For adults

Health anxiety

Health anxiety, once called hypochondria, is a persistent fear of having or developing a serious illness. For some people there are no symptoms to speak of; for others the symptoms are real and persistent, and the worry about them has taken over. It is not making a fuss or seeking attention. It is kept going by checking the body, searching symptoms and seeking reassurance, and CBT is the psychological treatment with the most trial evidence for it.

What health anxiety is

Health anxiety differs from ordinary concern about health because it persists, it is set off by bodily sensations rather than by evidence of disease, and reassurance does not settle it for long. A clear scan can bring relief for an afternoon, and by the evening the doubt has often moved to a new symptom. The sensations themselves are real. Palpitations, a tight chest, a twitch, difficulty swallowing and a lump you can feel are often produced or made stronger by anxiety, through adrenaline, over-breathing and muscle tension held for months, and are then read as signs of the disease you fear. Where the fear centres on the sensations themselves, such as a racing heart, there is a large overlap with panic and agoraphobia.

Two forms of health anxiety

The worry takes two forms, and it helps to know which is closer to yours. In the first, there are few or no symptoms, and the fear is of developing or having missed an illness: a family history of cancer, an article about a heart condition, or a friend’s diagnosis sets off months of checking and searching for a disease you have no signs of. The American diagnostic manual (DSM-5) calls this illness anxiety disorder, and the World Health Organization’s (ICD-11) keeps the older name, hypochondriasis. In the second, there are real and often persistent symptoms, such as pain, fatigue, dizziness, palpitations or gut problems, sometimes with a medical explanation and sometimes without one, and the difficulty is the amount of time, thought and worry that goes into them, and the way life has organised itself around them. The DSM-5 calls this somatic symptom disorder and ICD-11 bodily distress disorder. Many people sit somewhere between the two, and where you sit can change as the symptoms come and go.

The distinction matters for treatment. In the first form, most of the work is dropping the checking, searching and reassurance and learning to live with not knowing. In the second, the symptoms are not going to be argued away, and I do not try to. The work is about how you respond to them: what you do when a symptom flares, how much of the day goes to monitoring it, and what has been given up because of it. Your GP stays involved for the medical side, and treatment runs alongside any investigation or medical care rather than instead of it.

What health anxiety looks like day to day

• Checking a mole or a lump several times a day, and finding it changed because you keep pressing it.
• Taking your pulse, blood pressure or oxygen level far more often than any clinician would ask you to.
• Searching symptoms online, then searching for a story that ended well.
• Asking your partner to look at something, then asking again in case they were being kind.
• Or the opposite, skipping appointments and screening letters and leaving results unopened.
• Avoiding exercise in case it strains the heart, or holidays far from a good hospital.

The checking loop

1. Trigger: A headache, a lump, a twinge in the chest
2. Thought: What if it’s something serious?
3. Feeling: Anxiety, and the body feels even more noticeable
4. Checking: Pressing it, searching online, asking someone
5. Relief, for now: Calmer for a while, then the doubt returns
6. Then back to the first step, and the loop runs again.
7. Other situations that now set it off too: A news story about an illness, A friend’s diagnosis, A TV medical drama, A doctor’s appointment.

Where treatment steps in. You cut down the checking and reassurance step by step, and learn that you can live with the doubt without settling it.

New triggers. Over time, more situations become linked to the trigger and start the loop off too.

What treatment involves

Cognitive behavioural therapy is the psychological treatment with the most trial evidence for health anxiety (Cooper and colleagues, 2017). First we map the fears and everything you do about them, including the checking, searching, questions, appointments and the things you have quietly stopped doing, much of which has become automatic. The worksheet on the habits that keep anxiety going helps with spotting the smaller ones.

The main thing you learn in treatment is that you can handle the anxiety and the not knowing without checking, searching or asking. So, in steps you choose, you stop the checking, searching and asking, and return to things you have avoided, such as a health programme on television or exercise that raises your heart rate. Anxiety rises at first and usually becomes easier with practice. Alongside that, rather than debating whether your headache is a tumour, we run some experiments. You might compare what a sensation does when you watch it closely with what it does when you leave it alone, or notice what your throat feels like after ten deliberate swallows. You write the prediction on the behavioural experiment sheet beforehand and record what happened. Often you also see that the feared thing does not happen, which helps, but the aim is to be able to carry on with your day without needing that answer.

Sources

• Cooper, K., Gregory, J. D., Walker, I., Lambe, S., & Salkovskis, P. M. (2017). Cognitive behaviour therapy for health anxiety: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110-123. doi.org (opens in a new tab)

Common questions

Written by Dr Daniel O’Rourke, PhD, ABPP, CPsychol, HCPC-registered Clinical Psychologist Last reviewed: September 2026