This distinction isn't just academic or ticking boxes on a diagnostic criteria, it determines the type of support and treatment that will actually help. Understanding which category your experience falls into can be the first step towards finding the right path forward, whether that's targeted therapy for health anxiety or comprehensive support for navigating life with ongoing health challenges.
As a health psychologist and Cognitive Behavioural Therapist, when somebody says to me,
"I have bad health anxiety", I want to unpack exactly what they mean because 'health anxiety' is the term for an anxiety disorder with specific diagnostic criteria in the DSM-5. In the DSM it was previously termed 'hypochondriasis' and now updated to "illness anxiety disorder". This diagnosis is given to people who are experiencing excessive anxiety about health, with fears of escalation of serious illnesses in absence of medical diagnoses or tests to indicate cause for concern [1].
I've worked with people with illness anxiety disorder extensively. They generally were in good health, although may have an existing condition - interestingly that wasn't the focus of concern - and they would have shifting concerns about what different sensations in the body meant. In one course of therapy an individual may worry that they had throat cancer, then multiple sclerosis and then a heart condition. Fears flitted around a lot based on the elevated vigilance to physical experiences in the body.
Now, it is therefore crucial that this sort of anxiety disorder is differentiated from someone who is anxious about experiencing ongoing physical symptoms related to a chronic illness regardless of whether the cause of that condition is clearly explained or not. For example chronic fatigue or fibromyalgia are conditions that are frequently called 'medically unexplained' which can be problematic for reasons beyond the scope of this article [2].
Feeling anxious about bodily discomfort and all that comes with health issues is not pathological. If it were to be treated as such, it would be completely invalidating - gaslighting even - to the person seeking treatment. What is required here, rather than the anxiety to be targeted, is the relationship with the body, health and the self. I think of the issues arising here as more of an 'adjustment' issue, where someone is encountering something fundamentally difficult to manage and needs support to work through this. Of course, I personally think that this support should be highly personalised and targeted to the experience of the physical health and symptoms so that the individual can be empowered to identify where psychology and physiology are impacting each other and how best to influence this.
Illness anxiety diagnostic criteria are [3]:
- You are preoccupied with having or acquiring a serious illness
- You have no or minimal somatic symptoms
- You are highly anxious about health and easily alarmed about personal health issues
- You repeatedly check your health status or maladaptively avoid doctor appointments and hospitals
If you identify with this, I've found cognitive behavioural therapy for health anxiety to be very effective and when I worked in the NHS had a 90% recovery rate for this.
You can access CBT through the NHS if you are in England, seek treatment at
IAPT services or ask for a referral from your GP.
If this is not accessible to you, then I highly recommend Dr Kirren's 10 Times Calmer book which includes a lot of important information and strategies specific to health anxiety.
Perhaps this might sound familiar: you wake up in the morning and the first thing you do without thinking is to check how you are feeling. If your symptoms are still there, your heart sinks. But if they aren’t - you feel anxious about them potentially beginning.
Or maybe you are going about your day, you feel an unexpected new or familiar symptom, and your brain fixates on the sensation to try and work out if it is getting worse, or what caused it.
Understandably, you may begin to focus on the symptoms and keep coming back to them, whilst worrying this may make it worse. Symptom focussing can make symptoms worse, but so does blaming yourself and getting frustrated. It becomes a vicious cycle.
There are ways to address this. One is tailored and appropriate therapy, it can be really helpful in supporting you navigate issues coming up including decision making about health, changes in your role or sense of identity, bodily hypervigilance and working out when to act and when to detach, the impact of health issues on mood and relationships and how to work with the mind and body to mitigate symptoms where possible.
Understanding the intricate relationship between your mind and body is crucial when managing chronic health conditions. This is where a research-informed, holistic approach can make a significant difference to your wellbeing and symptom management.
It is about learning how we can interrupt the amplification of physical symptoms by working with attentional processes and emotional experiences, for example by shifting the attention focus on symptoms to external focus of attention and learning to train attention to be on the present. Additionally, working and training your mind to begin to calm panic down as opposed to feeling frustrated, fearful and anxious.
If you are looking for therapy, then this is one of the therapies that my clinicians and I provide at my practice, Mind Body Blossom. You are welcome to
reach out to us here to see if we might be the right fit for you.
Additionally, our Body Mind Connect membership offers comprehensive support through our evidence-based membership programme. I created this platform to help people with chronic conditions who are suffering, understand the connection between their biology and psychology. In the programme you will learn how to work with your mind and body, through a series of modules which can be taken at your own pace, and either lead through with our ‘my journey’ section or based on your own concerns.
Additionally, we offer practical strategies, a supportive community of people who truly understand your experience, and weekly workshops that blend science with real-world application. If you're navigating the complex emotional and physical landscape of chronic health conditions, Body Mind Connect provides the specialised, research-informed support that acknowledges both the reality of your physical symptoms and the psychological impact they have on your life.
References: [1] J. M. Newby, M. J. Hobbs, A. E. J. Mahoney, S. (Kelvin) Wong, and G. Andrews, 'DSM-5 illness anxiety disorder and somatic symptom disorder: Comorbidity, correlates, and overlap with DSM-IV hypochondriasis', Journal of Psychosomatic Research, vol. 101, pp. 31–37, Oct. 2017, doi: 10.1016/j.jpsychores.2017.07.010.
[2] F. Creed et al., 'Is there a better term than "Medically unexplained symptoms"?', Journal of Psychosomatic Research, vol. 68, no. 1, pp. 5–8, Jan. 2010, doi: 10.1016/j.jpsychores.2009.09.004.
[3] S. A. and M. H. S. Administration, 'Table 3.32, DSM-IV to DSM-5 Illness Anxiety Disorder Comparison'. Accessed: May 17, 2025. [Online]. Available: https://www.ncbi.nlm.nih.gov/books/NBK519704/table/ch3.t32/
