“Psychology Works” Fact Sheet: Health Anxiety

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What is health anxiety?

Most people have felt anxious about their health or the health of loved ones at some point in their lives. In fact, we are often faced with health situations in which it is entirely appropriate to feel some anxiety. For example, you may be waiting for the results of a biopsy or your friend may have just been diagnosed with a serious illness. It is natural to feel anxious and upset in these situations. Similarly, most of us worry about death and dying from time to time. Experiencing anxiety about illness and death is normal.

Worries about health and dying can become a problem if they get in the way of living and enjoying life. Health anxiety involves fears of having or developing a serious disease such as cancer, heart disease, or multiple sclerosis. Health anxiety is often associated with high levels of worry, substantial focus on bodily symptoms, repeated checking for signs and symptoms related to health concerns, focus on death and dying, and frequent efforts to obtain reassurance from family members, friends, or health care professionals. Some people with health anxiety avoid going to doctors because of fears of being diagnosed with a serious disease or because of dissatisfaction with previous health care experiences. Individuals with health anxiety may also avoid other situations related to illness and death, including activities such as spending time with loved ones who are ill, attending funerals, and writing a will.

Worries about health may be triggered by experiences such as everyday symptoms (a skipped heartbeat, a headache), a frightening experience such as finding a breast lump, or coping with illness or death of a loved one. Anxiety may also be triggered by stories about health issues in the community or media. Worries may be mild and transient or they may have a more severe and chronic course, waxing and waning over time. Some individuals may worry about one specific illness or body symptom, while others worry about many. Health anxiety can occur on its own and may then be termed illness anxiety disorder.  It may also be part of other problems such as panic disorder, generalized anxiety disorder, obsessive-compulsive disorder and depression. People who have diagnosed medical conditions may also experience high levels of anxiety as a reaction to their health problems. In some circumstances, the level of health anxiety may be excessive and may interfere with normal functioning and enjoyment of life.

How prevalent is health anxiety?

Estimates suggest that 3-10% of the general population suffer from significant health anxiety. Up to 30% of the population experience intermittent or milder fears about their health. This is a relatively common problem and one that can cause significant interference. It can also be costly to the health care system when it results in high levels of health service utilization.

What are the main causes of health anxiety?

There are a variety of factors that may contribute to the development and onset of problems with health anxiety. These include:

Genetics: Some people are born with a temperament that leads them to be more prone to experiencing anxiety than most people. In addition, most forms of anxiety run in families to some degree.

Family background and childhood experiences: Individuals who experience a stressful family life during their childhood (such as family conflict, high family stress, or abuse) are more likely to develop problems with anxiety and depression. People who have problems with anxiety in general may be more likely to also have worries and fears about health and illness.

Social Learning: We can learn many things from our parents, siblings, or other significant people in our lives. Sometimes these lessons can be positive but at times we can pick up negative things from those around us. Children often model what their parents or siblings do. For example, if an anxious parent avoids a range of situations, children watching this are likely to behave in similar ways (i.e., engaging in avoidance).

Parents or other important people can also pass on fears through verbal communication. For instance, fearful or anxious people may be overly concerned about potential dangers and often communicate these fears to their children by saying certain things, such as: “If you have a stomach ache you had better stay home and be in bed until you feel better” or “Did you hear about Sally – she was fine one day then she was diagnosed with brain cancer, and now she’s dead”.  In this case, viewing health as fragile and illness as painful and deadly may lead a child to become focused on health concerns, avoid certain situations, or worry excessively about illness and death.

Illness and death experience: Health anxiety may also be related to stressful experiences with illness and death in childhood or during the adult years.

What psychological treatments are used to treat health anxiety?

The primary psychological treatment that has been shown to be effective with this problem is cognitive-behavioural therapy (CBT). This treatment involves:

  • understanding anxiety and how problems with anxiety can develop;
  • decreasing specific behaviours such as checking one’s body for symptoms and asking for reassurance about one’s health;
  • learning how to counter the excessive worries about health and illness;
  • overcoming avoidance of situations related to illness and death using exposure strategies;
  • learning to face worries about illness realistically and directly which can reduce the fear associated with these thoughts;
  • coping with fear of death by emphasizing the importance of accepting the reality of death and enjoying life to the fullest; and
  • general anxiety management strategies such as relaxation techniques and increasing exercise.

How effective are psychological methods of treating health anxiety?

Research demonstrates that cognitive-behavioural treatment is helpful in reducing fears about having and/or getting a serious illness. Studies show that individuals receiving from 6 to 20 treatment sessions generally report decreased illness fear and a reduction in accompanying depression. Both individual and group treatments are effective.

Where do I go for more information?

For the public:

For the professional:

  • Treating Health Anxiety and Fear of Death: A Practitioner’s Guide. By P. Furer, J.R. Walker, & M.B. Stein (2007). New York: Springer.
  • Treatment of Health Anxiety and Hypochondriasis: A Biopsychosocial Approach. By J. Abramowitz & A. Braddock (2008). Ashland, OH: Hogrefe & Huber.
  • Treating Health Anxiety: A Cognitive-Behavioral Approach. By S. Taylor & G.J.G. Asmundson (2004). New York: Guilford Press.
  • Tackling Health Anxiety: A CBT Handbook. By H. Tyrer (2013). London: RCPsych Publications.

You can consult with a registered psychologist to find out if psychological interventions might be of help to you. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, click https://cpa.ca/public/unpsychologue/societesprovinciales/.

 

This fact sheet has been prepared for the Canadian Psychological Association by Patricia Furer, Ph.D., C.Psych., Dept. of Clinical Health Psychology, University of Manitoba.

Revised: June 2020

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