mother and daughter sitting feeling worried

Health Anxiety

October 23, 2024

Lucy Robinson

About the Author: Lucy is a low-intensity cognitive behavioural practitioner who treats and assesses adults who experience common mental health difficulties within the NHS.

Team Mindsum

About the Editor: Our team of researchers and writers edited this article. Our content is published after careful review and approval by the editorial board.

What is health anxiety?
Symptoms of health anxiety in children and young people
Causes of health anxiety in children and young adults?
Treatment options
The recovery journey
What types of professionals are involved?
How to support a loved one with health anxiety
Useful resources

What is health anxiety?

Health anxiety is where someone will believe that they are seriously ill or dying. This will be due to ‘symptoms’ they have noticed that are either normal bodily functions or the symptoms of a benign illness, not a serious one. It was once called ‘hypochondria’ but is now more appropriately known as health anxiety.

This can be part of a generalised anxiety disorder presentation. Still, if the fixation is on the health this will indicate that health anxiety is the main difficulty of the child/young person.

Healthy anxiety has always been prevalent in children and young people but possibly due to COVID-19 there has been an increase in recent cases. It can be extremely distressing to a child/young person when they are experiencing health anxiety as they genuinely believe that something could be wrong. They can be terrified.

Symptoms of health anxiety in children and young people

The symptoms of health anxiety can range from child to child. As outlined above it is usually a fear of being seriously ill and/or dying that is the marker of health anxiety.

This fear may be driven by different root fears, these can include worrying about the process of being ill e.g. specific symptoms such as chemotherapy, worrying about the process of dying and/or worrying about leaving people behind.

The symptoms of health anxiety can include:

Catastrophising physical feelings for example ‘I have a headache it must be a brain tumour’
Fear of becoming seriously ill
Fear of death
Avoiding TV shows/ movies involving health storylines e.g. hospital dramas
Checking body for symptoms e.g. constantly feeling neck for lumps
Googling symptoms
Seeking reassurance from friends and family
Seeking reassurance from GP
Not believing health professionals/family/friends when told they are okay
Irritability

“Cara has begun to think that she could have cancer. She has started to check her body for lumps as well as checking her freckles on her body. She will then google any lumps that she finds as well as any other symptoms she has noticed. Cara’s parents have observed that Cara will attend a GP appointment for one symptom and then be worrying about a different symptom a week later. Cara does not believe her parents when they tell her that she is not seriously ill and insists on her parents booking more GP appointments. Cara’s parents have decided it might be helpful for her to receive some professional support.”

Causes of health anxiety in children and young people

Whilst professionals are unsure what can directly cause health anxiety numerous factors may increase the likelihood of a child experiencing health anxiety:

Serious illness or a death within the child’s close social circle including family
A child’s illness
Family history of health anxiety
Childhood abuse
A stressful event

Treatment

Unlike other anxiety disorders in England, there is no set clinical guidance for how to treat and assess specifically health anxiety but rather anxiety in general. This can make it more confusing for patients and families to know if the best treatment is being offered. However, it is agreed that the treatment offered should be a form of cognitive behavioural therapy.

Cognitive Behavioural Therapy (CBT) is an effective form of talk therapy for health anxiety where the child will learn about how their anxiety is maintained by behaviours, thoughts and physical feelings within a vicious cycle. This will be learnt through self-monitoring and reflection. They will then learn how to break that vicious cycle using different tools and techniques.

For example, a child may learn that a behaviour that contributes to their health anxiety is googling their symptoms. So, they learn a technique to manage that urge to google their symptoms such as a relaxation technique.

There will be home practice as a result of the CBT where the child will have the chance to monitor their symptoms and/or implement tools and techniques they have learnt in between sessions. This is a really key part of the CBT, a lot of the progress will come from the effort levels put into home practice.

Other family members may also be involved with the CBT due to the large influence they have on the child/young person. For example, potential responses from the family may be explored when the child/young person seeks reassurance.

