Health anxiety: when every symptom means the worst

It is half past one in the morning. Eleven tabs are open on your phone. The first is innocent: “pain under left rib”. The last has a word in its title that you can no longer forget. In between are forums where someone writes that the doctors told them it was nothing too, and then it wasn’t. Your heart is beating faster than an hour ago, and now you can feel it in your neck as well. Which is another symptom. Which needs looking up.

If this sounds familiar, you are not alone. What is happening is what professionals call health anxiety — a constant, hard-to-control worry that you have or will get a serious illness, which persists even when doctors find no reason for it. The older term is hypochondria, but the profession is moving away from it, because in everyday language it has become an insult. People with health anxiety do not invent illnesses or exaggerate to get attention. They really suffer — sometimes more than people with a diagnosis, because nobody can tell them what is wrong.

In this post I will write about what keeps health anxiety alive: searching online, checking the body, and reassurance that helps for an hour. And also about how to keep a good relationship with your doctor, and how to tell a symptom that needs checking from a symptom that fear is feeding.

When the body becomes a control panel

Every body sends signals all the time. The heart skips a beat now and then, the stomach rumbles, a muscle twitches, the head aches slightly, a patch of skin looks a different colour. Most people don’t even notice these signals, because the brain filters them out as unimportant. In health anxiety that filter is swapped. The body becomes a control panel that must be watched constantly, and every new signal could be the first sign of something terrible.

The key pattern was described back in the 1980s by the British psychologists Paul Salkovskis and Hilary Warwick. The problem is not that a person feels bodily sensations — we all do. The problem is the interpretation: an ordinary sensation is taken as proof of serious illness. That interpretation triggers anxiety, anxiety produces new bodily sensations (a pounding heart, tightness in the chest, tingling, digestive trouble), and these confirm the original interpretation. You will find a short explanation of the term in the knowledge base under health anxiety.

That this is no marginal problem is shown by the fact that health anxiety was the subject of one of the larger studies of its kind in hospitals. Peter Tyrer and colleagues enrolled 444 patients with marked health anxiety from English hospital outpatient clinics — cardiology, gastroenterology, neurology, endocrinology and respiratory medicine. People who received five to ten sessions of cognitive behavioural therapy on top of usual care had noticeably less health anxiety after a year than those who received usual care alone, and the effect held later too. The very fact that there were enough such patients in the clinics for a study this large tells you how often anxiety hides behind visits to specialists.

“Dr Google” and cyberchondria

Looking up symptoms online is so common today that we hardly notice it any more. For most people it is useful: they read that a headache after a sleepless night is to be expected, and move on. For someone with health anxiety, though, the internet is something else. Researchers coined a word for it: cyberchondria — repeated, excessive searching for health information online that increases anxiety instead of reducing it.

Why does this happen? Search engines and forums don’t show illnesses according to how common they are, but according to what people read and write about. A rare serious illness is more interesting than a common harmless one, so it ranks high. Forum stories are written mainly by people who had a bad experience — someone with an ordinary headache doesn’t post about it. And once you have read the name of a serious illness, you can’t forget it.

A review of studies published in 2019 by Ryan McMullan and colleagues showed that health anxiety is linked both to more frequent online health searching and to people feeling more distressed after searching, not less. Vladan Starcevic and David Berle described how searching works much like a compulsion: it promises a certainty it never delivers, so it has to be repeated. Every new search opens new questions.

On top of that, searching mostly happens at night, alone, when there is nobody to say “come on, go to sleep”, and when a tired brain leans towards the worst explanations. I have written about how the brain leaps to the worst outcome in “What if …”: why the brain would rather predict a hundred disasters than one calm day.

Checking and reassurance: what helps today harms tomorrow

Searching online is just one form of what professionals call safety behaviours. Others are less visible but just as important:

• Body checking: repeatedly taking your pulse or blood pressure, feeling for lymph nodes, examining your skin, watching your stools, testing whether you can still take a deep breath.
• Reassurance seeking: asking your partner or parents “does this seem normal to you?”, repeat visits to the doctor, new tests, a second and third opinion.
• Avoidance: someone afraid of cancer skips a screening appointment; someone afraid for their heart stops exercising; someone avoids news about illness and stops visiting sick friends.

All these behaviours have one thing in common: they bring short-term relief but keep anxiety going in the long term. When you take your blood pressure and it is normal, a weight lifts. A few hours later doubt appears — what if the monitor was wrong, what if the reading was normal only at that moment. And because the measurement calmed you, you’ll repeat it. The brain learns that safety comes only through checking, never on its own.

Reassurance from loved ones holds another trap. A partner, mother or friend who answers your questions helps out of love. But every answer becomes part of the loop. Over time you need reassurance more often, your loved ones become exhausted and frustrated, and then you feel lonely and misunderstood. In relational family therapy, which I am training in, it often turns out that health anxiety has also become the language of a relationship: a way someone seeks closeness, or a role in which a couple or family has become stuck. It can help if you and those close to you agree how you will respond — by understanding the feeling, not by proving yet again that nothing is wrong. You can read more about how avoidance keeps fear alive in the knowledge base under avoidance.

What it looks like in a relationship

The dialogue below (composite, not a real person) shows how reassurance can turn into a dance nobody meant to start.

“Are you sure it’s just a bruise? Look again.”
“I’ve looked. Three times. It’s a bruise. You knocked into the table.”
“But I don’t remember doing that. What if it’s not from that?”
“I don’t know what else to tell you.”
“I don’t need you to tell me anything. I need you to know how scared I am.”
Silence. “All right. You’re scared. I’m here.”

