Introduction

If you spend excessive time worrying about your health, checking your body for symptoms, or searching the internet for medical information, you may wonder whether you have “health anxiety” or “hypochondriasis.” These terms are related but not identical — and the way clinicians think about them has changed significantly in recent years. The term hypochondriasis was removed from the DSM-5 in 2013 and replaced with two new diagnoses: illness anxiety disorder and somatic symptom disorder. Meanwhile, health anxiety is a broader, non-clinical term used to describe the full spectrum of health-related worry. This guide explains how these terms relate to each other, what the current diagnostic categories look like, and how to get appropriate treatment.

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Terminology: What Changed and Why

The Old Term: Hypochondriasis

In the DSM-IV (1994), hypochondriasis was defined as a preoccupation with fears of having a serious disease based on a misinterpretation of bodily symptoms, persisting despite medical reassurance. It was classified as a somatoform disorder.

The problem with the term “hypochondriasis” was:

• •It was perceived as pejorative (people labeled “hypochondriacs” felt dismissed)
• •It implied that the person’s symptoms were “all in their head” — not real
• •It did not distinguish between people who had significant physical symptoms and those who had few or no symptoms
• •It lumped together people who had very different clinical presentations

The New Terms (DSM-5, 2013)

The DSM-5 replaced hypochondriasis with two distinct diagnoses:

1. Illness Anxiety Disorder (IAD) — For people who are preoccupied with having or acquiring a serious illness, but who have somatic symptoms that are not present or are only mild. The core feature is anxiety about health, not physical symptoms.

2. Somatic Symptom Disorder (SSD) — For people who have one or more distressing somatic (physical) symptoms plus excessive thoughts, feelings, or behaviors related to those symptoms. The core feature is the reaction to physical symptoms, not just worry about illness.

The Informal Term: Health Anxiety

Health anxiety is not a DSM-5 diagnosis. It is a widely used informal term that encompasses the spectrum of health-related worry — from mild concern to severe, disabling preoccupation. Many clinicians and researchers prefer this term because:

• •It is less stigmatizing than “hypochondriasis”
• •It captures the full range of health-related anxiety
• •It acknowledges that health anxiety exists on a continuum (mild → moderate → severe)
• •It is the term most commonly used in CBT research and self-help literature

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Current Diagnostic Categories

Illness Anxiety Disorder (DSM-5-TR: 300.7 / F45.21)

Diagnostic Criteria:

• •Preoccupation with having or acquiring a serious illness
• •Somatic symptoms are not present or, if present, are only mild in intensity
• •High level of anxiety about health
• •Excessive health-related behaviors (repeatedly checking body for signs of illness, seeking medical reassurance) OR maladaptive avoidance (avoiding doctor appointments or hospitals)
• •Illness preoccupation has been present for at least 6 months
• •The preoccupation is not better explained by another mental disorder

Specifier:

• •Care-seeking type: Medical appointments, examinations, and procedures are frequently used (the person goes to the doctor repeatedly)
• •Care-avoidant type: Medical care is rarely used (the person avoids doctors out of fear of receiving bad news)

Somatic Symptom Disorder (DSM-5-TR: 300.82 / F45.1)

Diagnostic Criteria:

• •One or more somatic (physical) symptoms that are distressing or result in significant disruption of daily life
• •Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns:
• •Disproportionate and persistent thoughts about the seriousness of symptoms
• •High level of anxiety about health or symptoms
• •Excessive time and energy devoted to symptoms or health concerns
• •Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months)

Key Point: Somatic Symptom Disorder does not require that the physical symptoms be medically unexplained. A person can have a diagnosed medical condition (e.g., irritable bowel syndrome, chronic pain) and still meet criteria for SSD if their reaction to the symptoms is excessive.

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Health Anxiety: The Broader Picture

Health anxiety exists on a spectrum:

Most people experience some health anxiety during their lives — especially during a personal health scare, after a loved one’s diagnosis, or during a public health crisis (e.g., COVID-19 pandemic). Health anxiety becomes a clinical concern when it is persistent (6+ months), causes significant distress, and impairs functioning.

