Obsessive compulsive disorder - OCD treatment and therapy from NOCD

The Ultimate Guide to Health Anxiety—and How to Overcome It

By Dr. Keara Valentine

Jun 05, 202412 minute read

Reviewed byPatrick McGrath, PhD

There’s nothing like worrying about your health to keep you up at night. You feel an abdominal cramp and fear your appendix is bursting. You hear about a friend’s cancer diagnosis and immediately start checking your body for signs and symptoms of cancer—even if you’re perfectly healthy. You think about taking public transit but then remember the threat of dangerous germs lurking everywhere and hop in your car instead.

Health anxiety is extremely common. In fact, everyone gets anxious about their health from time to time. That’s not a problem. When the anxiety is short-lived and prompts you to check on an issue you’ve been ignoring, it can even be considered helpful. But when health anxiety is persistent and all-consuming—even when there’s no tangible reason for concern—that’s a sign that the worry is an issue in itself.

Are you struggling with health anxiety? Our specialized therapists can help.

Is my health anxiety a mental health problem?

People with health anxiety, or the preoccupation with being or becoming ill, used to commonly be referred to as “hypochondriacs.” But that diagnosis was removed from the Diagnostic and Statistical Manual of Mental Disorders in 2013, because of the offensive connotations associated with the word. Medical professionals now use the term illness anxiety disorder (IAD) instead.


That said, IAD isn’t the only mental health condition that could explain your tendency to jump to worst-case scenarios regarding your health. Health anxiety can also be a factor in obsessive compulsive disorder (OCD)—specifically Contamination OCD and Health Concern OCD.


IAD and OCD can cause severe distress and have a debilitating impact on people’s lives. Booking health exam after health exam, even if you have no symptoms. Avoiding grocery stores because you just might catch a lethal disease. Changing your clothes multiple times a day just in case you came into contact with something that could make you sick. This is just a glimpse into what it’s like to live with health anxiety. 


Making matters worse, sufferers often feel misunderstood and ashamed, and are led to believe that they are “just paranoid” or should simply “get over” their fears, when in reality, they can’t—at least not on their own.


The good news is that IAD, Contamination OCD, and Health Concern OCD—while they differ in their symptoms—are all highly treatable with a specific type of therapy called Exposure and Response Prevention.

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IAD

  • Constant worry about health that persists despite exams, lab tests, or reassurance from a professional
  • Often based on misperception of normal bodily sensations. Symptoms, if they exist at all, are mild or vague
  • Includes “safety behaviors” to relieve anxiety (e.g. refraining from exercise due to fear of a heart attack)
  • Intense anxiety over getting sick lasts for six months or longer
  • Anxiety jumps around—i.e. first it’s about a brain tumor, then you think your hand is tingling and it shifts to multiple sclerosis

OCD

  • Repetitive, intrusive thoughts about illness or contamination that cause distress
  • May be in response to specific feelings, other triggers like news articles, or based on no symptoms at all
  • Includes excessive and often ritualistic compulsions to relieve distress (repeating a prayer or excessively washing hands)
  • May be in response to specific feelings, other triggers like news articles, or based on no symptoms at all
  • Obsessions/compulsions take up at least 1 hour per day

Health Concern OCD

​​Health Concern OCD is a subtype of OCD marked by intrusive thoughts about developing a serious medical condition. Obsessions and compulsions are the hallmark symptoms of all forms of OCD including Health Concern OCD. Obsessions are intrusive thoughts, mental images, or urges that cause distress. Meanwhile, compulsions are mental or physical acts done in an attempt to relieve the resulting discomfort brought on by the obsession. The great irony about this condition—which is sometimes called Health Anxiety OCD—is that sufferers worry that an unidentified illness can rob them of healthy years, but their OCD (while ensuring that they give this fear endless attention) is what really robs them of the life they want to live.

Symptoms of Health Concern OCD

Common Obsessions

  • Thinking you are ill but fearing that health professionals failed to detect it
  • Worrying that you have an undetected illness you might transmit to others
  • Fearing that normal sensations are a sign of cancer/HIV/fill-in-the-blank disease
  • Fixating on specific physical sensations like heart rate or energy level.

