Skip to main content Accessibility help
×
×
Home

Health anxiety: detection and treatment

  • Peter Tyrer and Helen Tyrer

Summary

Health anxiety is an important new diagnosis that is increasing in frequency because of changing attitudes towards health, particularly excessive use of health information on the internet (cyberchondria). People with abnormal health anxiety become over-diligent monitors of their health, misinterpret most somatic sensations as evidence of disease, consult medical professionals unnecessarily and frequently, and are often over-investigated. Relatively few patients with health anxiety present to psychiatrists; most are seen in primary and secondary medical care. This paper reviews the diagnosis and presenting features of health anxiety, its identification in practice and its treatment. A range of simple psychological treatments have been shown to have long-lasting benefit for the disorder but are greatly under-used.

LEARNING OBJECTIVES

  • To be able to identify abnormal health anxiety with the aid of probe questions
  • To respond to people whom you have identified with excessive health anxiety in a way that facilitates its treatment
  • To learn a few simple techniques derived from cognitive–behavioural therapy that can lead to long-term benefit

DECLARATION OF INTEREST

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Health anxiety: detection and treatment
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Health anxiety: detection and treatment
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Health anxiety: detection and treatment
      Available formats
      ×

Copyright

Corresponding author

Correspondence Professor Peter Tyrer, Centre for Psychiatry, Imperial College London, London W12 0NN, UK. Email: p.tyrer@imperial.ac.uk

