psychology-research/anxiety | Psychology Documentation

Health Anxiety (Illness Anxiety Disorder)

Health anxiety is the persistent worry that you have, or will soon develop, a serious illness despite little or no medical evidence. In DSM-5 it is classified as Illness Anxiety Disorder (IAD) and sits in the Somatic Symptom and Related Disorders chapter. Core diagnostic points are ① a pre-occupation with having or acquiring a grave disease, ② high anxiety about health, ③ excessive checking or maladaptive avoidance (e.g., shunning doctors), and ④ symptoms that last ≥ 6 months and are not better explained by another condition. (Table 3.32, DSM-IV to DSM-5 Illness Anxiety Disorder Comparison)

How Common Is It?

Lifetime community prevalence ≈ 1 – 3 %.
Rates are much higher in primary-care and specialty clinics (7 – 20 %). (Illness Anxiety Disorder: A Review of the Current Research and ...)
COVID-19 produced a measurable spike in new-onset health anxiety worldwide. (Illness Anxiety Disorder: A Review of the Current Research and ...)

Why Does Health Anxiety Persist?

| Maintaining factor | Example | |--------------------|---------| | Catastrophic misinterpretation | “A skipped heartbeat = heart attack.” | | Selective attention to bodily sensations | Constant “body-scanning.” | | Safety-seeking behaviours | Google searches, repeated reassurance, or total avoidance; they quell fear short-term but prevent disconfirmation long-term. (How Our Safety Behaviors Feed Anxiety | Psychology Today, [PDF] Challenging Avoidance and Safety Behaviours) | | Intolerance of uncertainty | Needing 100 % certainty that one is healthy. | | Media amplification of risk | 24-hour health news and social media heighten perceived threats. (Plane crashes, pandemics, toxic spatulas. How do we live with so much risk?) |

The well-known CBT model (Warwick & Salkovskis) describes a vicious cycle: misinterpretation → anxiety → checking/avoidance → temporary relief → more misinterpretation.

Assessment Tools

Health Anxiety Inventory (HAI)
Illness Attitudes Scale (IAS)
Whiteley Index – brief screening often used in primary care.

Evidence-Based Treatments

| Approach | Key points | Evidence | |----------|------------|----------| | Cognitive-Behavioural Therapy (CBT-HA) | Identifies misinterpretations, drops safety behaviours, uses exposure & response prevention (ERP). | Meta-analyses show small-to-medium effect sizes; adverse-event rate ≈ 10 %. (Unwanted outcomes in cognitive behavior therapy for pathological ...) | | Exposure & Response Prevention | Systematic exposure to feared sensations/images while resisting checks. | Robust data from multiple RCTs; D-cycloserine being explored as an enhancer. (Exposure and Response Prevention in the Treatment of Obsessive ...) | | Pharmacotherapy (SSRIs/SNRIs) | Helpful when anxiety or depression is comorbid; typical course 6–12 mths. | Clinical reviews support use as second line. (Illness Anxiety Disorder - StatPearls - NCBI Bookshelf) | | Digital & App-based CBT | Mobile programmes teach CBT skills, journaling and graded exposure. | 2024 RCTs show significant anxiety reduction in young adults. (Efficacy of a Mobile App-Based Intervention for Young Adults With ...) |

Treatment tip: Combining CBT with medication often yields the strongest and most durable gains.

Self-Help & Day-to-Day Coping

Scheduled “worry time” – postpone health thoughts to a 10-minute daily slot.
Limit reassurance and googling – set strict rules (e.g., no symptom search after 8 pm).
Grounding & mindfulness – focus on current sensations without judgment; use paced breathing.
Behavioural experiments – test predictions (“If I don’t check my pulse, I’ll faint”) to gather disconfirming evidence.
Balanced information diet – follow reputable sources only, and in moderation.

Worksheets for challenging avoidance and safety behaviours are freely available from clinical-resource sites. ([PDF] Challenging Avoidance and Safety Behaviours)

When to Seek Professional Help

Worry dominates > 1 hour per day or interferes with work, sleep, or relationships.
You avoid medical care entirely or use it excessively.
Self-help fails to lower distress after several weeks.

Your GP or a clinical psychologist can confirm the diagnosis and outline treatment options.

Key Takeaways

Health anxiety = worry + uncertainty + safety behaviours.
It is common, treatable, and distinct from normal health vigilance.
CBT (with ERP) is first-line; SSRIs/SNRIs and digital CBT are effective adjuncts.
Reducing reassurance-seeking and practising uncertainty tolerance are cornerstone skills.