by reassurance-seeking and often swing between endless reassurance and irritation. Neither helps, and being given a third option changes the household.

Supporting someone well

Take the symptoms seriously as symptoms, while being honest that anxiety is a plausible cause. Both things are true.

Stop giving reassurance, kindly and openly. Agree in advance: "I love you and I am not going to answer that question, because we agreed it makes things harder." That agreement is the intervention.

Agree limits on checking and searching rather than banning them outright.

Ask for cognitive behavioural therapy specifically. In England, self-refer to NHS Talking Therapies and say health anxiety by name.

Agree a plan with one GP: regular booked appointments rather than crisis ones, and an agreed threshold for investigation.

Resist requesting more tests. A negative test is not treatment and often makes things worse.

Treat any co-existing depression or anxiety disorder; medication helps a proportion of people.

Watch for a genuine change in pattern and get that assessed normally.

Where to get help

A GP practice, ideally the same one each time, for a consistent plan.

Self-referral to NHS Talking Therapies in England.

Anxiety UK run a helpline and support groups.

Mind for information on health anxiety and on getting therapy.