Health anxiety – sometimes called hypochondria in the past –
is something many people experience, though often quietly. It is that
persistent worry about symptoms, illnesses, or the possibility of something
being seriously wrong with the body. For some, it comes and goes with stressful
times. For others, it can feel like a constant presence, shaping daily
routines, relationships, and even identity.
What makes health anxiety particularly hard is how real it
feels in the body. The racing heart, the tight chest, the dizziness – these are
physical sensations, not imagined ones. And when they appear, the mind quite
understandably goes looking for an explanation. Unfortunately, for someone
caught up in health anxiety, the explanation is almost always the worst-case
scenario. A headache becomes a brain tumour; a cough feels like lung cancer;
fatigue is feared to be MS. The body becomes a battleground of symptoms, tests,
and endless scanning for signs of illness.
From an integrative therapy perspective, there isn’t just one
way to make sense of this. Therapy draws on different strands – psychodynamic,
person-centred, cognitive, behavioural, transactional, and relational – weaving
them together depending on what the person needs. This is important because
health anxiety is rarely about just one thing. It can have roots in past
experiences, current stressors, family patterns, and the way we cope with uncertainty.
A psychodynamic lens
A psychodynamic approach means paying attention to the
unconscious stories beneath the surface. Health fears often carry a deeper
meaning – grief, anger, or guilt that can’t easily be spoken. The body then
becomes the stage where those feelings play out. Someone may obsess over a lump
in their throat, but the real “lump” might be unexpressed grief sitting there.
Therapy involves listening carefully to this symbolic language of symptoms and
connecting current fears with earlier experiences of loss, abandonment, or helplessness.
Many people with health anxiety grew up in families where
illness was either minimised or exaggerated. A parent’s illness might have left
them terrified of death, or perhaps their own pain was brushed aside, leaving
them anxious and hyper-alert as adults. Exploring these histories often helps
make sense of why current worries feel so overwhelming.
A cognitive and behavioural lens
Health anxiety also has clear patterns in thought and
behaviour. A sensation sparks a catastrophic thought, which raises anxiety,
which then makes the sensation worse. Breaking this cycle can involve gentle
cognitive work – noticing automatic thoughts, weighing up evidence more
realistically, and learning to sit with uncertainty.
On a behavioural level, it may mean experimenting with
reducing checking behaviours. Constantly Googling symptoms or asking others for
reassurance brings short relief, but it fuels anxiety in the long run.
Practising alternatives, such as delaying checking or focusing on something
grounding, helps the nervous system learn that uncertainty can be tolerated.
A relational and person-centred lens
The therapeutic relationship itself is just as important.
Health anxiety often carries shame. People worry that their fears are
irrational or that others are tired of hearing them. In therapy, being received
without judgement, with real empathy, can itself be healing. Simply having a
space where fears aren’t dismissed but taken seriously makes a huge difference.
In an integrative frame, the relationship is part of the
treatment. Health anxiety often involves a deep longing for reassurance – for
someone to say “you’re safe, you’re okay.” A therapist can’t provide medical
guarantees, but they can offer containment: a steady presence that helps the
client hold their fears rather than be engulfed by them.
A transactional analysis lens
Transactional Analysis (TA) offers another angle. TA looks at
how people relate to themselves and others through three internal “ego states”:
Parent, Adult, and Child. In health anxiety, the inner Parent voice is often
loud, critical, fearful, warning that something is terribly wrong. The Child
part feels small and terrified, desperate for comfort. What is often missing is
the Adult state, which can pause, weigh evidence, and make balanced decisions.
A client might say: “My chest hurts – it must be a heart
attack.” Here, the Parent voice shouts doom, the Child panics, and reassurance
is urgently sought. Therapy can strengthen the Adult voice: “Yes, my chest is
tight, but I’ve noticed this happens when I’m anxious. I can monitor it without assuming catastrophe.”
TA also highlights relational dynamics. Many with health
anxiety repeatedly seek reassurance from loved ones. The Child asks, “Am I
going to be okay?” while the partner replies from a Parent stance. This cycle
soothes briefly but doesn’t resolve the anxiety. In therapy, exploring these
patterns helps the client see what they are really longing for – not endless
reassurance, but a deeper sense of safety and trust in themselves.
Acceptance, mortality, and meaning
At its heart, health anxiety is about our struggle with
uncertainty and mortality. None of us can know the future, and none of us are
immune to illness or death. For someone with health anxiety, this universal
truth feels unbearable. The thought of mortality lurks just beneath the surface
of every symptom. A stomach ache is not only discomfort – it is a reminder that
the body is fragile, that life has an end.
Many people find it easier to manage everyday stress than to
face the reality of death. Health anxiety can become a way of circling around
that truth without looking at it directly. The mind focuses on symptoms,
medical checks, and “what ifs,” but underneath lies the deeper fear: “One day,
I will die. People I love will die.” This is profoundly human, and therapy
gives permission to bring it into the open.
An integrative approach might gently help clients face
mortality, not as an enemy to be defeated, but as part of life that can shape
how we live. This does not mean minimising fear, but creating space to talk
about it honestly. Often, when the unspeakable is spoken, it loses some of its
grip. Clients may find relief in realising that death anxiety is something all
humans carry, not a private flaw or madness.
Acceptance-based approaches can support this process:
learning to sit with the reality that we are finite, while also noticing that
life continues in the present moment. Mortality awareness can even become a
guide. Rather than paralysing us, it can remind us to live more fully, to spend
time with people we love, to invest in what matters, and to loosen the grip of obsessive checking.
Exploring mortality can also connect to spiritual or
existential questions. Clients may want to talk about what gives life meaning,
how they want to be remembered, or how to live more authentically. These
conversations are often avoided in everyday life, yet in therapy they can be
deeply freeing. Health anxiety then shifts from being purely about fear to
being about a search for meaning, belonging, and acceptance of the human condition.
Humanising the struggle
Most of all, it’s important to humanise health anxiety. It
isn’t “silly” or “attention-seeking.” It usually has roots in genuine
suffering: early experiences of illness, fears of loss, or a longing not to be
left alone. Health anxiety is the mind and body’s way of protecting us, even if it overshoots.
In therapy, the aim isn’t to remove all worry – no one can do
that – but to help people build a kinder relationship with their fears and
their bodies. This might mean fewer hours spent scanning for symptoms, more
tolerance of uncertainty, and more space for relationships, passions, and ordinary life.
Final thoughts and observations
Health anxiety is complex, layered, and deeply human. An
integrative approach doesn’t rely on one method, but brings together many:
exploring unconscious patterns, reshaping unhelpful thoughts, easing compulsive
behaviours, deepening the therapeutic relationship, working with ego states
through TA, and engaging directly with mortality.
Ultimately, the work is about helping people reclaim their
lives from anxiety, to live with uncertainty while still engaging with what
matters most. Therapy attends not just to symptoms, but to the whole person –
their history, relationships, and hopes – and in doing so, opens the door to a
steadier and more embodied way of living.
Please do feel free to reach out if you are ready to take some steps....