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How Health Anxiety Maintains Itself

Regardless of whether the clinical diagnosis is IAD or SSD, health anxiety is maintained by a self-reinforcing cycle:

1. Trigger: A bodily sensation (headache, chest tightness, mole, twitch), a health-related news story, or a loved one’s illness
2. Catastrophic interpretation: “This headache means I have a brain tumor.” “This mole is melanoma.” “My chest tightness is a heart attack.”
3. Anxiety and physical symptoms increase: Anxiety itself produces physical symptoms (rapid heartbeat, dizziness, muscle tension, stomach distress), which are then interpreted as further evidence of illness
4. Safety behaviors: Body-checking (feeling for lumps, checking pulse), internet searching (“symptoms of brain tumor”), seeking reassurance from doctors, family, or online forums
5. Temporary relief: Reassurance provides short-term anxiety reduction
6. Uncertainty returns: The relief is temporary; the worry returns, often about the same or a new symptom
7. Cycle repeats: Each cycle reinforces the belief that symptoms are dangerous and that reassurance is necessary

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How Treatment Works for Health Anxiety

Cognitive Behavioral Therapy (CBT)

CBT is the most evidence-based treatment for health anxiety, regardless of whether the diagnosis is IAD or SSD. CBT for health anxiety includes:

Cognitive Restructuring:

• •Identifying catastrophic health beliefs (“If I have a headache, it’s a tumor”)
• •Evaluating the actual probability of the feared outcome
• •Developing more balanced interpretations of bodily sensations
• •Learning to tolerate uncertainty about health

Behavioral Experiments:

• •Testing catastrophic predictions in controlled ways
• •Reducing body-checking and reassurance-seeking
• •Learning that reducing safety behaviors does not lead to the feared outcome

Exposure:

• •Exposure to health-related triggers (reading the word “cancer,” visiting a hospital, watching medical shows)
• •Interoceptive exposure (experiencing anxiety-related physical sensations without interpreting them as dangerous)
• •Reducing avoidance of health-related situations

Response Prevention:

• •Stopping body-checking (no more checking moles, pulse, or lumps)
• •Stopping internet health searching
• •Limiting reassurance-seeking from doctors, family, and online sources

Medication

• •SSRIs (e.g., sertraline, fluoxetine, escitalopram): First-line pharmacological treatment for health anxiety. Effective for reducing the obsessive quality of health worries and the compulsive checking/reassurance-seeking behaviors.
• •SNRIs (e.g., venlafaxine): Alternative to SSRIs.
• •Benzodiazepines: Not recommended for long-term use due to dependence risk and because they can maintain the anxiety cycle by providing temporary relief.

Self-Help

For mild to moderate health anxiety, self-help resources based on CBT principles can be effective:

• •Workbooks such as Overcoming Health Anxiety by Willson & Veale
• •Psychoeducation about the health anxiety cycle
• •Self-guided exposure and response prevention
• •Mindfulness training

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When to Seek Professional Help

Consider professional evaluation if:

• •Health worries consume more than an hour per day
• •You frequently visit doctors, get tests, or seek reassurance about your health
• •You avoid medical settings, health information, or situations that remind you of illness
• •Internet health searching is interfering with your work or relationships
• •Your health anxiety has been present for 6 months or more
• •You have been told by doctors that nothing is wrong, but you remain convinced something is

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Sources

• •American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR).
• •Tyrer, P. (2018). “Recent advances in the understanding and treatment of health anxiety.” Current Psychiatry Reports, 20(5), 38.
• •Hedman, E. et al. (2016). “Internet-based cognitive behavior therapy vs. internet-based psychodynamic therapy for health anxiety.” Journal of Consulting and Clinical Psychology, 84(10), 879–888.
• •National Institute of Mental Health (NIMH) — Anxiety Disorders.
• •Anxiety and Depression Association of America (ADAA) — Health Anxiety.