Health anxiety: when worry about your health takes over

When worry about your health won't let go

Everyone worries about their health now and then. You find a lump, get a headache that lasts all afternoon, or notice a mole that looks different, and for a day or two you wonder whether something is wrong. Then you get it checked, or it goes away, and you stop thinking about it.

Health anxiety is when you can't stop thinking about it. The fear stays even after a normal exam or normal test results. You might be afraid of cancer, or of something wrong with your heart. Checking your body, searching your symptoms online, and asking people whether you look okay can take up hours of your week. Doctors may call this illness anxiety disorder, or somatic symptom disorder when physical symptoms are the main focus.

This guide follows one person, Dana, to show how health anxiety works and how it gets better. A few months ago, Dana felt a small lump on the side of her neck. That night she searched online and read about cancer until 2 a.m. Her doctor examined her the next week and told her it was nothing to worry about, and Dana felt relieved for about a day. Then the doubt came back. Had the doctor pressed hard enough? Should she have asked for a scan?

Now Dana presses on the lump about ten times a day to see whether it has changed. It has gotten sore, and she worries that the soreness means it's getting worse. She spends 15 minutes every morning looking over her moles in the bathroom mirror. About eight times a day, she asks her husband whether she looks pale. He always says no, and she feels better for a little while. She has stopped watching hospital shows, and she scrolls past any news story about cancer.

If this sounds like you, you aren't weak, and you aren't making it up. The feelings in your body are real. What keeps health anxiety going is the scary meaning your mind gives those feelings, and the checking that follows. Both of those can change with practice. Health anxiety is very treatable, and the tools in this guide are the ones therapists use to treat it.

Working on health anxiety still means seeing a doctor when you need one. Near the end of this guide, you'll find a list of the symptoms that do need medical care, and how quickly.

What's happening in your body and mind

Your body makes small sensations all the time, like a twinge in your side or a headache after a long day. Most people notice these for a moment and then forget about them.

With health anxiety, your mind jumps to the scariest explanation. A headache turns into "What if it's a brain tumor?" A sore spot turns into "What if it's cancer?" That thought sets off your body's alarm system, the same fight-or-flight response that gets you ready to run from danger. Your body fills with adrenaline, and you feel afraid.

Anxiety then causes body sensations of its own. Adrenaline makes your heart pound. Tense muscles can give you a headache or a sore neck. Breathing fast can make you feel lightheaded or like you can't get a full breath, and your stomach may get upset. So the fear creates new sensations, and each new one looks like more proof that something is wrong.

Attention adds to the problem. When you keep watching one part of your body, you notice more going on there. Dana notices every small feeling in her neck, because she checks it so often.

When the fear gets high enough, you do something to feel safer. You press on the spot, search your symptoms, ask someone if you look okay, or book another appointment. You feel relief, but it doesn't last. Doubt creeps back in, like Dana's "Did the doctor press hard enough?" You end up watching your body even more closely than before, and the next sensation you notice starts the cycle over again.

Why checking keeps the fear going

Checking feels responsible. If something is wrong, you want to catch it. The trouble is that checking also brings relief, and relief is a reward. Each time Dana presses on her neck and feels calmer, her brain learns that pressing is what keeps her safe. The next time she's scared, pressing is the first thing she reaches for, and she never gets to find out that she would have been okay without it.

Checking backfires in other ways too. Pressing on a lump every day makes it sore, and then the soreness becomes one more thing to worry about. Searching your symptoms online brings up rare, frightening causes near the top of the results. Reassurance fades within days, because no test can rule out every illness you might get someday.

Therapists call habits like these safety behaviors. They help you feel safe in the moment, and they keep the fear going over time. Common ones in health anxiety include:

• Pressing, poking, or looking at a part of your body to see whether it has changed
• Taking your pulse or checking your breathing
• Searching your symptoms online, or rereading health information
• Asking people "Do I look okay?" or "Are you sure it's nothing?"
• Going back to the doctor about the same symptom, or getting another opinion

Avoiding works the same way. Some people with health anxiety stay away from doctors entirely, because they're afraid of what they might hear. Others, like Dana, stay away from reminders of illness, such as hospital shows and news stories. Avoiding brings quick relief too, and your brain decides that whatever you avoided must have been dangerous.

Being told you're fine doesn't help for long either. Your body's alarm learns from experience. You can know that your tests came back normal and still feel afraid, because knowing a fact doesn't switch the alarm off. What calms the alarm is going through the thing you fear, without checking, and seeing for yourself that you can handle it.

Nobody can promise you that you'll never get sick, and as long as you need that promise, the worry will keep asking for one more check. What helps is getting more comfortable with not knowing for sure, a little at a time.

The way out: face the fear in small steps

Therapists help people do this with a treatment called exposure. It means facing the things you've been avoiding and cutting out the checking, a little at a time, while you stay with the fear long enough to learn that you can handle it. Exposure is a main part of cognitive behavioral therapy (CBT). You can start practicing it on your own, and a therapist can help if you get stuck.

