Quick summary: Health anxiety is a treatable cycle in which every attempt to feel safe, from checking and Googling to asking for reassurance, keeps the fear alive. Normal test results calm people for a few hours because relief teaches the brain that safety only comes from the next round of reassurance. Cognitive behavioural therapy, planned medical contact and a more careful family response can break the loop, and a randomised trial in hospital clinics found that twice as many patients reached normal levels of health anxiety with it.

In my practice I often meet a certain kind of client. They arrive with a folder of normal blood tests, two clear scans, and a phone history full of searches like “headache that won’t go away” and “early signs of MS”. Their doctors have told them they’re healthy, and they believe it for a few hours. Then a new twinge shows up and the whole cycle starts over.

Medicine used to call these people “the worried well”. The phrase is kindly meant, but it misses the point. Their bodies may be fine, yet their lives often aren’t. The NHS describes health anxiety as spending so much time worrying that you’re ill, or going to get ill, that it starts to take over your life, and notes that it is related to obsessive compulsive disorder.

The cost is not only emotional. For some people, repeatedly Googling symptoms ends up making the worry worse, while others swing the other way and find that health anxiety keeps them from seeking medical treatment at all. Both reactions come from the same fear.

What health anxiety actually is

All of us notice our bodies. Health anxiety starts when noticing becomes monitoring, and monitoring becomes a full-time job. The core is a catastrophic reading of ordinary sensations: a skipped heartbeat means heart failure, and a forgotten word means dementia. Once that reading takes hold, it is held in place by behaviours that feel like they protect you. Three show up again and again.

• Checking: pressing on a lump over and over, taking your pulse, or looking at your skin in the mirror.
• Reassurance-seeking: asking a spouse, a GP or a search engine whether “this is normal”.
• Avoidance: skipping hospital dramas on TV, refusing to talk about illness or, the opposite, avoiding doctors completely because you dread what they’ll find.

Why reassurance doesn’t work

This is the part that surprises families. If someone is scared of being ill, surely the kind thing is to tell them they’re fine? In the short run, yes, their anxiety drops. But in my clinical experience the relief teaches the brain one thing: the only way to feel safe is to get reassured again. Each round brings less relief, and the gap before the next request gets shorter. That’s why the NHS self-help advice suggests keeping a diary of how often you check your body, ask for reassurance or look up health information, and then gradually cutting down.

Searching online is the same loop, only faster, and it’s open all night. Researchers call it “cyberchondria”: excessive or repeated online health searching that leaves people more distressed. A meta-analysis of 20 studies with 7,373 participants found a strong link between health anxiety and cyberchondria. A later review in the Journal of Medical Internet Research concluded that this kind of searching is best understood as a safety behaviour, kept going because it brings relief some of the time.

Culture and the body

Working in Saudi Arabia, and with pilgrims who come from all over the world, has taught me that health anxiety doesn’t look the same everywhere. In many families, emotional distress is talked about through the body. “My chest is tight” may be the only acceptable way to say “I am overwhelmed”, and a good clinician listens to both meanings at once.

Faith can help here too. Many of my patients find real comfort in tawakkul, trusting God after taking reasonable steps. I don’t use it to dismiss their fear. I use it to help them tell the difference between a reasonable step (a check-up, or a test the doctor actually recommends) and a compulsive one (a fourth opinion on the same symptom).

What actually helps

The good news is that health anxiety responds well to treatment, and cognitive behavioural therapy has strong evidence behind it. In a multicentre randomised trial published in The Lancet, 444 health-anxious patients attending hospital medical clinics received either five to ten sessions of adapted CBT or standard care. After a year, about twice as many in the CBT group had reached normal levels of health anxiety (13.9% vs 7.3%), and the benefit held at two years. In practice, recovery usually involves five steps.

1. Mapping the cycle: write down one recent episode, including the sensation, the thought it set off, the anxiety, what you did and how long the relief lasted. Seeing the loop on paper takes away much of its power.
2. Cutting back safety behaviours step by step: not all at once. If you check your pulse twenty times a day, aim for fifteen this week. The anxiety will rise and then, if you wait, it will fall on its own, and that is the lesson your brain needs to learn.
3. Changing how reassurance happens in the family: relatives can learn a warm, consistent reply, such as “I can see you’re scared. We agreed I won’t answer health questions, but I’ll sit with you”. It’s hard to do, and it’s one of the most loving things they can offer.
4. Booking medical contact on a schedule: one trusted doctor and regular planned appointments, rather than urgent visits driven by panic. This keeps genuine care in place while ending the doctor-shopping.
5. Testing the predictions: “If I don’t check, I’ll miss something deadly” is a hypothesis, so treat it like one and look back at the evidence from the past year.

A word to clinicians

Telling a patient “there’s nothing wrong with you” can feel like being sent away, and it often backfires. A better line is something like: “Your tests show your body is healthy, and your distress is real. Let’s treat the part that’s actually making you suffer”. That validates the person without validating the catastrophe.

The bottom line

The “worried well” aren’t wasting anyone’s time. They are stuck in a well-understood, treatable cycle in which every attempt to feel safe keeps the fear going. Recognising the cycle is the first step out of it.

Dr Malik Sherjeel Awan is a clinical psychologist based in Makkah and the author of books on psychology and relationships, followed by over 400,000 people. Website: sherjeelawan.com (https://sherjeelawan.com)