Understand Health Anxiety and How to Treat it

Defining Health Anxiety

Health anxiety is marked by an excessive fear of having, or developing, a serious illness. The term hypochondriasisoften comes to mind, as it was the former classification in the DSM-IV. However, the medical and mental health fields have since moved away from “hypochondriac,” recognizing it as outdated, stigmatizing, and dismissive.

Clients experiencing health anxiety often report very real and distressing physical symptoms, which may stem from an actual medical condition or be medically unexplained. The previous diagnostic label of hypochondriasis required ruling out physical illness first. Unfortunately, this approach excluded individuals who had both medical conditions and excessive anxiety about their health. It also reinforced a false mind-body divide, implying that unexplained symptoms were “all in the head.” This perspective invalidated many clients and contributed to the stigma surrounding the term.

In response to these concerns, the DSM-5 replaced hypochondriasis with two new diagnoses: Illness Anxiety Disorder (IAD) and Somatic Symptom Disorder (SSD). Both involve excessive health-related fears, but SSD requires significant somatic symptoms, while IAD involves few or none. In either case, clients’ fears are disproportionate to the medical reality or cause significant distress and impairment.

From a clinical standpoint, it’s often useful to conceptualize health anxiety as existing on a continuum, from mild worry to severe impairment, with IAD and SSD representing the more extreme end.

Common Features of Health Anxiety

When working with clients who experience health anxiety, clinicians may observe:

• Excessive worry or rumination about health

•  Heightened selective attention to bodily sensations or functions

• Excessive body checking or symptom monitoring

• Repeated reassurance seeking from loved ones or healthcare providers

• Frequent health-related internet searching (“cyberchondria”)

• Avoidance of illness- or death-related cues

• Frequent medical consultations

• Avoidance of medical appointments

• Overwhelming fear of having a serious or untreatable disease

• Intense fear regarding a current medical condition

Although many clients share these features, the presentation can vary widely. Some are consumed by reassurance seeking and medical testing, while others cope through total avoidance of health information.

Common Comorbidities

Health anxiety, whether or not it meets criteria for IAD or SSD, often coexists with other mental health conditions. The most common comorbidities include panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD).

This overlap is understandable, given shared mechanisms: the hyper-focus on bodily sensations in PD, obsessive illness-related thoughts and compulsive reassurance-seeking in OCD, and the pervasive worry and intolerance of uncertainty characteristic of GAD. Health anxiety may present as a symptom dimension within OCD or as an independent condition that mimics its cognitive-behavioral patterns.

Clinically, it’s important to assess how these disorders interact. Health anxiety can both trigger and be triggered by other anxiety or mood disorders, creating a complex interplay that requires an integrated treatment plan.

Risk Factors for Health Anxiety

As with most psychological conditions, health anxiety develops through a combination of biological, psychological, and social factors.

Clients may be more vulnerable if they have experienced:

• Personal illness or the illness, disability, or death of a loved one

• A parent or caregiver with prominent health anxiety

• Trauma in childhood (e.g., neglect, abuse, exposure to illness or violence) or adulthood

• Chronic stress or repeated exposure to health-related content (e.g., medical training, media, or social circles)

Psychological factors often include:

• Insecure attachment styles

• Low distress tolerance or emotional instability

• Personality traits such as neuroticism or heightened anxiety sensitivity

• The presence of another psychiatric condition

Genetic and biological predispositions may also play a role.

Sometimes the onset is linked to a clear triggering event (e.g., a diagnosis, medical scare, or bereavement). Other times, it emerges gradually, with clients reporting an increasing preoccupation with health that seems to have “taken over.”

From a therapeutic perspective, why health anxiety began is less critical than how it is being maintained. Once the fear cycle is established, unhelpful cognitions, beliefs, and behaviors become self-reinforcing. Treatment should therefore focus on disrupting these maintaining processes rather than identifying an exact origin story.

How Health Anxiety is Maintained

Each client’s health anxiety has unique features, but across presentations, we see consistent cognitive and behavioral patterns. Clients typically hold dysfunctional core beliefs about health, illness, and uncertainty, such as “If I don’t catch an illness early, it will be too late,” or “Serious diseases strike at random; no one is safe.”

These core beliefs influence perception and interpretation. When health-related, they lead to cognitive distortions, for example, misinterpreting benign sensations as evidence of serious disease. Clients may selectively attend to bodily cues, catastrophize ambiguous sensations, and discount benign explanations.

These misinterpretations elevate anxiety, which then drives safety behaviors like excessive body checking, reassurance seeking, and avoidance. Such behaviors provide short-term relief but maintain the fear long term by reinforcing the belief that danger is imminent unless the client engages in these rituals.

A central therapeutic goal in CBT is to help clients recognize and gradually disengage from this self-reinforcing cycle.

Health Anxiety and Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) remains the first-line, evidence-based treatment for health anxiety. It helps clients identify and modify unhelpful thoughts, beliefs, and behaviors, and replace them with more adaptive, flexible responses.

CBT for health anxiety is collaborative, structured, and skill-focused. It’s grounded in the cognitive model or the principle that our thoughts shape our emotions and behaviors. In this context, the therapeutic goal is to help clients develop a more balanced, reality-based view of health and illness, increase tolerance for uncertainty, and reduce unhelpful coping strategies.

Clinically, this involves techniques such as:

• Cognitive restructuring (e.g., examining catastrophic interpretations of symptoms)

• Behavioral experiments and graded exposure (e.g., reducing body checking or reassurance seeking)

• Psychoeducation about anxiety and physiological arousal

• Mindfulness or acceptance-based strategies to increase non-reactivity toward bodily sensations

CBT equips clients with lifelong tools to manage anxiety and build resilience. When clients begin to approach their health fears with intentionality, anxiety naturally diminishes, creating space for a fuller, more flexible life.

Want to take the next step to help clients with health anxiety?

If you are a mental health professional and want to better understand health anxiety and how to treat it, take my comprehensive course- Treating Health Anxiety with Exposure-Based Cognitive Behavioral Therapy. If you are a licensed clinical social worker, this course is approved by ASWB for 13 clinical continuing education credits.