Small steps matter. Facing a fear works a lot like building strength. You start with a weight you can manage, lift it until it feels light, and then add a little more. If Dana started with the hardest thing on her list, like reading a detailed article about the cancer she fears most, she would probably panic, press on her neck, and search online for an hour. Her brain would learn that the article was dangerous, and the fear would grow.

A fear ladder keeps each step hard enough to teach you something and small enough that you'll stick with it. It's your list of steps, in order from easiest to hardest. To build one:

1. List what you avoid and what you check. Be specific. "Health stuff" is too vague to practice. "Watch one episode of a hospital drama" is specific enough to do tonight.
2. Rate each item from 0 to 100 for how anxious you'd feel doing it without checking or asking anyone afterward. A 0 is totally calm. A 50 is uncomfortable, and you could get through it. A 100 is the most anxious you can imagine.
3. Put the list in order from easiest to hardest. If there's a big jump between two steps, add a step in between by changing one thing, like how long you do it or whether someone is with you.
4. Pick a starting step you'd rate around 30 to 50. If you start too high, you'll probably quit partway through, and quitting teaches your brain that the step was dangerous. If you start too low, you won't learn much.

Here is Dana's ladder, with the hardest step at the top:

Dana's ladder mixes two kinds of steps. Some face things she has been avoiding, like hospital shows and waiting rooms. Others ask her to go without checking. The step about a new ache has an exception. If a symptom is on the list of warning signs near the end of this guide, don't wait a week. Do what the list says.

How to practice a step

Each time you practice, you're testing what your anxiety says will happen. Every practice has three parts: before, during, and after. Dana's first step, reading a news story about someone with cancer, shows how each part works.

Before: write down what you're afraid will happen

Right before she starts, Dana writes one sentence about what she's afraid of: "I'll get so scared that I'll have to check my neck and look up my symptoms, and I'll be a wreck all night." Then she writes down how sure she feels that it will happen, from 0 to 100%. Right now it feels 70% likely.

She also writes down her plan. She'll read the story three times in a row, and she won't press her neck, search anything, or ask her husband how she looks. Writing this down matters, because once it's over, it's easy to forget how sure you were, and then you miss what the practice taught you.

During: stay with it, and skip the checking

Dana reads the whole story, and her anxiety climbs to about 60. Her heart speeds up, and she feels a strong urge to touch her neck. Instead of pushing the feeling away, she describes it to herself in plain words, "heart fast, neck tight, about a 60," and lets it be there. Then she reads the story again, and then a third time.

If you stay with it, anxiety usually rises, peaks, and then starts to come down on its own. For a short step like reading a story, repeat it several times in a row. For a longer one, like sitting in a waiting room, stay for the whole time you planned. If you do stop early, go back to the step as soon as you can. A practice still counts if your anxiety never comes down, because what teaches your brain is finding out that your prediction was wrong.

After: write down what happened

When she's done, Dana writes down what happened: "I felt scared for about 15 minutes. I didn't check my neck or search anything. Then I watched TV with my husband." She rates her prediction again, and now it feels about 30% likely. She adds one line about what she learned: "I can read about cancer, feel scared, and get through it without checking."

The gap between what Dana expected and what happened is what teaches her brain that she can handle this. Each time she practices, she sees that gap again, and the alarm gets a little quieter.

How often to practice

Practice most days, and at least three or four times a week. Once a week usually isn't enough for the new learning to stick. Keep practicing the same step until it feels noticeably easier. A good sign is when your anxiety during the step is about half of what it was the first time, or when it's clear that your prediction isn't coming true. Then move up to the next step. A single step often gets easier within a handful of practices, and climbing a whole ladder usually takes several weeks to a few months.

Judge each practice by what you did. If you stayed for the time you planned and skipped the checking, it was a success, even if it felt awful the whole way through.

Some days will feel harder than others. Fear often comes back a little when you're stressed, sleeping badly, or sick, even with something ordinary like a cold. That's normal, and it doesn't erase what you've learned. Go back down one step for two or three practices, then start climbing again.

Steps you can't do in real life

Some fears can't be practiced in real life. Dana can't practice getting a cancer diagnosis, so the writing step on her ladder lets her face that fear in her imagination.

Write about a page describing the moment you fear, using "I" and the present tense, as if it's happening right now. Include what you see and hear, what your body feels, and the thoughts you dread most. Leave out any happy ending, since that would work like reassurance, and stop at the frightening, uncertain part. Then read it aloud, or record it on your phone and listen, for 20 to 30 minutes a day. Keep going each day until it feels boring or much less upsetting, which often takes one to two weeks. Then write a harder version.

If the scene would bring back a frightening medical experience that really happened to you, save this step for work with a therapist trained in trauma-focused therapy.

Tools for health worries

Use these tools alongside your fear ladder. They cut back on the checking and reassurance that keep health anxiety going, and they give you a clear way to work with your doctor.

Tool 1: One appointment for each new symptom

If a doctor has never looked at the symptoms that worry you, start by getting checked once. A few medical problems can cause feelings a lot like anxiety, including an overactive thyroid, heart rhythm problems, asthma and other lung conditions, low blood sugar, side effects of some medicines (such as decongestants, steroids, and stimulants), and withdrawal from alcohol or sedatives. An exam and basic blood tests usually settle the question. After that, the same familiar symptoms don't need a new round of tests each time they come back, unless something about them changes.

