Health Anxiety

Many people, at some point in their lives will go through a period of worry about health. Health anxiety is broad term used to describe excessive worry about having and/or getting an illness or disease that can range in severity from mild and short-lived to chronic and debilitating.

Illness Anxiety Disorder is the current DSM 5 category for clinically significant health worry. Illness Anxiety disorder should not be confused with the more severe Somatic Symptom Disorder. Although they have overlapping features, illness anxiety disorder is focused on disease while somatic symptom disorder is characterized by intense attention to and worry about somatic (or body sensations) which are interpreted as a sign of life threatening disease or illness.

Below, I have organized the the DSM 5 definitions of Illness anxiety disorder into the categories:

Cognitive Features and Themes
  • “Preoccupation with having or acquiring a serious illness”
  • “There is a high level of anxiety about health, and the individual is easily alarmed about personal health status.”
  • “Illness preoccupation has been present for at least 6 months, but the specific illness that is feared may change over that period of time.”
  • “The illness-related preoccupation is not better explained by another mental disorder,such as somatic symptom disorder, panic disorder, generalized anxiety disorder, body dysmorphic disorder, obsessive-compulsive disorder, or delusional disorder, somatic type.”
  • Harmless bodily changes and/or sensations such as onset of pain or appearance of a rash can be interpreted as a sign of illness.

Recent research has identified clinical features common to health anxiety and OCD: both are characterized by themes of vulnerable-self and narratives involving an imagined and/or extremely implausible threat that the person attempts to resolve through repetitive loops of checking and reassurance seeking. Health worriers also distrust medical opinions and findings which is similar to the distrust of the senses and reality seen in OCD. Additionally, there is a continuum of disease conviction or belief in health anxiety similar to the phenomenon of immersion into the obsessional narrative that occurs in OCD.

Somatic Features

“Somatic symptoms are not present or, if present, are only mild in intensity. If another medical condition is present or there is a high risk for developing a medical condition (e.g., strong family history is present), the preoccupation is clearly excessive or disproportionate”.

Behavioral Responses

“The individual performs excessive health-related behaviors (e.g., repeatedly checks his or her body for signs of illness) or exhibits maladaptive avoidance (e.g., avoids doc tor appointments and hospitals)”. There is also:

  • Avoidance certain disease related stimuli related to one's disease fears
  • There is also reassurance seeking from medical providers, family and/or friends
  • Checking repeatedly other sources of medical information such as the internet, medical websites, magazines or books
  • Repeated request for medical tests

Cognitive and behavioral therapy is the treatment of choice for health anxiety. Given the similarities between health anxiety and OCD, many of the CBT methods used to treat OCD apply to the treatment of health anxiety.

I make modifications to the inferential based approach (IBA) used in the treatment of OCD. In treating health anxiety, it is necessary to incorporate the unique relationship between misinterpreted body sensations and assumptions of illness vulnerability. Confusion between perception and imagination is a core cognitive feature of the IBA model. Yet, in health anxiety, real not imagined body sensations are often present. This requires a shifting of the concept of “senses”, in the IBA model, away from sensations and over to the interpretation of illness or disease. The problem, however, is that people with health anxiety invent stories about what these sensations represent while distrusting evidence to the contrary. From here forward, the same IBT methods used in OCD are followed.


© 2023 Robert Safion, M.Ed.

Treatment of Obsessional Spectrum Anxiety

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