10 - Understanding health anxiety

Summary

Health anxiety and medically unexplained symptoms are challenging both for patients and for clinicians. This chapter discusses a conceptual framework for health anxiety, focusing on diagnostic considerations, epidemiology, etiology, measures of health anxiety, clinical considerations, practical management, treatments, and future research directions. Determining the prevalence of health anxiety is challenging in large part due to variability in classification. When considering predisposing factors for health anxiety, family studies can be informative. While the genetics of health anxiety are not yet understood, by examining related disorders people can gain a sense of familial risk factors. The somatic amplification seen in health anxiety, as well as somatization and pain disorders, may also occur through a process of immune-mediated sensitization. The two treatment modalities for hypochondriasis with the most empirical support, cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are discussed in the chapter.