Common Compulsions

  • Repeated visits to the ER or doctors
  • Requests for unnecessary or repeat medical tests
  • Asking loved ones to check you for signs of illness
  • “Neutralizing” obsessive thoughts about being sick with “healthy thoughts”

The OCD Cycle 

Compulsions only provide, at best, short-term relief for distress. In fact, intrusive thoughts start coming on more often as you try to keep them away. This process begins to spiral, and the OCD cycle can eventually take up the better part of your days (and even years). OCD symptoms typically worsen over time without proper treatment, so it’s critical to seek support from a trained OCD specialist.

The OCD cycle of obsession, distress, compulsion, and temporary relief.

What causes OCD?

There’s no one cause of OCD, but a number of different factors are thought to play a role. Family history (for instance, if a close relative has OCD), differences in brain structures, as well as personality traits like perfectionism may result in a greater likelihood of developing OCD. Experiencing stressful or traumatic life events could also up your risk.

Why your anxieties could 
be OCD

Sometimes, worries about your health can actually be signs of a completely different condition. NOCD’s Tia Wilson explains why your constant searching for answers about your health might actually be a symptom of OCD.

Contamination OCD

Contamination OCD is a subtype of OCD characterized by an obsessive fear of becoming contaminated or contaminating others. Like Health Concern OCD, Contamination OCD symptoms include both obsessions and compulsions. But in the case of Contamination OCD, the obsessions center specifically around germs, dirt, and uncleanliness. The fear of something bad happening if you come into contact with bodily fluids or any other perceived contaminants leads to distress, which becomes a trigger to engage in compulsions. Often, these compulsions disguise themselves as innocent or even healthy rituals, such as adhering to strict sanitization regimen when you sit down to eat at a restaurant.

You're not alone. 25% of people with OCD struggle with contamination fears.
Over 25% of people with OCD struggle with contamination fears.

Common symptoms of Contamination OCD

Common Obsessions
  • Fear of becoming contaminated by touching surfaces that may have “hidden” germs
  • Obsessive fears about dirt
  • Persistent fears about HIV, blood, cancer, bodily fluids, feces, or urine
  • Extreme fear that someone might cough or sneeze on you
  • A fear of wearing clothes that may have contaminants on them
  • Fears of spreading germs to others

Common Compulsions

  • Washing your hands or showering excessively
  • Spending an excessive amount of time disinfecting your living space
  • Engaging in prayer to try to “ward off” any contamination when you leave the house
  • “Neutralizing” obsessive thoughts about being sick with “healthy thoughts”
  • Washing clothes multiple times after being in a public space
  • Avoiding other people, including family members and loved ones

Illness Anxiety Disorder (IAD)

IAD is characterized by excessive worry about having or developing a serious disease, often even if tests confirm that nothing is wrong. People with this condition sometimes have mild physical sensations, but their fixation on them is out of proportion to what’s really going on—for instance, they have a headache, and think it could be a sign of a brain tumor.

Common Symptoms of IAD
  • Having illness-related fears that last for at least six months and affect your quality of life or interfere with your relationships
  • Being hyper vigilant about normal body symptoms, especially those that appear in the head, neck, abdomen, or chest, and thinking they are related to a serious illness
  • Constantly researching illnesses online
  • Seeking excessive care or medical testing for reassurance that you don’t have an illness (care-seeking IAD). For instance, taking a Covid test after sneezing once.
  • Avoiding medical professionals completely out of fear that you do have an illness (care-avoidant IAD)

What causes IAD?

Healthcare experts don’t know the exact cause of IAD, but a history of childhood trauma or serious childhood illness might precede the symptoms in some cases, as can major life stress. Likewise, having a parent with IAD is associated with increased risk of developing it yourself. Personality—like traits of being a bit neurotic—can also be at play.

How common is IAD?

IAD is a common condition, but many experts believe it may be underreported. Estimates of how prevalent it is vary widely, with anywhere from 1.3 to 10 percent of the population fitting
the criteria.

You can conquer your fears

Fear may seem like something you have to live with forever, but it’s not. Sam Temple, a NOCD member who dealt with crippling health anxiety, got her life back from OCD when she started ERP therapy.

Do I have OCD or IAD?

