Health Anxiety

Fear of Illness

What is Health Anxiety?

Health anxiety is a psychiatric disorder also called hypochondria or hypochondriasis. Health anxiety involves a preoccupation with fears of having a severe physical illness. People with health anxiety have a preoccupation with possible physical ailments, despite medical evaluation and reassurance, personal distress, and interference with work or relationships. For a diagnosis, symptoms must last at least six months, and, for over half of patients, symptoms last two years or more.

Hypochondriasis is considered a somatoform disorder, a class of psychological disorders that involve reports of physical symptoms from a patient, despite the inability of a physician to find a medical cause. It is believed that unconscious psychological conflicts become translated into physical problems or complaints, outside of the patient's conscious awareness. Health anxiety is not to be confused with disorders in which an individual intentionally fakes a physical illnesses for attention or to avoid punishment (malingering).

Common Symptoms of Health Anxiety

People with health anxiety may have the following symptoms:

• Excessive worry about having a severe physical problem.
• Preoccupation with bodily functions, sensations, or performance.
• Obsessive rumination or intrusive thoughts about condition.
• Ideas and fears of having an illness that cannot be easily stopped.
• Extreme suggestibility, for example a person may become alarmed at the slightest hint of illness, or even from reading about a disease, knowing someone who becomes sick, etc.
• Extensive fascination with medical information. For example, the person may read medical books or journals, watch television programs about health or medicine, be preoccupied about health news, etc.
• Unrealistic fears of being infected or contaminated by something touched, something eaten, or contact with another person.
• Excessive health-preserving behavior, for example eating only certain health food or overdoing things to keep fit.
• Over-focus on possible cause of symptoms. For example the patient needs an explanation for the symptoms and is more concerned about the meaning of the symptoms than the distress they cause.
• Fear of taking prescribed medication.

Health Anxiety and Related Disorders

Many patients with anxiety disorders suffer from medically unexplained physical symptoms. Patients are often preoccupied with how their body is functioning and may catastrophically misinterpret normal physical sensations. Anxiety disorders such as generalized anxiety disorder (excessive anxiety about everyday concerns), panic disorder, and even clinical depression, are often associated with hypochondriacal complaints. There is an overall agreement that health anxiety and panic disorder are related, but the exact nature of the relationship remains unclear. Both disorders involve many similarities, including hyper-focus on body sensations and overuse of health services.

Health anxiety has some overlapping similarities to obsessive-compulsive disorder, most notably obsessive concerns about bodily harm and contamination. "Obsessive rumination" is a prominent symptom for many patients with health anxiety, and fears of being infected or contaminated are also prominent with OCD. This raises the question of whether health anxiety should be viewed as an OC spectrum disorder, an illness closely related to OCD. The difference between health anxiety and OCD, however, is that hypochondriacs fear having a disease while people with OCD fear getting a disease. Even so, both groups have obsessions, compulsions to check, and are not convinced by repeated reassurance.

Treatment for Health Anxiety

Treatments for many anxiety disorders are also effective for health anxiety, most notably cognitive-behavior therapy. Antidepressant serotonin reuptake inhibitors also seem to be somewhat effective.

About the Author: M. Williams, Ph.D., is a clinical psychologist with an interest in anxiety disorders. This article was adapted from an article about Hypochondriasis at the BrainPhysics OCD Mental Health Resource and is used with permission.