References

Hide All
American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders (5th edn) DSM-5). APA.
Bass, C, Pearce, S (2016) Severe and enduring somatoform disorders: recognition and management. BJPsych Advances, 22: 8796.
Clark, DM, Salkovskis, PM, Hackmann, A, et al. (1998) Two psychological treatments for hypochondriasis: a randomized controlled trial. British Journal of Psychiatry, 173: 218–25.
Cooper, K, Gregory, J, Walker, I, et al. (2017) Cognitive behaviour therapy for health anxiety: a systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45: 110–23.
Eilenberg, T, Fink, P, Jensen, JS, et al. (2016) Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomised controlled trial. Psychological Medicine, 46: 103–15.
Fallon, BA, Petkova, E, Skritskaya, N, et al. (2008) A double-masked, placebo-controlled study of fluoxetine for hypochondriasis. Journal of Clinical Psychopharmacology, 28: 638–45.
Fallon, BA, Ahern, DK, Pavlicova, M, et al. (2017) A randomized controlled trial of medication and cognitive-behavioural therapy for hypochondriasis. American Journal of Psychiatry, 174: 756764.
Fink, P, Ømbol, E, Christensen, KS (2010) The outcome of health anxiety in primary care: a two-year follow-up study on health care costs and self-rated health. PLoS One, 24: e9873.
Greeven, A, van Balkom, AJLM, Visser, S, et al. (2007) Cognitive behavior therapy and paroxetine in the treatment of hypochondriasis: a randomized controlled trial. American Journal of Psychiatry, 164: 91–9.
Greeven, A, van Balkom, AJ, van der Leeden, R, et al. (2009) Cognitive behavioral therapy versus paroxetine in the treatment of hypochondriasis: an 18 month naturalistic follow-up. Journal of Behavior Therapy and Experimental Psychiatry, 40: 487–96.
Hedman, E, Andersson, G, Andersson, E, et al. (2011) Internet-based cognitive behavioural therapy for severe health anxiety: randomised controlled trial. British Journal of Psychiatry, 198: 230–6.
Hedman, E, Axelsson, E, Görling, A, et al. (2014) Internet-delivered exposure-based cognitive–behavioural therapy and behavioural stress management for severe health anxiety: randomised controlled trial. British Journal of Psychiatry, 205: 307–14.
Hedman, E, Andersson, E, Lekander, M, et al. (2015) Predictors in Internet-delivered cognitive behavior therapy and behavioral stress management for severe health anxiety. Behaviour Research and Therapy, 64: 4955.
Hedman, E, Axelsson, E, Andersson, E, et al. (2016a) Exposure-based cognitive–behavioural therapy via the internet and as bibliotherapy for somatic symptom disorder and illness anxiety disorder: randomised controlled trial. British Journal of Psychiatry, 209: 407–13.
Hedman, E, Andersson, E, Ljótsson, B, et al. (2016b) Cost effectiveness of internet-based cognitive behaviour therapy and behavioural stress management for severe health anxiety. BMJ Open, 6: e009327.
Kenyon, FE (1964) Hypochondriasis: a clinical study. British Journal of Psychiatry, 110: 478–88.
Mayou, R (2014) Is the DSM-5 chapter on somatic symptom disorder any better than DSM-IV somatoform disorder? British Journal of Psychiatry, 204: 418–9.
McManus, F, Surawy, C, Muse, K, et al. (2012) A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of Consulting and Clinical Psychology, 80: 817–28.
Olatunji, BO, Kauffman, BY, Meltzer, S, et al. (2014) Cognitive-behavioral therapy for hypochondriasis/health anxiety: a meta-analysis of treatment outcome and moderators. Behavior Research and Therapy 58: 6574.
Scarella, TM, Laferton, JA, Ahern, DK, et al. (2016) The relationship of hypochondriasis to anxiety, depressive and somatoform disorders. Psychosomatics, 57: 200–7.
Seivewright, H, Green, J, Salkovskis, P, et al. (2008) Cognitive–behavioural therapy for health anxiety in a genitourinary medicine clinic: randomised controlled trial. British Journal of Psychiatry, 193: 332–7.
Stein, DJ, Kogan, CS, Atmaca, M, et al. (2016) The classification of obsessive-compulsive and related disorders in the ICD-11. Journal of Affective Disorders, 190: 663–74.
Sunderland, M, Newby, JM, Andrews, G (2013) Health anxiety in Australia: prevalence, comorbidity, disability and service use. British Journal of Psychiatry, 202: 5661.
Tyrer, P, Cooper, S, Crawford, M, et al. (2011) Prevalence of health anxiety problems in medical clinics. Journal of Psychosomatic Research, 71: 392–4.
Tyrer, H, Ali, L, Cooper, F, et al. (2013) The Schedule for Evaluating Persistent Symptoms (SEPS): a new method of recording medically unexplained symptoms. International Journal of Social Psychiatry, 59: 281–7.
Tyrer, P, Tyrer, H (2014a) The departure of hypochondriasis is no loss. Australian and New Zealand Journal of Psychiatry, 48: 772–3.
Tyrer, P, Cooper, S, Salkovskis, P, et al. (2014b) Clinical and cost-effectiveness of cognitive behaviour therapy for health anxiety in medical patients: a multicentre randomised controlled trial. Lancet, 383: 219–25.
Tyrer, H, Tyrer, P, Lisseman-Stones, Y, et al. (2015) Therapist differences in a randomised trial of the outcome of cognitive behaviour therapy for health anxiety in medical patients. International Journal of Nursing Studies, 52: 686–94.
Tyrer, P, Eilenberg, T, Fink, P, et al. (2016a) Health anxiety: the silent disabling epidemic. BMJ, 353: i2250.
Tyrer, P, Tyrer, H (2016b) Health Anxiety: Part 1 – Concept, Prevalence and Management (CPD Online Module). Royal College of Psychiatrists.
Tyrer, P, Tyrer, H, Morriss, R, et al. (2017a) Clinical and cost-effectiveness of adapted cognitive behaviour therapy for non-cardiac chest pain: multicentre, randomised controlled trial. Open Heart, 4(1): e000582.
Tyrer, P, Tyrer, H (2017b) Health Anxiety: Part 2 – Cognitive Behaviour Therapy (CPD Online Module). Royal College of Psychiatrists.
Tyrer, P, Salkovskis, P, Tyrer, H, et al. (2017c) Cognitive-behaviour therapy for health anxiety in medical patients (CHAMP): randomised controlled trial with outcomes to 5 years. Health Technology Assessment, 21(50): 158.
Van den Heuvel, OA, Veale, D, Stein, DJ (2014) Hypochondriaisis: considerations for ICD-11. Revista Brasiliera de Psiquiatria, 36: S217.
Walker, J, Vincent, N, Furer, P, et al. (1998) Treatment preference in hypochondriasis. Journal of Behavioural and Therapeutics in Experimental Psychiatry, 30: 251–8.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Advances
  • ISSN: 2056-4678
  • EISSN: 2056-4686
  • URL: /core/journals/bjpsych-advances
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Health anxiety: detection and treatment

  • Peter Tyrer and Helen Tyrer
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *