ABSTRACT
Health anxiety arises when bodily changes or sensations are believed to be indicative of a serious disease. The magnitude of health anxiety can differ from person to person; as such, it is typically conceptualized along a continuum ranging from mild to severe (e.g., Taylor & Asmundson, 2004). Health anxiety can be adaptive because it motivates us to seek clinical care. However, it can become maladaptive when characterized by excessive worry and impaired functioning. In this chapter, we will discuss (a) diagnostic and descriptive features of health anxiety, (b) etiological factors contributing to health anxiety, (c) assessment strategies for treatment planning, (d) empirically supported treatments, and (e) a case example illustrating assessment and cognitive-behavioral treatment of severe health anxiety. We conclude with a summary and suggestions for future research.
Clinically signi®cant expressions of health anxiety are commonly referred to as health anxiety disorders. These include hypochondriasis (American Psychiatric Association (APA), 2000), symptom presentations failing to meet full diagnostic criteria for hypochondriasis, and disease phobia and delusional disorder, somatic type. Details of disease phobia and delusional disorder, somatic type, are discussed elsewhere (see Taylor & Asmundson, 2004). Hypochondriasis is de®ned by a preoccupation with fears of having, or the idea that one has, a serious disease, based on a misinterpretation of bodily sensations (APA, 2000). To be diagnosed with hypochondriasis, this preoccupation must persist despite appropriate medical evaluation and reassurance from physicians. Disease-related beliefs cannot be delusional or restricted to a speci®c concern about appearance, and they must be markedly distressing or associated with interference in daily functioning. The symptoms must persist for at least 6 months and cannot be better accounted for by another disorder. Hypochondriasis with poor insight is his or
her concerns as excessive or unreasonable. Health anxiety can be clinically important even when people do not meet full diagnostic criteria for hypochondriasis (e.g., when a person has excessive health anxiety lasting less than 6 months, when excessive health anxiety is present but does not interfere signi®cantly with daily functioning, or when a person is preoccupied with fears of having a disease but eventually responds to medical reassurance). This is often referred to as abridged hypochondriasis (Gureje et al., 1997). Because current ®ndings suggest that the abridged form is no less disabling than the full disorder (Creed, 2006), we use the term `excessive health anxiety' to represent full or abridged hypochondriasis in this chapter.