IAD and OCD certainly share some similarities, which is why the best way to know what you’re struggling with is to see an OCD specialist who is trained to spot the differences.


Taylor Newendorp, MA, LCPC, a therapist at NOCD, notes that more often than not, those with IAD actually are experiencing some kind of symptom that they fear is a sign of a serious illness. For example, someone who has a tiny mole on their arm may worry they have skin cancer. Someone with OCD, on the other hand, tends to be more worried about a hypothetical future—“What if I get cancer one day?” That’s not always the case, but it is a pattern some experts see.


What’s more,“With IAD, they might just run to the bathroom and check quickly to see if that spot of concern has got any bigger. With OCD, you’ll see very ritualistic kinds of behaviors. People may have to check it a certain number of times,” says Dr. Patrick McGrath, psychologist and Chief Clinical Officer at NOCD.


Another indicator that you could be dealing with OCD rather than IAD: You’ve experienced other OCD subtypes, whether it’s Harm OCD, Relationship OCD, or something else. “The likelihood is that somebody with OCD is going to have some other types of obsessions outside of just health or contamination concerns,” says Dr. McGrath.


Finally, Newendorp says you shouldn’t stress too much about knowing for sure whether it’s IAD or OCD because “at the end of the day, you would use Exposure and Response Prevention therapy to treat IAD, Contamination OCD, and Health Concern OCD—and it’s highly effective for treating all of these conditions.”

What if it’s a real medical illness and not
health anxiety?

No health professional would encourage you to ignore a hunch that something is wrong; listening to your gut can be life-saving. However, there’s a big difference between a true intuition and brain wiring that has gone awry.


Here’s some perspective: “Real health concerns typically present with clear, consistent symptoms that persist and often get worse over time if untreated,” says Evan Vida, PsyD, a psychologist at the Center for Anxiety & Behavioral Therapy. “Anxiety, on the other hand, often amplifies minor or normal bodily sensations, creating a disproportionate fear of serious illness and is accompanied by a significant amount of ‘what if’ thinking.”

We can help you get your life back from the grip of health anxiety—no matter what the root cause.

How to treat health anxieties

When health anxiety takes away from your quality of life, it’s definitely time to seek professional help. As we mentioned earlier, Exposure and Response Prevention (ERP) therapy is considered the gold-standard treatment for OCD and IAD.


ERP is an evidence-based therapy, which in simple terms means that extensive research has been done to prove that it’s successful. This specialized treatment is unlike traditional talk therapy or general cognitive behavioral therapy (CBT). And without practicing ERP specifically, it’s very likely that your health anxiety will get worse, not better.


ERP works by gradually exposing you to what triggers your health fears, and teaching you response prevention strategies to cope with your distress—things that don’t involve engaging in safety behaviors or compulsions. For example, one of the first exposures you do might simply be to watch a movie about someone struggling with an illness. Over time, you might go for a brisk walk without tracking your heart rate (say, if fear of a heart attack is all-consuming for you), or touch a doorknob without washing your hands (if fear of contamination plagues you). You will never be forced into anything before you’re ready, but you will be encouraged to take steps that move you toward recovery.


Through the ERP process, you learn to realize that your fears are often unfounded, or that you can handle your worst-case-scenarios better than you thought you could. “From my personal experience treating OCD, people are shocked at how quickly they experience relief from symptoms once they start ERP therapy,” says Dr. McGrath.


Want inspiration to tackle your health anxieties? Read these NOCD member stories.

Medication can be used to supplement therapy

Most cases of OCD and IAD can be successfully treated with ERP—no medication required. That said, medication can help people with more severe cases of these disorders. For example, Selective Serotonin Reuptake Inhibitors (SSRIs)—which work by increasing the levels of serotonin in the brain and can help take the edge off anxiety—may make it easier for some to participate in ERP so they can regain control of their lives.


Still, medications are typically best used in combination with ERP if you want lasting results. “I’ve worked with a lot of people who will start with medication because it requires the least effort,” says April Kilduff, LMHC, LCPC, LPCC, a therapist at NOCD. “People want that magic pill, and they might have a little bit of relief, but not the complete recovery they hoped for.” That, or their symptoms return when they stop taking the drug. “So at that point, their only option is to reach out and do ERP,” she says.

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