From then on, use one appointment for each new symptom. Book a visit when a new symptom lasts more than two to three weeks, or when it's on the list of warning signs below. At the visit, tell the doctor what you're afraid it is, so they know exactly what you're worried about. Then accept the plan, and don't look for another opinion on the same symptom unless it changes or the plan says to.

This can feel risky at first. Extra visits and second opinions work like any other reassurance, though. They bring a few days of relief, and then the doubt comes back and asks for more. One visit with a clear plan gets you the care you need.

Tool 2: Stop searching your symptoms

Searching your symptoms feels like it will settle the worry. Instead, the results tend to put rare, frightening causes near the top, and you end up more scared than when you started. To make searching harder:

• Delete health bookmarks and symptom-checker apps.
• Block the health websites you use most. On an iPhone, the Content & Privacy Restrictions setting in Screen Time can block specific websites. On a computer, a site-blocking browser extension does the same.
• When the urge to search comes, write the worry down in a note on your phone, and leave it there. If you use worry time, the daily worry appointment from our general anxiety guide, save the note for then.

Tool 3: Cut back on checking, a little at a time

You don't have to stop all your checking at once. You can cut it back in stages. Start by counting. For two days, keep a tally in your phone's notes app each time you check your body, search a symptom, or ask someone for reassurance. That count is your starting point. Then plan how you'll cut each kind of checking down, week by week, until it's gone or down to what your doctor recommends. Here is Dana's plan:

Checks your doctor has asked you to do are medical care, and they stay. That's why Dana's plan keeps a monthly skin check if her doctor recommends one. The same goes for carrying an asthma inhaler, an EpiPen, glucose tablets, or any medicine your doctor told you to carry. Talk to your prescriber before you change how you use a medication.

Expect your anxiety to go up at first when you cut back. That means the plan is working, because your brain is finally getting the chance to learn that you're okay without the check. If you stick with it, the anxiety comes down. A check that feels too hard to cut can become a step on your fear ladder.

Tool 4: Cut back on reassurance

Asking someone you love whether you look okay is a kind of checking too. It helps for a few minutes, and then the doubt comes back, often with a new question. Over time, it teaches you that you can't handle not knowing unless someone else tells you you're fine. It also wears out the people you keep asking.

If there's someone you usually ask, talk about it together at a calm moment, since springing a new rule on someone in the middle of a scare usually backfires. Agree that answering is feeding the worry, and plan to cut back together. Ask them to hold the line even when you push.

Then set a budget. Use your count from Tool 3 to see how many times you ask on a typical day. Start the daily budget a little below that number, and shrink it each week until it reaches zero. Dana asks about eight times a day, so her husband answers up to five times a day in the first week, then three, then one, and then none. Once the day's answers are used up, he uses a script they agreed on ahead of time:

He can also offer something else, like sitting together or asking which step on her ladder she's working on. Expect the worry to push back hard for the first week or two, with more asking and more upset. It tends to settle if you both stick with the plan.

Tool 5: Make a plan with your doctor

A plan with your doctor gives you a clear answer to "Should I go in?" that doesn't depend on how scared you feel that day. Ask for a regular check-in every few months, in place of a visit every time a new worry comes up. Also ask which specific symptoms should make you call before your next check-in. You could say:

Dana's doctor agreed to see her every few months. Until then, Dana will call if the lump in her neck grows or starts to feel hard, or if anything on the list below shows up.

When a symptom does need attention

The goal is the same medical care a person without health anxiety would get. Act on the warning signs below. Most other new symptoms can wait two to three weeks, and if one is still there by then, book a visit.

Get medical care the same day if you're coughing up or vomiting blood, or if you have black or bloody stools.

Book an appointment for:

• Weight loss you can't explain, repeated fevers, or drenching night sweats
• A lump that's growing, feels hard, or is still there after two to three weeks
• Any new symptom that keeps getting worse, or lasts more than two to three weeks without getting better

Also act on anything your doctor has specifically told you to watch for.

More guides on anxiety

This guide covers health anxiety. For anxiety in general, or for another kind of anxiety, read one of these next:

• Principles of handling anxietyHow anxiety works, why it keeps coming back, and simple tools for worry, anxious thoughts, and a tense body.
• Panic attacksSudden waves of fear with a racing heart, dizziness, or trouble breathing, and worry about when the next one will hit.
• Social anxietyFear of being judged or embarrassed, avoiding people, and replaying conversations afterward.
• Intrusive thoughts and OCDDisturbing thoughts that won't leave, and things you feel driven to do over and over, like checking or washing.

A book for health anxiety

If you'd like a full self-help program, try It's Not All in Your Head by Gordon Asmundson and Steven Taylor. It explains the checking and reassurance cycle and walks you through cutting it back.

The book link is an Amazon affiliate link. As an Amazon Associate, Psychofarm earns from qualifying purchases, at no extra cost to you. See our disclosures.

The methods in this guide are based on cognitive behavioral therapy for anxiety.