Health Anxiety (Illness Anxiety Disorder)

Illness anxiety disorder (formerly hypochondriasis) involves preoccupation with having or acquiring serious illness for at least 6 months, with disproportionate response to mild somatic sensations and excessive health-related behaviors (frequent body checking, doctor visits, internet searching) or maladaptive avoidance (skipping medical appointments). Two subtypes: care-seeking and care-avoidant.

Cognitive features include catastrophic interpretation of normal bodily sensations, attentional bias toward illness-related stimuli, and selective memory for illness threats. Behavioral features include reassurance seeking from physicians and family, repeated body checking and palpation, internet symptom searching (cyberchondria), and either excessive medical investigation or healthcare avoidance.

Cognitive behavioral therapy with cognitive restructuring targets catastrophic beliefs, exposure and response prevention reduces reassurance seeking and body checking, mindfulness-based approaches help tolerate uncertainty, and stress management addresses underlying anxiety. SSRIs (sertraline, fluoxetine) provide additional benefit. Avoid repeated unnecessary investigations that reinforce illness beliefs while ensuring serious conditions are excluded.