Synopsis
Identify health anxiety while remaining alert to genuine illness, explain the maintaining cycle, and replace repeated reassurance with collaborative assessment, cognitive behavioural treatment and proportionate safety-netting.
- Health anxiety is persistent preoccupation with having or acquiring serious illness, often sustained despite appropriate assessment and reassurance.
- Common behaviours include body checking, reassurance seeking, repeated health searches, comparing symptoms and avoiding illness-related cues or healthcare.
- Checking reduces anxiety briefly but increases attention to bodily variation and prevents lasting learning that uncertainty can be tolerated.
- Take concerns seriously and assess relevant disease; health anxiety and physical illness can occur in the same person.
- Agree a consistent explanation, planned reviews and clear red-flag thresholds rather than offering unlimited tests or absolute reassurance.
- Cognitive behavioural therapy targets catastrophic interpretation, selective attention, checking, reassurance and avoidance through collaborative behavioural experiments.
- Ask permission before linking anxiety and bodily sensations, and use the person's own feared prediction rather than imposing a label.
- Measure change in preoccupation, checking, avoidance and participation as well as the intensity of physical sensations.
Key red flags
New objective abnormality, physiological instability or a materially changed symptom pattern requires ordinary presentation-specific assessment.
Suicidal thoughts, hopelessness, inability to eat or sleep, or dangerous attempts to diagnose or treat oneself need urgent risk evaluation.
Avoidance of examination or treatment for a plausible serious condition may create immediate medical risk despite the anxiety mechanism.
Repeated emergency attendance, escalating private investigations or severe occupational and relationship loss signals high impairment and need for coordinated care.
Investigation priorities
Evaluate the presenting symptom, objective findings and relevant personal or family risk before applying a health-anxiety formulation.
Management branches
Illness preoccupation or healthcare behaviour is causing persistent distress or impairment.
- Ask what illness is feared, what evidence seems convincing, what would count as reassurance and how long relief usually lasts.
- Complete a proportionate physical and mental-health assessment, summarising what is known, what remains uncertain and why further tests are or are not indicated.
- Offer a working health-anxiety formulation and agree planned follow-up plus explicit symptoms or signs that should prompt earlier review.