Medication

Medication should not usually be offered in the management of anxiety disorders in children. It should only be offered under special circumstances where it is clear why cognitive behavioural therapy alone is not going to be effective and only used in the short term.

What types of mental health professionals are involved?

There are different professionals that may or may not be involved throughout the treatment process of health anxiety for children and young people. These might include doctors, psychiatrists, cognitive behavioural therapists, support workers and social workers. These terms might be confusing, but the main difference is in the training that each of these professionals has received.

Cognitive Behavioural Therapists

These are therapists who have been trained in cognitive behavioural theory using this model to form an idea of a patient’s mental health difficulties and to treat them. When working with health anxiety the therapists would have been trained in how to help the child/young person recognise and manage their symptoms to improve wellbeing. There are numerous names for these therapists; within the NHS you might recognise child wellbeing practitioners, psychological wellbeing practitioners, cognitive behavioural therapists and clinical psychologists as some people who are trained in forms of CBT.

Doctors

These are professionals who are trained in medicine. This will likely be the family GP, who might discuss options of support and possible referrals to mental health services with the family.

Psychiatrists

These are professionals who are also trained in medicine. However, they also specialised in the field of psychiatry. So they can provide consultation and medication for a wide range of mental disorders such as anxiety, health anxiety, schizophrenia, psychosis, bipolar disorder and so on.

Mental Health Nurses

Nurses trained in mental health might also be involved with the child or young person. If the child or young person is in a hospital setting or is seen by a crisis team due to self-harm or suicide, a mental health nurse might help to give treatment by administering medication.

Support Workers

‍Workers trained in helping vulnerable people to live better lives might also be involved with the child or young person. This might be within a community setting or a crisis. Their role is to provide emotional and practical support (e.g. helping parents to cope, helping with paperwork, and making child-care arrangements).

Social Workers

Workers trained in protecting vulnerable individuals might also be involved with the child or young person. This might also be within a community or a crisis. Social workers will problem-solve and organise the right support for the child or the young person to ensure their protection.

The Recovery Journey

The journey of recovery from health anxiety can look different for each child or young person. However, usually, the stages are the same as CBT can be quite a structured approach.

Assessment

This is an important phase, where the therapist will get a feel of what is going on with the child or young person. The therapist might try to identify the severity and symptoms of the health anxiety, along with other important background information. The therapist will ask some questions, including certain questions about the possibility of self-harm or suicide. This will help to create a full picture of what is going on and to know what type of treatment will be most helpful.

Therapy sessions

These sessions will take place at a specific time and regularly. An important aspect of the therapy session is the relationship that the therapist will build with the child or young person. This will create a safe space that will encourage them to talk about their feelings. The child will be able to develop a better understanding of their feelings and learn helpful ways to tackle health anxiety.

Homework

This can be an important part of treatment for health anxiety, especially when having CBT. This is because health anxiety affects everyday situations in the child or young person’s life. The home practice is where the child or young person will use the tools and techniques learnt within the sessions in their daily lives and those everyday situations.

Progress and setbacks

When having treatment for health anxiety, there will be progress and there may be setbacks. For example, because of the health anxiety itself, a child or a young person may struggle to trust the therapist that the anxiety is the one driving these fears, not a form of instinct. It is important not to feel discouraged when this happens, as these types of setbacks can be quite normal when dealing with health anxiety. These situations provide opportunities to discover new ways to move forward together with the therapist.

Ending therapy

The therapist will eventually prepare the child, young person and parents for the end of therapy. This is a very important phase because the child or young person needs to become confident in coping with difficult feelings without relying too much on the professional. This is particularly important with health anxiety to prevent a source of reassurance or dependence. The child or young person will leave therapy with many skills that they can use without the help of the therapist.

Follow up

There might be an agreement with the therapist to have a follow-up meeting. This is to check how the child or young person is coping. If they are doing well, there will be no need for more support. But if they continue to have challenges with health anxiety or any other issues, this will be an opportunity to have extra support.