The last two lines are different from everything before. The partner stops proving the bruise isn’t dangerous and acknowledges the fear. It is no miracle cure, but it often brings more peace than one more look at the skin. For many people it is also the first realisation that beneath the worry about the body lies a need to be seen.

Your relationship with your doctor

People with health anxiety often have a complicated relationship with doctors. They see them often, but don’t stay reassured for long after an examination. They fear being seen as “hypochondriacs”, so they sometimes describe symptoms more dramatically or, on the contrary, say nothing about their anxiety. The doctor, meanwhile, is in a difficult position: they order a test to reassure, but every new test can become a new source of uncertainty — especially when a result appears on the Slovenian patient portal zVEM before the doctor has explained it, with an unclear term or a value just at the borderline.

Some things that help many people:

• One doctor as a fixed point, not a new specialist or a new clinic each time. A doctor who knows you can more easily judge what is new.
• Say openly that you are scared. “I notice I jump to the worst very quickly” is information that helps your doctor; it doesn’t disqualify you.
• Scheduled check-ups instead of a visit for every symptom. Some people agree with their doctor on regular check-ups at set intervals. That way you don’t have to judge every time whether a symptom is serious enough.
• Ask what you should watch out for. Clear instructions on when to come back give more security than a general “it’s nothing”.

It is also important to understand that a doctor cannot guarantee one hundred per cent certainty. No test can. That is not a failing of the doctor or of medicine — it is part of living in a body. I have written about what happens when the test results are fine but the body still hurts in “The tests are normal, but it still hurts”: what therapy knows about psychosomatics, so I won’t repeat it here. You will also find a short explanation in the knowledge base under psychosomatics.

When to have a symptom checked anyway

This part matters, because health anxiety doesn’t make you immune to illness. People with health anxiety fall ill just like anyone else. So the aim is not to stop seeing your doctor, but to see them for the right reasons.

If you are in doubt, consult a doctor — that is always the right decision. But a consultation with a GP or out-of-hours service is something different from hours of searching online. The first brings a professional assessment; the second brings only new questions. If you have the signs listed in the warning box in the infographic above, don’t think and don’t search — call 112 (the emergency number in Slovenia).

A simple question you ask yourself before reaching for your phone can also help: Am I looking for information I need to make a decision, or am I looking for reassurance? If it is the second, the search probably won’t calm you for long.

Exercise: delaying the check

This exercise is built on the same principle as cognitive behavioural therapy for health anxiety: anxiety settles even without checking, but you can’t experience that as long as you always check. Don’t use it for the symptoms in the warning box above — for those, 112 applies.

1. Choose one behaviour. For example, searching symptoms online, taking your pulse, or asking your partner. Not all of them at once — just one.
2. When the urge comes, write it down and rate it. What you feel, where in your body, and how strong the anxiety is on a scale from 0 to 10.
3. Delay the check for thirty minutes. In that time, do something with your hands and body — wash the dishes, take a short walk, tidy something. Don’t try to convince yourself all is well; just wait.
4. After thirty minutes, rate the anxiety again. Write down the number. If you still want to check, you may — or you can extend the delay by another half hour.
5. After a week, read your notes. Notice how often the anxiety settled on its own and how often the symptom disappeared altogether. Gradually lengthen the delay.

The exercise is simple, but not easy. For the first few days it will feel like you are taking a risk. That feeling is exactly the point: only through such experience does the brain learn that safety can come without checking. If you find yourself getting stuck in your thoughts along the way, the post How to notice a thought instead of following it: an introduction to cognitive defusion may help too.

Where this explanation falls short

Health anxiety explains many experiences, but not all of them — and I want to be clear about that.

Not every concern about health is anxiety. Someone who has already survived a serious illness, who lost a parent to one, or who lives with a chronic condition has reason to pay attention to their body. Then attention is reasonable; what is needed is support in living with uncertainty, not a label. Doctors also sometimes get it wrong and miss a symptom, so a healthy measure of persistence — a second opinion on a new, persistent symptom — is entirely legitimate.

Health anxiety can be part of a different picture. Fear of a heart attack is often part of panic attacks — I wrote about this in Why a panic attack is not dangerous, even when it feels like a heart attack. Recurring thoughts about illness can be part of obsessive-compulsive disorder, depression, or a broader worry like the one I describe in Generalised anxiety disorder: when worry becomes a way of life. Which of these applies to you can only be assessed by a professional — a psychiatrist, clinical psychologist or psychotherapist who sees you in person.

Medication is sometimes part of treatment for severe health anxiety. Talk about it with your GP, who can refer you to a psychiatrist. Don’t start or stop medication on your own.

And if, alongside the fear for your health, thoughts come that you can’t go on, call the mental distress line Klic v duševni stiski on 01 520 99 00 in Slovenia (7 pm to 7 am) or the Samaritans helpline on 116 123 in Slovenia (every day, 24 hours).

What to remember

• Health anxiety is not make-believe: ordinary bodily sensations are read as signs of serious illness, and anxiety creates new ones.
• Searching online, checking and reassurance bring brief relief but keep the loop going in the long run.
• What helps: a steady relationship with one doctor, openness about your fear, and scheduled check-ups instead of a visit for every symptom.
• Have a new, persistent or worsening symptom checked by a doctor; for sudden severe signs, call 112 at once.
• Cognitive behavioural therapy and other forms of psychotherapy have been shown to help with health anxiety.