Health anxietyBMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l774 (Published 12 March 2019) Cite this as: BMJ 2019;364:l774
- Erik Hedman-Lagerlöf, associate professor1,
- Peter Tyrer, emeritus professor of community psychiatry2,
- John Hague, member of clinical executive of Ipswich and East Suffolk Clinical Commissioning Group, general practitioner3,
- Helen Tyrer, senior clinical research fellow2
- 1Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- 2Centre for Psychiatry, Imperial College, London, UK
- 3Derby Road Practice, Ipswich, UK
- Correspondence to: E Hedman-Lagerlöf
What you need to know
Consider health anxiety if the patient reports excessive worry about health that causes suffering and impairment
Avoid routinely reassuring the patient that all is well. Instead, acknowledge that that patient is worried and suggest seeking ways to address this.
Cognitive behaviour therapy focused on health anxiety is an effective treatment
A 46 year old man visits his general practitioner worried about episodes of chest pain and tightness. A recent CT coronary angiogram was normal. He has had numerous appointments with different GPs over the past year for a variety of symptoms that seem to settle down after reassurance or further investigation.
Normal concern about our health can sometimes turn into a persistent and excessive fear of being seriously ill. This is often referred to as health anxiety. In this article we offer practical tips to help clinicians identify and help people with persistent and disabling health anxiety, based on available evidence and our own clinical experience.
What you should cover
When to consider health anxiety
Health anxiety is common, with prevalence estimated at up to 20% in medical settings.1 Somatic symptom disorder and illness anxiety disorder replaced the term hypochondriasis in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),1 but the less pejorative term health anxiety is typically favoured in practice. Whichever term is used, the central questions for the clinician to answer are whether the patient’s worry is excessive in relation to the actual risk and what impact is this having on their life. These patients undergo more tests and examinations and use more health service resources than those without health anxiety.2 Although children can experience health anxiety,3 it typically begins in adulthood and follows a chronic but fluctuating course. Having a medical disease or diagnosis does not exclude health anxiety1—many people have both.
Clues that may prompt further …