Anxiety & Mood
Health anxiety (hypochondria): what it is and what helps
Constantly afraid that you have a serious illness, searching symptoms online, and tests don’t reassure you? What health anxiety is and what helps.
Health anxiety, also called hypochondria, is a persistent fear that you have or will develop a serious illness, even though tests do not show it. The fear leads to checking your body, frequent visits to doctors or, the opposite, avoiding any test. It is not “imagination” or weakness. Cognitive behavioural therapy has the most evidence, and it can also be done online.
What it is called today
The American diagnostic manual, DSM-5, split the old “hypochondriasis” into two diagnoses:
Illness anxiety disorder: the main difficulty is the fear of being ill. Physical symptoms are absent or mild.
Somatic symptom disorder: there are distressing physical symptoms, and the worry about them is excessive.
In everyday language and in research, the term “health anxiety” is often used to cover both.
What are the signs?
For a diagnosis of illness anxiety disorder, the following are needed for at least 6 months:
strong preoccupation with having or developing a serious illness
physical symptoms that are absent or mild; if a condition is present, the worry is out of proportion
high anxiety about health, and being easily alarmed by each new piece of information
excessive behaviours, such as repeatedly checking the body, or avoiding doctors and hospitals
There are two forms. In one, the person keeps making visits and having tests. In the other, they avoid any medical contact, out of fear of what might be found.
The thought “what if it’s something serious?” is a symptom of anxiety, not a sign that something is being missed. We accept the fear you feel, not the catastrophic scenario. Feeling it strongly does not make it more likely.
How common is it?
In Australia’s national mental health survey, 5.7% of the population had health anxiety at some point in their life and 3.4% at the time of the interview. It was linked to more distress, disability and use of health services. For the narrower diagnosis of illness anxiety disorder, the frequency is not known precisely, because the diagnosis has existed only since 2013.
Why don’t tests reassure you?
A clear test brings relief, but the relief does not last. Then a new symptom appears and a new check follows. The cycle is: bodily sensation → catastrophic interpretation → anxiety → checking or reassurance → brief relief → back to the start.
Searching symptoms online feeds this cycle. In an analysis of 20 studies with 7,373 participants, health anxiety was related to searching for health information online, and very strongly to “cyberchondria”: repeated searching that increases, rather than reduces, anxiety.
Checking and reassurance work like avoidance in any anxiety: they bring relief today and keep the problem going tomorrow. In therapy we reduce them gradually, in small and specific steps, without waiting for the fear to go first.
How is it treated?
Cognitive behavioural therapy (CBT). It works on catastrophic interpretations of bodily sensations, on checking and on seeking reassurance.
In an analysis of 19 randomised studies, CBT had a moderate to large benefit, largely maintained 12 to 18 months later. About 2 in 3 people responded (66%) and almost half (48%) reached remission.
Internet-delivered CBT, guided by a therapist, had results comparable to face-to-face therapy.
In a large study in hospital clinics in England with 444 patients, 5 to 10 sessions of adapted CBT reduced health anxiety more than usual care, with a benefit that lasted two years.
Medication. In a randomised study of 195 patients, fluoxetine, an antidepressant of the SSRI class, reduced hypochondriasis more than placebo in secondary analyses. Combining it with CBT gave a small additional benefit. About half of the patients did not respond, which the researchers note as a need for better treatments. The StatPearls database lists antidepressants as a second option after psychotherapy.
Do not start, change or stop a medicine on your own; this is done only with the doctor who follows you.
What you can do from today
Set a regular interval for visits to your doctor, instead of a visit every time you worry.
Gradually reduce checking your body and searching symptoms online.
When the worry comes, write the thought down and ask: “What evidence do I actually have? What did my last test show?”
In the assessment we first check whether there is a physical cause that needs treatment, so that you know nothing real is being overlooked. Then we work on the anxiety, not on the search for the next test.
When to ask for help
Your fear about your health has lasted for months and returns despite clear tests.
You spend a lot of time searching symptoms or checking your body.
You avoid doctors or tests out of fear of the result.
There are also panic attacks, low mood or insomnia.
Safety: Health anxiety does not mean that every symptom is anxiety. If you have severe chest pain, shortness of breath, fainting, sudden weakness or numbness on one side of the body, call 166 (ambulance, EKAV) or 112. If you have thoughts of harming yourself, call 166, 112 or the Suicide Prevention Line 1018.
How I can help
Book an assessment, at the practice in Trikala or online. See the page on anxiety and panic attacks and the article Physical symptoms of anxiety. The first conversation can also take place from your home: see how working with an online psychiatrist works, or book an appointment.
This article is educational and does not replace individual clinical assessment. Do not change or stop any treatment you are already taking without talking to your doctor.
Sources
Hameed S, et al. Illness Anxiety Disorder. StatPearls. Last updated 16 July 2023. Accessed 12 November 2026. https://www.statpearls.com/articlelibrary/viewarticle/23261/
Sunderland M, Newby JM, Andrews G. Health anxiety in Australia: prevalence, comorbidity, disability and service use. Br J Psychiatry. 2013. https://doi.org/10.1192/bjp.bp.111.103960
McMullan RD, Berle D, Arnáez S, Starcevic V. The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis. J Affect Disord. 2019. https://doi.org/10.1016/j.jad.2018.11.037
Axelsson E, Hedman-Lagerlöf E. Cognitive behavior therapy for health anxiety: systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Rev Pharmacoecon Outcomes Res. 2019. https://doi.org/10.1080/14737167.2019.1703182
Tyrer P, et al. Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. Lancet. 2014. https://doi.org/10.1016/S0140-6736(13)61905-4
Fallon BA, et al. A Randomized Controlled Trial of Medication and Cognitive-Behavioral Therapy for Hypochondriasis. Am J Psychiatry. 2017. https://doi.org/10.1176/appi.ajp.2017.16020189
