Symptoms of Health Anxiety
Health anxiety is characterized by excessive, persistent worry about having or developing a serious illness, driven by catastrophic misinterpretations of bodily sensations, changes in appearance, or normal bodily functions—even when medical evaluation reveals no significant pathology. 1, 2
Core Psychological Symptoms
The defining feature is a cycle of worry and reassurance-seeking regarding health concerns, rather than actual somatic symptoms themselves 1. Key psychological manifestations include:
- Excessive anxiety and worry about health that is difficult to control, persisting for at least 6 months 3
- Catastrophic misinterpretation of bodily sensations (such as pain, swelling, dizziness, fatigue, or changes in appearance) as evidence of serious disease 2
- Fear of illness rather than conviction of having illness, distinguishing it from classic hypochondriasis 4
- Preoccupation with health that causes clinically significant distress or impairment in social, occupational, or other important areas of functioning 1, 2
Behavioral Symptoms
Health anxiety manifests through characteristic maladaptive behaviors:
- Excessive reassurance-seeking from medical providers, leading to multiple medical consultations across different specialties 1, 5
- Repeated medical testing and investigations despite negative results and medical reassurance 5
- Excessive health-related internet searching (cyberchondria), which may be increasing the prevalence of this condition 4
- Body checking behaviors and hypervigilance to bodily sensations 2
- Avoidance behaviors related to health-related stimuli or situations that trigger health concerns 2
Associated Physical and Cognitive Symptoms
When health anxiety reaches clinical severity, patients commonly experience:
- Restlessness or feeling keyed up or on edge 3
- Being easily fatigued 3
- Difficulty concentrating or mind going blank 3
- Irritability 3
- Muscle tension 3
- Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep) 3
Functional Impairment
The presence of functional impairment distinguishes pathological health anxiety from normal health concerns 5. This includes:
- Interference with work, social relationships, and family functioning 1, 2
- Increased healthcare utilization and costs through unnecessary medical contacts 4
- Significant negative impact on well-being and quality of life 6
Clinical Prevalence and Context
- Lifetime prevalence is approximately 6% in the general population, rising to 13% in some estimates 1, 4
- Up to 20% prevalence in hospital outpatient settings, making it a common presentation in medical clinics 4
- Untreated health anxiety is associated with premature mortality, highlighting the importance of recognition and treatment 4
Important Clinical Distinctions
Health anxiety must be distinguished from appropriate health concerns in the context of actual medical illness 1. The key differentiator is that health anxiety persists despite:
- Appropriate medical evaluation showing no serious pathology
- Reassurance from healthcare providers
- Negative test results
- The worry being disproportionate to actual medical risk 3
Comorbidity with depression is common, with approximately 31% of patients with anxiety disorders also having major depressive disorder, necessitating screening for both conditions 7.