How to support a loved one with health anxiety

Managing health anxiety can be very challenging but there are a few things that you can do to help support someone you care about manage their health anxiety

Understand health anxiety

Having a read about health anxiety is a great start, as hopefully, it will give you some insight into what someone goes through when experiencing health anxiety. It will allow you to understand their triggers and symptoms. It can feel very isolating to have health anxiety at times, so having someone support you who has some knowledge about it can have a big impact.

Show empathy

It can be very difficult when a loved one is incredibly anxious about something that you may not understand. For example, not understanding why they are so focused on having a brain tumour when they have had a headache for a few hours. However, the primary emotion your loved one is feeling is genuine fear. Having empathy for their level of fear is crucial in helping them to feel less alone.

Support them with home practice

Home practice within therapy sessions can be quite daunting. It can involve challenging anxiety-provoking thoughts and reducing behaviours that the child may believe are keeping them safe. Support your loved one to engage in their home practice e.g. setting time aside to go through it with them and/or gentle reminders can be a great way to keep them on track and show your care.

Take part in mindfulness with them

When someone is feeling anxious and overwhelmed, mindfulness is a great way to help with these symptoms. There are numerous types of mindfulness that you can do with each other. A great technique is called ‘Leaves on a Stream’ where you imagine a stream with leaves on it. Every time a thought pops into your head you place it on a leaf and imagine it floating down a stream.

Encourage them to do fun activities

Help them to do more uplifting activities. For example, you might put on a funny movie or take them out to their favourite activity. This will allow them to experience positive feelings that will refocus them from the anxiety to the present.

Monitor their activity levels

Encourage them to stay physically active within a healthy range. Exercise shows promising results in helping to manage symptoms of anxiety in children. It can also help to refocus the child on the present as well as provide a sense of control to the child over their health. However, this is a fine balance and sometimes a child or young person will depend on exercise to monitor their health. Making sure the child is not over-exercising is also very important. If you are worried about this, it is always good to reach out to your GP.

Help them find the right support

Encourage them to find support through a GP or therapist. If this involves your young child under the age of 16, you can contact these services, however, it is best to involve your child as much as possible within this process. You might:

Help them search for a therapist, you can check registrations of private therapists here
Help them to book an appointment with a GP or therapist
Advocate for your child if they feel unable to do so within appointments
Offer support when they attend appointments (e.g. waiting in the waiting room or attending some sessions if you need to)
Encourage them to keep attending sessions and to not give up

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Know when to get urgent support

When your loved one is dealing with health anxiety, it is good to keep an eye out for signs of self-harm or suicide. Although it seems unlikely, some people with health anxiety have thoughts that if they get diagnosed with a serious illness then they will end their life rather than deal with the process of being unwell. If you suspect that your loved one is at risk of hurting themselves, you should get them immediate support.

You should contact a GP or the NHS urgent helpline.

Know what NOT to do

When a loved one is dealing with health anxiety, it is good to be mindful of the things we say and the way we react, as this can have a big impact.

Don’t reassure them too much

When someone is struggling with health anxiety it is a symptom that they will seek reassurance from others. This will maintain the anxiety as they are depending on others for comfort rather than being able to self-soothe. Talk to their therapist or a professional about how is best to respond to this reassurance seeking as they may suggest helpful phrases that you and your loved one can agree on.

For example, “I can see you are feeling really anxious about this now, shall we talk through the technique you spoke about in therapy?”

Don’t tell them to “They are just being silly”

This can make people feel very isolated when they are experiencing health anxiety. Children and young people experiencing health anxiety are genuinely scared. If they could stop the anxiety then they would.

Try to comfort them such as by asking “I can tell you are scared right now, are there any ways we could help with that outside of managing your health?

Maybe we could watch a TV show or do some mindfulness”. It may be difficult at the moment for them to think about anything else, but just being there for them can have a big impact.

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Look after yourself too

You need to look after yourself. Whether you are a parent, family member or a friend, you will be in a better position to give help, as long as you are taking care of your own well-being too.

For urgent support

To get urgent help, you or your loved one should contact the NHS urgent helpline or the Samaritans.