This chapter may appear to overlap with Chapter 4, but it is included for good reason. One of the major problems when assessing people who have health anxiety is to use the right approach to address their concerns. If the wrong questions are asked, the patient will be immediately put off and there is a danger they will not engage in therapy. One of the advantages of training nurses and other professionals in introducing and giving CBT therapy for health anxiety is that they can frame it in a medical context and therefore make it much more acceptable. But this has to be accompanied by the right type of question and the probe questions discussed in this chapter are essential to doing this properly.

Identifying health anxiety, probe questions and scales

Identification of psychological disorder within a medical setting is especially challenging. People who are very obviously anxious, who constantly present to services with health worries, or alternatively consult repeatedly with innocuous symptoms and requests for further investigations, are relatively easily identified as having health anxiety. Others may be identified after a diagnosis of medically unexplained symptoms (commonly abbreviated to MUS) has been made, although the proportion of those with medically unexplained symptoms who have clinically significant health anxiety is only about 30%, as many with medically unexplained symptoms are extremely bothered by their symptoms but do not think they have a serious disease. Clinical suspicion alone, without direct questioning, will almost certainly miss many cases of health anxiety or at best identify them late, usually only after (negative) lengthy investigations. Health professionals also vary in their ability to recognise the condition and the confidence with which they feel able to diagnose it, being especially nervous in the face of what are potentially worrying symptoms. The development of screening instruments acceptable to staff and patients, and which can be administered easily, is desirable to aid recognition and diagnosis in these settings. Such screening instruments need to have high sensitivity (the proportion of positive cases correctly identified) and high specificity (the proportion of negative cases correctly identified) to allow confidence in their clinical use and application to research.